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 for individuals seeking to appeal the denial of specialized services in nursing facilities. This form helps solve the problem of ensuring that residents receive necessary care and support by providing a formal mechanism for appealing denials.

This form is typically used by nursing facility residents or their legally authorized representatives (LAR) who wish to challenge the denial of specialized services, such as physical therapy, occupational therapy, or speech therapy. The required information includes contact details, Medicaid number, and document locator number. Key features include the definition of a LAR, the option to designate a hearing representative, and the requirement for signatures from the appellant or LAR.

The form must be returned to the Texas Health and Human Services Commission (HHSC) at P.O. Box 149030, Mail Code W356 Austin, TX 78714-9030. Key points to note include:

• Required information includes contact details, Medicaid number, and document locator number.
• A LAR is defined as an individual authorized by law to act on behalf of the resident or minor child.
• The form allows for designation of a hearing representative at any time during the fair hearing process.