TX HHS Form 8204. Subcontractor Credentialing Attestation Form

The TX HHS Form 8204, Subcontractor Credentialing Attestation Form, is a crucial document for provider agencies entering into subcontracting relationships. This form helps ensure that all contracting requirements are met, including initial credentialing and ongoing maintenance of subcontractor information.

This form requires the provider agency to attest that their subcontractors have met specific requirements, such as annual fingerprint-based criminal history checks, personnel reference checks, training completion, certification records, and professional licensure. The form also includes sections for documenting the subcontractor's educational history, work history, and experience working with individuals diagnosed with severe mental illness.

The Subcontractor Credentialing Attestation Form should be used by provider agencies entering into subcontracting relationships with Texas Health and Human Services (HHS) or other entities. The form must be maintained on file and made accessible to HHS staff upon request, ensuring compliance with contracting requirements and maintaining the integrity of the subcontracting relationship.