TX HHS Form 3726. Notification of Adverse Change in Financial Condition

The TX HHS Form 3726, Notification of Adverse Change in Financial Condition, is a crucial document that helps licensed nursing facilities notify the Texas Health and Human Services Commission (HHSC) of significant changes in their financial condition or events that could impact the delivery of essential care and services. This form is used to report adverse changes in financial condition, such as judgments or tax liens, bankruptcy filings, delinquent debt, or other financial issues that may affect a facility's ability to provide care.

The form requires facilities to provide specific information about the nature of the adverse change, including the dollar amount involved and how it affects their ability to deliver essential care and services. Facilities must also identify any actions taken to address the adverse change in financial condition. The notification must be submitted no later than 72 hours after the facility becomes aware of the change.

Key features of this form include the requirement for facilities to report significant changes in their financial condition, the need to provide specific information about the nature and impact of the change, and the responsibility to submit the notification within a specified timeframe. By using this form, licensed nursing facilities can ensure compliance with Texas Administrative Code (TAC) Section 19.1925 and maintain transparency regarding any adverse changes in their financial condition.

• This form is used by licensed nursing facilities to report significant adverse changes in their financial condition.
• The notification must be submitted no later than 72 hours after the facility becomes aware of the change.
• The form requires facilities to provide specific information about the nature and impact of the adverse change.