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

The TX HHS Form 5879, Relocation Services Contract (Provider Agreement), is a crucial document that facilitates the relocation of Medicaid-eligible individuals from nursing facilities to community-based settings. This contract outlines the terms and conditions for providers offering relocation services, ensuring a smooth transition for individuals with complex needs.

This form requires essential information from providers, including their name, physical address, National Provider Identifier (NPI) or Atypical Provider Number (API), and physical address of legal entity. Providers must also agree to comply with applicable federal and Texas state statutes and rules, as well as Department-specific documents and guidelines. The contract specifies the responsibilities of both parties, including the provision of relocation services, utilization of third-party resources, and identification of individuals with complex needs.

The Relocation Services Contract (Provider Agreement) is used in situations where Medicaid-eligible individuals require assistance relocating from nursing facilities to community-based settings. Key features of this form include the requirement for providers to comply with relevant laws and regulations, as well as their responsibilities in providing relocation services. By utilizing all available third-party resources and identifying individuals with complex needs, providers can ensure a successful transition for these individuals.

• This contract is used for Medicaid-eligible individuals relocating from nursing facilities to community-based settings.
• Providers must comply with applicable federal and Texas state statutes and rules.
• The contract outlines the responsibilities of both parties, including provision of relocation services and utilization of third-party resources.