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

The Individual Service Plan Signature Page (Form H1700-3) is a crucial document that helps solve the problem of ensuring individuals receive necessary services to meet their assessed medical, functional, and cognitive needs. This form is typically used in situations where an individual requires Home and Community-Based Services (HCBS) through the STAR+PLUS program. The applicant or member, along with their authorized representative or service coordinator, fills out this form to acknowledge review of the waiver services and accept a person-centered service plan.

The key features of this form include required information such as the individual's name, social security number, and Medicaid ID number. The form also highlights conditions for eligibility, including the understanding that STAR+PLUS HCBS may be an alternative to nursing facility services. Additionally, the applicant or member must acknowledge review of the waiver services shown on Form H1700-1 and agree that they match their identified goals.

The Individual Service Plan Signature Page is a critical step in the process of receiving HCBS through STAR+PLUS. By signing this form, the individual acknowledges acceptance of their person-centered service plan and understanding of the state's role in authorizing waiver services. Key points to note include:

• The applicant or member must understand that STAR+PLUS HCBS may be an alternative to nursing facility services.
• The individual must acknowledge review of the waiver services shown on Form H1700-1 and agree that they match their identified goals.
• The state will not pay for services until all eligibility decisions are made and waiver services are authorized by Texas Health and Human Services Commission.