TX HHS Form H1700-3. Individual Service Plan – Signature Page

The TX HHS Form H1700-3, Individual Service Plan – Signature Page, is a crucial document that helps individuals develop and agree upon a personalized plan to meet their medical, functional, and cognitive needs. This form should be used when an individual requires Home and Community-Based Services (HCBS) through the STAR+PLUS program as an alternative to nursing facility services.

This signature page requires essential information such as the applicant's or member's name, social security number, Medicaid ID number, and acknowledgement of their understanding of the STAR+PLUS HCBS program. The form also includes sections for service coordinators to verify assessments and identify necessary waiver services based on the individual's goals and needs.

The key features of this form include the applicant's or member's acknowledgement and acceptance of their individualized service plan, as well as the service coordinator's verification of the assessment and identification of waiver services. The form also highlights the importance of understanding that the state of Texas will not pay for services until all eligibility decisions are made and waiver services are authorized by Texas Health and Human Services Commission.