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 an application for participation in Title XIX Medicaid programs, specifically designed for ICF/IID facilities, nursing facilities, or rural hospital swingbed programs. This form helps solve the problem of obtaining a new or re-opened Medicaid contract for these types of facilities.

This application requires key information about the facility, including its name, ID number, physical and mailing addresses, phone numbers, and fax number. The applicant must also provide details about their type of entity, such as sole proprietorship or limited liability company, along with their federal tax ID or SSN. Additionally, the form asks for contact person information, including title, area code, and telephone number.

The TX HHS Form 3600 is used in scenarios where a facility seeks to participate in Medicaid programs for ICF/IID services, nursing facilities, or rural hospital swingbed programs. The application must be completed accurately and thoroughly to ensure successful processing. It is essential to review the form carefully and provide all required information to avoid delays or rejections.