TX HHS Form 4116-MHM-AA. Minor Home Modification and Adaptive Aids Summary Sheet

The TX HHS Form 4116-MHM-AA, Minor Home Modification and Adaptive Aids Summary Sheet, is a crucial tool for healthcare professionals to document minor home modifications and adaptive aids provided to patients. This form helps solve the problem of tracking and billing these services accurately, ensuring that patients receive the necessary support and care.

This summary sheet requires essential information such as patient details, service dates, and descriptions of the minor home modifications and adaptive aids provided. It also includes important sections for recording the frequency and duration of services, as well as any relevant notes or comments. The form is typically used in scenarios where patients require temporary assistance with daily living activities due to a medical condition or disability. Revision 25-1, effective January 1, 2025, ensures compliance with the Home and Community-based Services (HCS) Program Billing Requirements.