TX HHS Form 3022. Provider Selection

The TX HHS Form 3022, Provider Selection, is a crucial document that helps individuals select their preferred provider agencies (PAs) for Adult Mental Health (HCBS-AMH) services. This form should be completed by the individual or their Legally Authorized Representative (LAR) to choose the PA that best suits their needs.

This form requires key information, including the individual's name, CARE ID Number, Clinical Management for Behavioral Health Services (CMBHS) ID, and address. The individual must also select a recovery management (RM) entity and HCBS-AMH PA from a list provided by the HCBS-AMH program. Additionally, the form includes space for the individual to provide their point of contact information at referring entities.

The TX HHS Form 3022 is designed to facilitate the selection process for HCBS-AMH services, allowing individuals to choose their preferred providers and coordinate their care effectively. This form should be used by individuals seeking Adult Mental Health services through the HCBS-AMH program in Texas.