TX HHS Form 1140. PACE/SASO Registration Enrollment

The TX HHS Form 1140 is a registration enrollment form for the Program of All-Inclusive Care for the Elderly (PACE) Service Authorization System Online (SASO). Issued by the Texas Health and Human Services (HHS), this form is designed to facilitate the enrollment process for individuals seeking PACE services. The form requires information from both the applicant and the PACE organization, including demographic data, Medicaid numbers, and coordination details.

The purpose of this form is to ensure that applicants are properly registered and authorized to receive PACE services. The form also serves as a tool for PACE organizations to provide necessary information about their clients, including medical necessity approval dates and eligibility verification. By completing this form, applicants can initiate the enrollment process and begin receiving the benefits of PACE services.

This form is intended for use by PACE organizations, consultants, and HHSC Medicaid Eligibility Specialists. The submission instructions indicate that completed forms should be sent to the HHSC regional office for data entry. The form also includes a section for comments from both the PACE organization and HHSC, allowing for any necessary clarification or follow-up. By streamlining the enrollment process through this form, HHS aims to improve access to PACE services for eligible individuals in Texas.