TX HHS Form 1140. PACE/SASO Registration Enrollment

The TX HHS Form 1140, PACE/SASO Registration Enrollment, is a crucial document for organizations participating in the Program of All-Inclusive Care for the Elderly (PACE) program. This form helps streamline the enrollment process by collecting essential information from applicants and PACE organizations.

This form requires key details such as applicant name, Medicaid number, social security number, and residence address. It also captures coordination data entry information, including the date of medical necessity approval and Medicaid eligibility verification. The form is typically filled out by PACE staff or consultants, who must provide their name, title, phone number, and comments.

The TX HHS Form 1140 serves as a vital tool for ensuring accurate and efficient enrollment into PACE programs. By completing this form, PACE organizations can facilitate the coordination of services and ensure that applicants receive the necessary care. Key points to note include:

• Required information includes applicant name, Medicaid number, social security number, and residence address.
• The form is typically used by PACE staff or consultants for data entry purposes.
• The form must be submitted to the HHSC regional office for data entry.