- To document the service provider’s and employer’s acknowledgment of the relationship criteria for employers and service providers (including employees, contractors and vendors) and other parties in the Consumer Directed Services (CDS) option.
- To have the service provider document his or her eligibility to deliver services to the individual in the CDS option based on each relationship criterion.
- To determine and acknowledge the service provider's eligibility to deliver services based on the service provider's relationship to parties in the CDS option.
When to Prepare
The employer and service provider review the information on this form to ensure each party is aware of the allowed and disallowed relationships between applicable parties in CDS. If any criterion is marked Yes on this form, the employer must not hire the service provider.
Number of Copies
Original and two copies.
The employer keeps the original or a copy on file and gives the service provider a copy. The employer sends the original or a copy to the Financial Management Services Agency (FMSA) for validation of the service provider's eligibility for employment.
The employer and the FMSA must keep this form for five years after termination of the agreement, or until resolution of all outstanding litigation, claims and audits.
The employer enters the following information, as required:
- Service provider’s name, including maiden name if applicable
- Name of the individual receiving services
- Employer’s name
- Service provider's relationship to the individual receiving services
- Name of the designated representative (DR), if applicable
- Service provider's relationship to the employer
- Service provider's relationship to the DR
The service provider enters a check mark in the appropriate box for each question.
Form 1726, Relationship Definitions in Consumer Directed Services Employer's Acknowledgment and Certification.
- If the individual is enrolled in the Consumer Managed Personal Attendant Services (CMPAS) program, the spouse may be employed. CMPAS providers should check N/A (not applicable) for questions 4 and 5.
- If the individual is not with the Texas Department of Family and Protective Services (DFPS), check N/A for questions 6 and 7.
Sections 2–5: If the individual is enrolled in the Medically Dependent Children Program (MDCP), Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), or Primary Home Care (PHC), the service provider must also respond to the questions in each of those sections, as applicable.
Employer and Service Provider Certification
The employer must ensure the service provider is eligible to deliver services to this individual based on the relationship criteria. If any required criterion is marked Yes, the service provider is not eligible for employment through the CDS option and must not be hired.
The employer must place a check mark in the appropriate box to indicate whether the service provider is or is not eligible for employment.
The employer and service provider each sign the form to certify that the service provider meets/does not meet the criteria on the form and that the responses are accurate.
Note: If hired, the applicant must have met, and must continue to meet, the relationship criteria.
If there is a change in relationship or status of any party that results in the service provider no longer meeting all relationship criteria, the service provider cannot continue delivering services effective the date of the relationship or status change.
When a service provider no longer meets the relationship criteria, the employer must terminate the service provider's employment.