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 must be completed no later than 72 hours after the facility becomes aware of the change.

The form requires the facility to provide specific information about the adverse change, including its nature, the applicable Texas Administrative Code (TAC) section, and the dollar amount involved. Common scenarios that may trigger the use of this form include judgments or tax liens against the facility exceeding $50,000, bankruptcy proceedings, failure to maintain utilities or supplies, delinquent debt payments, and other financial difficulties.

This notification is essential for ensuring that HHSC is informed of any changes that could affect a facility's ability to deliver essential care and services. By completing this form, facilities can demonstrate their commitment to transparency and compliance with regulatory requirements. The TX HHS Form 3726 should be used whenever a licensed nursing facility experiences an adverse change in its financial condition or other events that could impact the delivery of essential care and services.