TX HHS Form 0009. Notice of Intent County Jail Reporting

The TX HHS Form 0009, Notice of Intent - County Jail Reporting, is a crucial document that helps Texas county jails participate in reporting the confinement and release of individuals receiving healthcare coverage provided by the Texas Health and Human Services Commission (HHSC) at the time of confinement. This form facilitates communication between the jail and HHSC, ensuring accurate tracking of healthcare services rendered to inmates.

The form requires county jails to provide essential information about their facilities, including main facility details such as name, area code, telephone number, mailing address, city, ZIP code, and county. Additionally, jails with multiple facilities must complete the information for each separate location. The primary contact person is also required to provide their full name, title, area code, telephone number, email address, and fax number.

By submitting this Notice of Intent, county jails demonstrate their intention to participate in reporting confinement and release information to HHSC. This form serves as a precursor to the Memorandum of Understanding (MOU), which outlines the responsibilities and procedures for reporting healthcare services provided to inmates. Key points to note include:

• The need for accurate reporting of healthcare services rendered to inmates
• The requirement for county jails with multiple facilities to provide separate information for each location
• The importance of designating a primary contact person for communication and MOU signatory purposes