TX HHS Form 2362. Receipt Certification by a Qualified Rehabilitation Professional

The TX HHS Form 2362, Receipt Certification by a Qualified Rehabilitation Professional, is a crucial document that helps ensure the proper delivery and certification of customized manual wheelchairs (CMWCs) to residents in nursing facilities. This form is used when a CMWC is provided to a resident, and it requires the authorizing therapist to coordinate with a qualified rehabilitation professional (QRP) to verify that the wheelchair meets the resident's needs.

The QRP must sign this form to certify their presence and involvement in the clinical assessment, as well as confirm that the CMWC has been evaluated to fit properly and meet the individual's needs. The nursing facility (NF) is responsible for uploading this completed form to the LTC Online Portal after delivery and certification. Failure to submit this receipt certification may result in HHSC withholding reimbursement for the CMWC.

Key requirements for this form include ensuring accurate and verifiable signatures, dates, and information. Alterations to the form are invalid and may lead to pending denial or denial status. To correct errors, a single line through the mistake, with the correction written next to it and initialled and dated, is acceptable.

• The TX HHS Form 2362 is used in situations where customized manual wheelchairs (CMWCs) are provided to residents in nursing facilities.
• The form requires the authorizing therapist to coordinate with a qualified rehabilitation professional (QRP) to verify that the CMWC meets the resident's needs.