Learn about the Medicaid 1115 Transformation Waiver Renewal.
For information about COVID-19, call 2-1-1 and select Option 6.
Find a COVID-19 testing site | COVID-19 vaccine | More COVID-19 information
Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
To provide information to an individual requesting services or an individual receiving ongoing services about their responsibilities and those of the Texas Health and Human Services Commission (HHSC) case manager or service coordinator and the Service Responsibility Option (SRO) provider.
When to Prepare
If the individual or member expresses interest in the SRO option after reviewing Form 1581-SRO, Service Responsibility Option (SRO) Overview, the case manager or service coordinator reviews all information on Form 1582-SRO.
Number of Copies
Original of pages with responsibilities listed, and original and one copy of signature page.
Give original responsibility pages and one copy of signature page to the individual or member. The case manager or service coordinator retains the original signature page in the case folder.
The case manager keeps the most recent copy in the case folder for five years after the case is denied or closed.
Responsibilities — Review the responsibilities of the individual or member, HHSC case manager or service coordinator, and SRO agency.
Signature – Individual/Member and Responsible Party — The individual, member, legally authorized representative (LAR) or designated representative (DR) signs and dates the form.
Signature – HHSC Case Manager or Service Coordinator — The case manager or service coordinator signs and dates the form.
Signature – SRO Agency Supervisor – The SRO agency supervisor signs and dates the form.