TX HHS Form 5879. Relocation Services Contract (Provider Agreement)

The TX HHS Form 5879, Relocation Services Contract (Provider Agreement), is a crucial document that enables healthcare providers to offer relocation services to Medicaid-eligible individuals. This contract helps solve the problem of assisting patients relocate from nursing facilities to community-based settings in specified regions.

This form requires essential information such as the provider's name and physical address, National Provider Identifier (NPI) or Atypical Provider Number (API), and the start date for service delivery. The contractor must comply with applicable federal and Texas state statutes and rules, including specific regulations and guidelines from the Department of Health and Human Services.

The Relocation Services Contract is used when a healthcare provider agrees to provide relocation services to assist Medicaid-eligible individuals relocate to community-based settings in specified regions. This contract outlines the terms and conditions for service delivery, including the utilization of third-party resources and identification of individuals with complex needs who are eligible for relocation services.