TX HHS Form 1570. ICF Request for Medical Need Assessment or Verification of RUG-III Category

The TX HHS Form 1570, ICF Request for Medical Need Assessment or Verification of RUG-III Category, is a crucial document that helps identify the medical needs of individuals with intellectual and developmental disabilities. This form is typically completed by Local Intellectual and Developmental Disability Authorities (LIDDA) or State Supported Living Centers (SSLC), providing essential information about an individual's current level of need and required services.

The form requires specific details, including the individual's name, date of birth, Medicaid number, and facility information. It also asks for the current or requested level of need, as well as the frequency code and RUG category. Additionally, the form needs to be signed by a designated nurse conducting the assessment or verifying the RUG-III category.

This form is essential for ensuring that individuals receive the necessary medical care and support. By completing this form, LIDDA or SSLC can verify an individual's high medical needs criteria and provide targeted services. Key points to note include:

• The form is used by LIDDA or SSLC to assess and verify an individual's medical needs.
• The form requires specific information about the individual, including their name, date of birth, and Medicaid number.
• The form must be signed by a designated nurse conducting the assessment or verifying the RUG-III category.