TX HHS Form 3071. Individual Election. Cancellation or Update

The TX HHS Form 3071, Individual Election. Cancellation or Update, is a crucial document for individuals seeking to elect, update, or cancel their Medicaid hospice services in the state of Texas. This form helps solve the problem of ensuring that patients receive the necessary care and support during their terminal illness.

This form requires important information from the individual, including their name, date of birth, social security number, and address. Additionally, it asks for the individual's diagnosis, provider information, and hospice details. The form also outlines the individual's responsibilities, such as understanding the difference between palliative and curative care, and waiving Medicaid services related to their terminal illness.

The TX HHS Form 3071 is typically used by individuals who are eligible for both Medicare and Medicaid benefits and need to elect or update their hospice services. The form can be filled out by the individual themselves or with the assistance of a healthcare provider or hospice representative. Key points to note include:

• The form must be completed in full, including all required information.
• Individuals under 21 years of age are not required to waive Medicaid services.
• The form can be used to cancel and re-elect the Medicaid Hospice Program at any time without penalty.