Texas Health and Human Services

The TX HHS Form 5916, Applicant/Contractor Screening Criteria, is a crucial document that helps solve the problem of ensuring accurate and comprehensive information about applicants or contractors seeking to enroll in or re-enroll with Texas Health and Human Services (HHS) programs. This form is typically used in situations where entities need to provide screening criteria for enrolment or monitoring purposes, such as changes in ownership or legal entity.

The TX HHS Form 5879, Relocation Services Contract (Provider Agreement), is a crucial document that facilitates the relocation of Medicaid-eligible individuals from nursing facilities to community-based settings. This contract outlines the terms and conditions for providers offering relocation services, ensuring a smooth transition for individuals with complex needs.

The TX HHS Form 5875, HCS Waiver Program Self-Assessment Certification, is a crucial document for organizations participating in the Home and Community-based Services (HCS) waiver program. This form helps ensure that providers are familiar with and committed to implementing the certification principles outlined in Texas Administrative Code 26, Part 1, section 565-565.37.

The TX HHS Form 5873, Waiver and Community-based Programs and Services - Medicaid and CHIP Services Contract Application Packet Checklist, helps ensure that all required forms and documents are submitted during the contract application process. This form is used by contract applicants and Texas Health and Human Services Commission (HHSC) staff to streamline the application process.

The TX HHS Form 5872, Certification of Pre-Application Orientation, is a crucial document that helps solve the problem of ensuring providers have completed necessary orientation requirements for various services. This form is typically used in situations where providers are contracting to offer services such as Community Living Assistance and Support Services (CLASS), Day Activity and Health Services (DAHS), or Primary Home Care/Family Care/Community Attendant Services (PHC/FC/CAS).

The TxHmL Financial Eligibility Information Form (Form 5842) helps determine the financial eligibility status of applicants for the Texas Home Living (TxHmL) Program. This form is typically used by the Local Intellectual and Developmental Disability Authority (LIDDA) to assess an applicant's financial situation and make a determination about their eligibility for the program.

Form 5871, Section 9, is a legally binding certification document used by entities seeking to enroll in the Texas Medicaid program or to secure a community services contract with the Texas Health and Human Services Commission (HHSC). This section is not a standalone form but a critical, concluding part of a larger application packet. Its primary function is to formalize the applicant's attestation to the truthfulness and completeness of the information provided throughout the entire application process.

The TX HHS Form 5831, Community-based Programs Access and Eligibility Services Contract Application Packet Checklist, is a crucial document for entities seeking to establish a contract with the Texas Health and Human Services Commission (HHSC) for community-based programs. This form serves as a checklist to ensure that all required forms and documents are submitted during the contract application process.

The TX HHS Form 5830, Community-based Programs Access and Eligibility Services Contract Application Packet Checklist, is a crucial document for entities seeking to establish a contract with the Texas Health and Human Services Commission (HHSC). This form helps ensure that all required forms and documents are submitted during the contract application process, streamlining the process and avoiding potential delays or denials.

The TX HHS Form 5606, Life Safety Code Certification, is a crucial document that helps ensure the safety of residents in Texas. This form is typically filled out by a representative of the fire safety authority having jurisdiction for a specific address, certifying that the residence complies with applicable portions of the National Fire Protection Association (NFPA) 101: Life Safety Code (LSC) or International Fire Code (IFC).