TX HHS Form H1700-A1. Certification of Completion/Delivery of STAR+PLUS HCBS Program Items/Services

The TX HHS Form H1700-A1, Certification of Completion/Delivery of STAR+PLUS HCBS Program Items/Services, is a crucial document that helps ensure the satisfactory completion of healthcare services for individuals enrolled in the STAR+PLUS Home and Community-Based Services (HCBS) program. This form is typically used by Member Representatives or caregivers to certify the delivery of specific program items/services, such as adaptive aids, emergency response services, or minor home modifications.

The form requires key information, including the member's name, Medicaid number, individual service plan start and end dates, and details about the completed program items/services. The certification process involves verifying that the services were delivered to the satisfaction of both the member and the Managed Care Organization (MCO) Representative. This ensures accountability and transparency in the delivery of healthcare services.

To complete this form, Member Representatives or caregivers must provide their printed name, signature, and date, as well as the MCO Representative's printed name, signature, and date. The form also includes a section for comments and any additional information that may be relevant to the certification process. Key points to note include:

• The form is used to certify the completion of STAR+PLUS HCBS program items/services.
• It requires key information about the member, including their name and Medicaid number.
• The certification process involves verifying that services were delivered to the satisfaction of both the member and the MCO Representative.