TX HHS Form 0013. Topic Nomination for Medical and Dental Benefits Consideration

The Texas Health and Human Services (HHS) Form 0013, "Topic Nomination for Medical and Dental Benefits Consideration," allows members of the public, state agencies, and others to request that the Texas HHS Commission consider coverage of a new service, technology, or benefit. This form is used to propose a topic for review and consideration of coverage by providing detailed information about the treatment, procedure, or device being nominated.

The form consists of four sections: Contact Information, Policy Request, Procedure, Treatment, or Device Information, and Additional Information. The first section requires nominators to provide their contact information, including date submitted, name, role, and phone number. The second section allows nominators to indicate their policy request or concern. The third section provides space for a brief description of the treatment, procedure, or device being nominated, as well as current alternative treatments, procedures, or devices.

This form is an essential tool for stakeholders seeking to have a new medical or dental benefit considered by the Texas HHS Commission. By providing clear and concise information about the proposed topic, nominators can help ensure that their request is thoroughly reviewed and considered for coverage. The Texas HHS Commission issues this form as part of its ongoing efforts to provide high-quality healthcare services to Texans.