TX HHS Form 8207. Telehealth Services Attestation

The TX HHS Form 8207, Telehealth Services Attestation, is a crucial document for Home and Community Based Services — Adult Mental Health Program (HCBS-AMH) Provider Agencies (PAs) or Recovery Management Entities (RMEs) to complete per the 1915(i) State Plan Amendment requirements. This form ensures that telehealth delivery of HCBS-AMH services is conducted in a safe and private environment, with informed consent obtained from each participant.

The form requires PAs or RMEs to provide their name, designee name (if different), contract number, address, and NPI. Additionally, it includes sections for Consent and Confidentiality Attestation, Service Delivery Attestation, and Affirmation. The latter involves a digital signature, indicating that the provider has read and understood the terms and conditions outlined in the document.

This form should be used by PAs or RMEs to attest to their compliance with telehealth delivery requirements for HCBS-AMH services. It is essential to complete this form per the submission instructions, which include uploading the signed form to the HCBS-AMH and YES Waiver Provider Hub at the time of contract execution or within 30 days from subcontractor execution date or hire date.