TX HHS Form 1023. Request for Services Funded by General Revenue

The TX HHS Form 1023, Request for Services Funded by General Revenue, is a crucial document that helps solve the problem of ensuring the health and safety of individuals who require specialized services. This form is typically used in situations where an individual's health and safety cannot be protected within the established waiver cost limit for a specific program.

The form requires detailed information about the individual, including their name, Medicaid number, date of birth, and waiver status. It also asks providers to explain why the individual's health and safety cannot be protected by the services provided within the established waiver cost limit. Furthermore, the form demands supporting documentation, such as medical and service records, to evidence the assessment conducted by clinical staff.

The TX HHS Form 1023 is a critical tool for ensuring that individuals receive the necessary services to protect their health and safety. Key features of this form include:

• Required information about the individual, including name, Medicaid number, date of birth, and waiver status
• Explanation of why the individual's health and safety cannot be protected by the services provided within the established waiver cost limit
• Supporting documentation, such as medical and service records, to evidence the assessment conducted by clinical staff