TX HHS Form 1047. Request for HCS Targeted NF Diversion Slot

The Texas Health and Human Services (HHS) Form 1047, Request for HCS Targeted NF Diversion Slot, serves as a crucial tool for individuals with intellectual or developmental disabilities who are at risk of long-term stays in nursing facilities. This form is designed to facilitate the diversion process, ensuring that eligible individuals receive necessary care and support in community-based settings.

The form requires information about the individual's current waiver services, level of care, and medical necessity, as well as documentation from the Local Intellectual and Developmental Disability Authority (LIDDA) indicating that the person meets specific criteria for diversion. This includes a determination that the individual has an intellectual or developmental disability, is appropriate for community placement, and has no available alternative resources to meet their needs.

This form is intended for use by LIDDA staff and other authorized personnel who are responsible for reviewing and processing requests for HCS Targeted NF Diversion Slots. The completed form, along with supporting documentation, should be submitted via secure email to [email protected], with the subject line "Request for HCS Targeted NF Diversion Slot." HHSC staff only: Review is complete, and the person is recommended for an HCS Targeted NF Diversion Slot.