TX HHS Form 3642. ICF/IID Medicaid Bed Reallocation Application

The TX HHS Form 3642, ICF/IID Medicaid Bed Reallocation Application, is a crucial tool for healthcare providers seeking to reallocate Medicaid beds. This form helps solve the problem of ensuring that Medicaid-funded facilities have sufficient capacity to meet the needs of their patients. It should be used when a provider wants to adjust their bed allocation to better serve their community.

The application requires key information, including applicant details, contact information, and community data. Specifically, it asks for the number of Medicaid beds requested, which cannot exceed six. The form also inquires about the applicant's readiness to utilize the reallocated beds and whether there is a need for the additional capacity. This includes questions about occupancy rates and waiting lists.

The TX HHS Form 3642 is designed for HHSC use only and should be submitted to Regulatory Services at P.O. Box 149030, Austin, TX 78714-9030. For assistance, contact the Specialist at Phone: 512-438-2630 or Fax: 512-438-2730.