TX HHS Form 2110-A. Community Care Intake Nursing Facility Diversion Slot Screening

The TX HHS Form 2110-A, Community Care Intake Nursing Facility Diversion Slot Screening, is a practical tool designed to help identify individuals who require nursing facility diversion slots. This form is typically used in situations where an individual's caregiver is no longer able to provide care, or when the individual experiences a sudden occurrence of a major illness/physical trauma and lacks a caregiver.

The form consists of five questions that assess whether an individual meets the criteria for a diversion slot. Questions 1-2 evaluate the individual's need for skilled nursing or medication administration in their home, while questions 3-5 determine if temporary arrangements are in place for care in the home and if these arrangements will be ending soon. If the answers to questions 1-2 are "Yes," the individual meets the criteria for a diversion slot.

Key features of this form include required information on major life events, caregiver availability, and temporary care arrangements. The form also outlines follow-up actions, such as contacting the Community Services Interest List (CSIL) Unit staff to place the individual in the NF Diversion Slot queue. By using this form, healthcare professionals can efficiently identify individuals who require nursing facility diversion slots and provide necessary support.

• This form is used to identify individuals who meet the criteria for a nursing facility diversion slot.
• It assesses an individual's need for skilled nursing or medication administration in their home.
• The form requires information on major life events, caregiver availability, and temporary care arrangements.