TX HHS Form 3612. Transfer Process Checklist

The TX HHS Form 3612 Transfer Process Checklist is a crucial document that facilitates the transfer of services for individuals in Texas Health and Human Services (HHS) programs. This form helps solve the problem of ensuring a smooth transition between service providers, allowing individuals to choose their preferred provider or Financial Management Services Agency (FMSA). The form is typically used when an individual or legally authorized representative (LAR) desires a transfer, and the service coordinator (SC) must begin the process within three days.

The key features of this form include the required information, such as the individual's name, CARE ID, and SC's notification date. The form also outlines specific procedures, such as reviewing legal guardianship information, discussing the transfer option with the individual/LAR, and obtaining signatures on Form 3617. Additionally, the form highlights follow-up actions, such as completing data entry in the HHSC data system and submitting Form 3617 to Program Eligibility and Support (PES) for authorization.

Some key points to note include:

• The transfer process must begin within three days after SC notification
• The form requires signatures from the individual/LAR, receiving provider/FMSA, and SC
• Data entry in the HHSC data system is required, except for emergency transfers
• A transfer IPC must be signed and dated by all parties on or before the transfer effective date