TX HHS Form 3006. No Reject Appeals

The TX HHS Form 3006, "No Reject Appeals," is a document used by HCBS-AMH Providers to justify the denial of services for an individual in the Adult Mental Health (HCBS-AMH) Program. This form helps providers explain the reasons why they are unable to support an individual in the community and provides a summary of the justification.

The form requires key information, including the individual's name, CARE ID number, date of birth, and date of discharge. Additionally, it asks for the name and contact details of the Legally Authorized Representative (LAR) if applicable. The provider must also provide a summary outlining the reason(s) why they are not able to support the individual in the community.

This form should be used when an HCBS-AMH Provider needs to justify the denial of services for an individual. It is intended for internal use only and should be completed by the provider agency and recovery manager entity. The form does not specify any specific conditions or scenarios, but it can be used in various situations where a provider needs to provide justification for denying services.