TX HHS Form 3611. Involuntary Termination of Consumer Directed Services IPC Cover Sheet

The TX HHS Form 3611, Involuntary Termination of Consumer Directed Services IPC Cover Sheet, is a crucial document for resolving situations where the health or welfare of an individual is at risk. This form helps address immediate concerns by facilitating the involuntary termination of consumer-directed services (CDS) and outlining necessary steps to ensure the individual's well-being.

This cover sheet requires specific information, including the reason for involuntary termination, service planning team meeting justification, and a plan of correction or back-up plan if applicable. The form also outlines the responsibilities of the service planning team, which must submit a packet to Program Enrollment/Utilization Review (PE/UR) that includes the signed IPC form, service planning team meeting minutes, and other relevant documentation.

The TX HHS Form 3611 is typically used in situations where an individual's health or welfare is at immediate jeopardy. Key features of this form include:

• Immediate termination due to immediate jeopardy of the individual's health or welfare
• Termination due to recommendation by the service planning team, including reasons outlined in Texas Administrative Code (TAC) Chapter 41
• Required information includes signed IPC form, service planning team meeting justification, and plan of correction or back-up plan if applicable