TX HHS Form 3600. Application for Participation in Title XIX Medicaid: ICF/IID. Nursing Facility or Rural Hospital Swingbed Program

The TX HHS Form 3600 is a crucial document for healthcare facilities seeking to participate in the Title XIX Medicaid program's ICF/IID, Nursing Facility or Rural Hospital Swingbed Program. This form helps solve the problem of ensuring compliance with Medicaid regulations and facilitates the application process for these types of facilities.

The form requires key information from applicants, including facility details such as name, ID number, physical address, and contact information. It also asks about the type of application being submitted, whether it's a new contract or a re-opened one. Additionally, the form requests legal entity information, including the applicant's name, tax ID or SSN, and contact person details.

Key features of this form include the need for applicants to check all applicable boxes regarding their type of application and provide supporting documentation as required. The form also emphasizes the importance of accurate and complete information, highlighting the potential consequences of incomplete or inaccurate submissions. By filling out this form, healthcare facilities can ensure a smoother application process and compliance with Medicaid regulations.

• This form is used by healthcare facilities seeking to participate in the Title XIX Medicaid program's ICF/IID, Nursing Facility or Rural Hospital Swingbed Program.
• The form requires key information from applicants, including facility details and legal entity information.
• Applicants must check all applicable boxes regarding their type of application and provide supporting documentation as required.