TX HHS Form 3083. Optional Health Care Services Notification

The TX HHS Form 3083, Optional Health Care Services Notification, is a crucial document for counties in Texas to notify the state about the health care services they choose to provide or discontinue. This form helps solve the problem of keeping track of optional health care services offered by each county and ensures that the necessary information is submitted to the Texas Health and Human Services (HHS) County Indigent Health Care Program (CIHCP).

The form requires counties to select the appropriate column for each optional health care service they choose to provide or discontinue. Key features of this form include the option to indicate the provision or discontinuation of services such as Advanced Practice Nurse, Ambulatory Surgical Center, Colostomy Medical Supplies and Equipment, Counseling Services, Dental Care, Diabetic Supplies and Equipment, Durable Medical Equipment, Emergency Medical Services, Federally Qualified Health Center, Home and Community Health Care, Vision Care, and Other Medically Necessary Services or Supplies.

This form should be used by counties in Texas to notify the CIHCP of their optional health care services. The completed form can be submitted electronically to [email protected] or by fax to 512-776-7203. The form requires the signature of the County Judge/Designee, along with printed name and title, mailing address, city, state, and ZIP code, area code, and phone number.