TX HHS Form 1141. PACE/SASO Registration Disenrollment

The Texas Health and Human Services (HHS) Form 1141, PACE/SASO Registration Disenrollment, is used to document the disenrollment of participants from the Program of All-Inclusive Care for the Elderly (PACE) Service Authorization System Online (SASO). This form serves as a vital tool for tracking participant information and managing disenrollment processes.

This form is intended for use by PACE organizations, which must submit completed forms to the HHSC regional office for data entry and to designated PACE consultants. The form requires detailed information about the participant, including their name, Medicaid number, social security number, and residence address. Additionally, it captures reasons for disenrollment and coordination details.

The Texas HHS Form 1141 is an essential tool for managing participant enrollment and disenrollment in the PACE program. By completing this form, PACE organizations can ensure accurate tracking of participant information and compliance with program requirements. The form's instructions are clear and concise, making it easy to use and understand.