TX HHS Form 8607. Conflict of Interest Screening of a Representative of the Office

The Conflict of Interest Screening of a Representative of the Office Form 8607 is a crucial tool for ensuring the integrity and credibility of the Texas Long-Term Care Ombudsman Program. This form helps identify potential conflicts of interest that may impact the effectiveness of the program's work, particularly in situations where ombudsmen or interns have competing interests.

The form requires representatives to disclose specific information about their relationships with long-term care facilities, day activity and health services, home and community support services agencies, and other businesses. This includes ownership or investment interest, employment history, and involvement in licensing or certification processes. The form also emphasizes the importance of immediate reporting of conflicts of interest to the managing local ombudsman (MLO) and annual screenings for certified ombudsmen.

Key features of this form include the requirement to disclose personal and financial relationships with long-term care facilities, as well as employment history and involvement in licensing or certification processes. The form is typically filled out by ombudsmen interns or certified ombudsmen who must be screened before performing functions of the Ombudsman Program and annually thereafter.

• The Conflict of Interest Screening Form 8607 helps identify potential conflicts of interest that may impact the effectiveness of the Texas Long-Term Care Ombudsman Program.
• The form requires representatives to disclose specific information about their relationships with long-term care facilities and other businesses.
• Certified ombudsmen must be screened before performing functions of the Ombudsman Program and annually thereafter.