TX HHS Form 2020-A. Notification of Readiness for a Health Survey of a Hospice Inpatient Unit

The TX HHS Form 2020-A, "Notification of Readiness for a Health Survey of a Hospice Inpatient Unit," is a crucial document that helps hospice agencies prepare for an initial health survey of their inpatient unit. This form is typically completed by the agency's authorized representative and submitted to the designated survey office after admitting at least one client and providing hospice inpatient services.

The form requires key information about the agency, including its name, license issuance date, inpatient unit address, days and hours of operation, and contact details. Additionally, a minimum of one patient's information must be included, featuring their name, health insurance claim number or identification number, address, and admission date. This information is essential for the survey process to ensure compliance with regulatory requirements.

The form also includes conditions that must be met before submitting it, such as admitting at least one client and providing hospice inpatient services. It's important to note that this form is only used after an initial license has been issued for an alternate delivery site (ADS) with an inpatient unit (IPU). Key points to keep in mind include:

• Submit the completed form to your regional program manager by mail or fax.
• Retail a copy of this form for your records.
• The form is only used after an initial license has been issued for an ADS with an IPU.