Texas Health and Human Services

The TX HHS Form 1737, Employer and Employee Service Agreement, is a crucial document that helps solve the problem of clarifying the roles, responsibilities, and expectations between an employer and employee in a consumer-directed services (CDS) program. This form is typically used in situations where an individual receives services through a CDS option funded by the Texas Health and Human Services Commission (HHSC). The employer, who may be the individual themselves or their parent/guardian, fills out this form to establish a service agreement with the employee.

The TX HHS Form 1739, Service Provider Agreement, is a crucial document that facilitates the provision of services to individuals through the Consumer Directed Services (CDS) Option. This agreement is typically used in situations where an individual receives home and community-based support programs, and a service provider is responsible for providing authorized services, items, or goods.

The TX HHS Form 1740, Service Backup Plan, is a crucial document that helps ensure continuity of essential services for individuals receiving Consumer Directed Services (CDS). This form is used in situations where the case manager or service coordinator has determined that a specific service is critical to an individual's health and welfare or is required by program specifications.

The TX HHS Form 1741, Corrective Action Plan, is a crucial document that helps resolve issues in Consumer Directed Services. This form is typically filled out by employers or designated representatives to address specific problems or concerns in their services. The plan outlines the necessary actions to be taken to correct these issues and ensures that responsible parties are held accountable.

The TX HHS Form 1742, Service Backup Plan for HCS, TxHmL, and CFC Services, helps ensure continuity of care by providing a plan for backup services in case of absence or unavailability. This form is typically used when an individual's waiver services (HCS) program or Community First Choice (CFC) service requires a backup plan to guarantee uninterrupted support.

Form 1582 explains the core responsibilities of everyone involved in the Consumer Directed Services (CDS) option in Texas. Unlike agency-based care, CDS gives an individual (or their legally authorized representative) the authority to hire, train, and supervise their own service providers. This document outlines what is expected from the CDS employer, the case manager or service coordinator, and the Financial Management Services Agency (FMSA).

The TX HHS Form 1140, PACE/SASO Registration Enrollment, is a crucial document for organizations participating in the Program of All-Inclusive Care for the Elderly (PACE) program. This form helps streamline the enrollment process by collecting essential information from applicants and PACE organizations.

The TX HHS Form 1141, PACE/SASO Registration Disenrollment, is a crucial document that helps resolve the issue of participant disenrollment from the Program of All-Inclusive Care for the Elderly (PACE) Service Authorization System Online (SASO). This form is typically used in situations where a participant's enrollment needs to be terminated or discontinued. The PACE organization is responsible for completing this form, providing required information such as the participant's name, Medicaid number, and reason for disenrollment.

The TX HHS Form 1142, PACE/SASO Registration Change, is a crucial document for updating information related to the Program of All-Inclusive Care for the Elderly (PACE) Service Authorization System Online (SASO). This form helps resolve issues with participant registration and ensures accurate records.

The TX HHS Form 1143, Cystic Fibrosis Treatment Agents Prior Authorization Request (CSHCN), is a crucial document for healthcare providers to obtain prior authorization for cystic fibrosis treatment agents. This form helps solve the problem of securing necessary approvals for patients with cystic fibrosis who require specific treatments. The form is typically completed by prescribing physicians and other healthcare providers who need to request approval for treatment agents such as Pulmozyme, Inhaled Tobramycin (TOBI), Cayston, or Kalydeco.