TX HHS Form 2361. PASRR Specialized Services Fair Hearing Request

The TX HHS Form 2361, PASRR Specialized Services Fair Hearing Request, is a crucial document used to appeal the denial of specialized services for nursing facility residents. This form helps solve the problem of ensuring that individuals receive the necessary care and support to maintain their health and well-being.

This form should be used when a resident or their legally authorized representative (LAR) wishes to dispute the decision made by the Texas Health and Human Services Commission (HHSC) regarding the denial of specialized services. The required information includes contact details, Medicaid number, and document locator number. Key sections include Section A for nursing facility residents' information, Section B for LARs, and Section C for hearing representatives.

The form also outlines common scenarios of use, such as appealing the denial of physical therapy, gait trainers, orthotic devices, prosthetic devices, positioning wedges, special needs car seats, standing boards, customized manual wheelchairs, speech therapy, or occupational therapy. The conditions explicitly mentioned include the requirement for two witnesses if signed by an X.