TX HHS Form 1141. PACE/SASO Registration Disenrollment

The TX HHS Form 1141, PACE/SASO Registration Disenrollment, is a crucial document that helps resolve the issue of participant disenrollment from the Program of All-Inclusive Care for the Elderly (PACE) Service Authorization System Online (SASO). This form is typically used in situations where a participant's enrollment needs to be terminated or discontinued. The PACE organization is responsible for completing this form, providing required information such as the participant's name, Medicaid number, and reason for disenrollment.

The form requires specific details, including the participant's organization name, contract number, transmittal date, and voluntary or involuntary disenrollment reasons. Additionally, it includes a section for coordination with other community-based services, allowing for seamless transitions. The form also outlines responsibilities, such as submitting completed forms to the HHSC regional office for data entry and designated PACE consultants.

Key features of this form include:

• The need for participant disenrollment in situations where enrollment is no longer necessary or feasible
• The requirement for specific information, including participant name, Medicaid number, and reason for disenrollment
• The importance of coordination with other community-based services for a smooth transition
• The responsibility of the PACE organization to complete and submit the form