TX HHS Form 3086. End of Year Report

The TX HHS Form 3086, End of Year Report, is a crucial document used to track and report on the County Indigent Health Care Program (CIHCP) activities. This form helps healthcare providers and organizations submit their annual reports, providing essential information on client services and expenditures.

This report requires key details such as total number of unduplicated clients served, with specific breakdowns for SSI appellants, total expenditures categorized by service type, and delivery system reform incentive payments (DSRIP) projects. The form also asks for top diagnoses of clients and federal poverty guideline percentages used to determine eligibility. Additionally, the report includes a section for uncompensated care expenditures under the 1115 Waiver.

The TX HHS Form 3086 should be completed by healthcare providers and organizations participating in the CIHCP program at the end of each fiscal year (September 1 through August 31). The form is typically faxed to CIHCP at 512-776-7203, ensuring timely submission and compliance with reporting requirements.