Health and Human Services Required Forms 1733 and1735 for Consumer Directed Services, Service Option

Date: August 11, 2021 Attention: Financial Management Services Agencies (FMSA) Effective Date: July 1, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: Texas Children’s Health Plan would like to remind our network Financial Management Services Agency (FMSA) providers of two required forms from Health and Human Services for Consumer Directed Services, Service Option. How this impacts providers:

Form	Purpose of form	FMSA/CDS employer responsibility
1733, available	To document that the Employer or LAR/Member and employee acknowledge that the employer may train and supervise the employee in the delivery of certain tasks and/or services without the involvement of a licensed nurse through Consumer Directed Services (CDS).	FMSA should have the LAR/member and chosen employee to sign the form.  The FMSA will know the selected employee first, due to the required background check on them.
1735 for Medically Dependent Children Program (MDCP),  Community First Choice (CFC) and Personal Care Services (PCS) Complete the most applicable form(s) available here: https://www.hhs.texas.gov/laws-regulations/forms/1000-1999/form-1735-employer-financial-management-services-agency-service-agreement	To document the separate and mutual responsibilities of the employer/Member/Member’s LAR and the Financial Management Services Agency (FMSA) in using the Consumer Directed Services (CDS) option. To provide program specific information about the services that can be self-directed, the provider qualifications, service delivery documentation and training requirements.	The CDS employer and FMSA are required to complete Form 1735 or Form 1735-S and the applicable addendum during the following times: 1.     At the CDS orientation when enrolling in the CDS option; 2.     any time the employer changes FMSAs; 3.     if there is change in employer, such as an individual turning age 18; and 4.     if the individual changes programs.   The CDS Employer/FMSA must submit copies of these signed forms to the MCO for the members file.

Next steps after completing forms: Signed forms should go to the FMSA and they will maintain a signed copy. The employer or LAR/Member and all parties must keep the form and addendum for six years after signing the form and addendum, or until resolution of all outstanding litigation, claims and audits. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.