Form 1584, Consumer Participation Choice

Instructions

Updated: 3/2025

Purpose

Gives the person requesting services or the person receiving ongoing services the choice to participate in the Consumer Directed Services (CDS) option, the Service Responsibility Option (SRO) or the provider Agency Option (AO).

The person may choose the CDS option for the following services:

• Client Managed Personal Attendant Services (CMPAS) - personal attendant care
• Community Care Services Eligibility (CCSE), Primary Home Care (PHC), Community Attendant Services (CAS) or Family Care - personal attendant services
• Community First Choice personal assistance services/habilitation (CFC PAS/HAB)
• Community Living Assistance and Support Services (CLASS):
  • transportation (habilitation)
  • respite
  • nursing
  • physical therapy
  • occupational therapy
  • speech and language therapies
  • CFC PAS/HAB
  • supported employment
  • employment assistance
  • cognitive rehabilitation services
  • support consultation
• Deaf Blind with Multiple Disabilities (DBMD) Program:
  • transportation (habilitation)
  • CFC PAS/HAB
  • intervener services
  • respite services
  • supported employment
  • employment assistance
  • support consultation
• Home and Community-based Services (HCS):
  • transportation (supported home living)
  • respite services
  • nursing services
  • cognitive rehabilitation therapy
  • CFC PAS/HAB
  • supported employment
  • employment assistance
  • support consultation
• Texas Home Living (TxHmL) Program:
  • adaptive aids
  • audiology
  • behavioral support
  • CFC PAS/HAB
  • dental
  • dietary services
  • employment assistance
  • employment readiness
  • individual skills and socialization
  • minor home modifications
  • nursing
  • occupational, physical, and speech/language therapies
  • respite
  • support consultation
  • supported employment
  • transportation (community supports)
• Medically Dependent Children Program (MDCP):
  • respite services
  • CFC PAS/HAB
  • flexible family support
  • employment assistance
  • supported employment
  • adaptive aids
  • minor home modifications
  • personal care services
• STAR Kids:
  • personal care services
  • CFC PAS/HAB
• STAR+PLUS:
  • personal care services
  • CFC PAS/HAB
• STAR+PLUS Home and Community Based Services (HCBS):
  • personal assistance services
  • CFC PAS/HAB respite services
  • nursing services
  • physical therapy
  • occupational therapy
  • cognitive rehabilitation therapy
  • speech and language therapies
  • supported employment
  • employment assistance
  • support consultation

The person may choose the SRO option for the following programs administered by managed care organizations.

• MDCP
  • employment assistance
  • flexible family support services
  • respite
  • supported employment
  • personal care services
• STAR Kids
  • personal care services
  • CFC PAS/HAB
• STAR+PLUS
  • personal care services
  • CFC PAS/HAB
• STAR+PLUS Home and Community Based Services (HCBS):
  • personal assistance services
  • CFC PAS/HAB respite services
  • nursing services
  • physical therapy
  • occupational therapy
  • cognitive rehabilitation therapy
  • speech and language therapies
  • supported employment
  • employment assistance
  • support consultation

Procedure

When to Prepare

The person must sign the form showing their choice between the CDS, SRO and AO options at the initial presentation of information about service delivery options. A new form is signed any time the person chooses a different option.

Number of Copies

Original and one copy.

Transmittal

Each time the form is signed because the person chooses a different service delivery option, the case manager or service coordinator keeps the original signed form in the case record or person’s record. The person receives a copy of the completed form.

Form Retention

The case manager keeps the original, signed Form 1584 in the case folder for five years after the case is denied or closed.

Detailed Instructions

Person's Name — Enter the person's name.

Person’s No. — Enter the person's assigned number.

CDS Option — If the person elects to have services through the CDS option, enter the name of the financial management services agency (FMSA) chosen by the person.

Service Responsibility Option — If the person elects to have services through the SRO, enter the name of the SRO provider selected by the person.

Agency Option — If the person elects to have services delivered by a provider agency, enter the name of the agency provider selected by the person.

Review the information on the form.

Person or Responsible Party Signature and Date — The person or legally authorized representative signs and dates the form showing the options chosen.

Witness Signature and Date — The witness signs and dates the form if the person or legally authorized representative cannot sign but can make their mark.

Case Manager or Service Coordinator Signature and Date — The case manager or service coordinator signs and dates the form.