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 used to facilitate the involuntary termination of consumer-directed services (CDS) in Texas. This form helps resolve issues where the individual's health or welfare is at immediate jeopardy, or when recommended by the Health and Human Services Commission (HHS) or other government agencies.

This cover sheet requires essential information, including the program type (Home and Community-based Services or Texas Home Living), the reason for involuntary termination, and supporting documentation. The form must include a signed IPC form, service planning team meeting justification, and a description of attempts to resolve issues. Other required elements include the employer's/designated representative's back-up plan, plan of correction, and conditions for re-enrollment.

The TX HHS Form 3611 should be used in situations where immediate termination is necessary due to imminent health or welfare risk, or when recommended by a government agency. The form must be submitted with the packet to Program Enrollment/Utilization Review (PE/UR) along with supporting documentation and justification for the involuntary termination recommendation.