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 certify their compliance with Texas Home Living (TxHmL) waiver program principles. This form helps ensure that providers are familiar with and committed to implementing the necessary guidelines to deliver quality services.

The form requires the Legal Entity Name (type or print legibly) and Doing Business As (DBA), 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 their organization will adhere to these principles.

This self-assessment certification is essential for organizations participating in the TxHmL Waiver Program and should be completed by the Authorized Representative. The form does not specify a particular scenario or condition, but rather serves as a general certification of compliance with TxHmL program principles (TX HHS Form 5920: TxHmL Waiver Program Self-Assessment Certification).