TX HHS Form 0007. Notification of County Jail Confinement and Release

Form 0007, titled “Notification of County Jail Confinement and Release”, is an official Texas Health and Human Services Commission (HHSC) form used by county jails to report when an individual receiving HHSC health care coverage is confined or released. The purpose of this form is to ensure that eligibility records and benefit statuses are updated accurately and on time.

This form plays a critical administrative role. When incarceration is not reported correctly, it can lead to improper benefit payments, compliance issues for the facility, and delays in restoring coverage after release.

When This Form Must Be Submitted

Form 0007 is required in two specific situations involving individuals who receive health care coverage from HHSC:

• When an individual has been confined in a county jail for more than 30 days, the confinement must be reported as soon as possible after the 30-day period.
• When an individual previously reported as confined is released, the release must be reported within 48 hours.

If neither of these situations applies, the form should not be submitted.

Who Is Responsible for Completing the Form

The form is completed by authorized county jail personnel or facility representatives who have assigned credentials for HHSC reporting systems. The individual completing the form must have access to the county’s secure file transfer credentials and be familiar with inmate intake and release records.

Legal and Administrative Context

HHSC requires timely reporting of incarceration and release events to comply with state and federal rules governing public health benefit eligibility. Certain health care benefits are limited or suspended during incarceration, and HHSC relies on county jails to provide accurate confinement data.

Failure to submit this form correctly or on time may result in inaccurate eligibility records and potential compliance issues for the reporting facility.

Explanation of Key Sections

Facility Information

This section identifies the county jail submitting the report. It includes the facility name, HHSC jail identifier number, contact telephone number, and physical address. Accurate facility identification is essential for HHSC to validate the report.

Individual Completing the Form

Here, the staff member responsible for the submission provides their full name, title, organization, phone numbers, fax number, and email address. This allows HHSC to follow up if clarification or corrections are needed.

Individual Information

This section captures identifying information about the individual being reported, including full name, date of birth, Social Security number or TIERS individual number, race/ethnicity, and gender. Accuracy in this section is critical to ensure the correct HHSC record is updated.

Report Type and Dates

The reporting party must indicate whether the submission is for adding an individual (confinement) or removing an individual (release). The report date, confinement date, and release date must be entered clearly and consistently with facility records.

Common Mistakes to Avoid

• Submitting the form before the 30-day confinement threshold has been reached.
• Missing the 48-hour reporting window after release.
• Entering incorrect TIERS or Social Security numbers.
• Using outdated facility identifiers or contact details.
• Uploading the form without proper authorization credentials.

Practical Tips for Accurate Submission

• Verify confinement duration before submitting a confinement report.
• Confirm release dates directly from official jail records.
• Double-check identifying numbers to avoid record mismatches.
• Ensure the form is uploaded using your county’s assigned GlobalScape credentials.
• Keep a copy of the submitted form for internal records.

Real-Life Scenarios Where Form 0007 Is Required

• A county jail inmate receiving Medicaid coverage remains incarcerated beyond 30 days, requiring the jail to notify HHSC of continued confinement.
• An individual previously reported as confined is released on parole, and the jail must report the release within 48 hours.
• A facility conducts an audit and discovers a confinement was never reported, prompting immediate corrective submission.

Documents and Information You May Need

• Official jail intake and release records
• HHSC jail identifier number
• Individual’s TIERS or Social Security number
• Authorized GlobalScape login credentials

Frequently Asked Questions

Is Form 0007 required for short-term jail stays?

No. The form is required only when confinement exceeds 30 days or when reporting a release from a previously reported confinement.

How quickly must a release be reported?

The release must be reported within 48 hours of the individual leaving confinement.

Can medical providers submit this form?

No. The form is intended for use by county jail facilities or authorized representatives.

How is the form submitted?

The completed form must be uploaded through the GlobalScape secure file transfer system using county-assigned credentials.

What happens if the form is submitted late?

Late submission may result in inaccurate benefit status and could require follow-up or corrective action.

Is this form used for state prisons?

No. This form is specific to county jail confinement and release reporting.

Micro-FAQ

• Purpose: Reports county jail confinement or release to HHSC.
• Who files: Authorized county jail staff.
• Deadline: After 30 days of confinement or within 48 hours of release.
• Attachments: None required, but accurate jail records are needed.
• Submitted to: Texas Health and Human Services Commission via GlobalScape.

Related Forms

• HHSC Eligibility Update Forms
• Inmate Status Reporting Forms
• Texas Public Assistance Notification Forms

Form Details

• Form Name: Notification of County Jail Confinement and Release
• Form Number: 0007
• Issued By: Texas Health and Human Services Commission (HHSC)
• Region: Texas
• Revision Date: December 2018