TX HHS Form 5920. TxHmL Waiver Program Self-Assessment Certification

The TX HHS Form 5920, TxHmL Waiver Program Self-Assessment Certification, is a crucial document for organizations seeking to participate in the Texas Home Living (TxHmL) Waiver Program. This form helps ensure that providers are familiar with the program's certification principles and will implement them accordingly.

The form requires the Legal Entity Name (type or print legibly) and Doing Business As (DBA) information, as well as a review of TxHmL certification principles outlined in Texas Administrative Code 26, Section 566.7-566.11. By signing this form, the Authorized Representative certifies that they are familiar with each principle and will implement them.

This self-assessment certification is essential for organizations seeking to participate in the TxHmL Waiver Program. Key features include:

• Review of TxHmL certification principles
• Certification that the organization is familiar with each principle and will implement them
• Signature by an Authorized Representative
• Date of completion