TX HHS Form 6502. Denial of Application for DB-MD

The TX HHS Form 6502, Denial of Application for DB-MD, is a crucial document that helps resolve issues related to the denial of applications for enrollment in the Deaf-Blind Multiple Disabilities Medicaid Waiver (DB-MD) Program. This form is typically used by individuals who have had their application denied and are seeking to appeal the decision.

The form outlines the reasons for denial, which may include insufficient information or failure to meet program eligibility criteria. It also provides instructions on how to request a hearing to appeal the decision, including the requirement to complete the Request for Appeal (see Page 2) and return it to the issuing agency within 90 days of the notice date. Failure to request a hearing within this timeframe may result in the loss of the right to appeal.

Key features of the form include the provision of reasons for denial, instructions on how to request a hearing, and a deadline for taking action. The following are some key points to note:

• The DB-MD Program is designed for individuals with deaf-blindness and multiple disabilities.
• Applications may be denied due to insufficient information or failure to meet program eligibility criteria.
• A hearing can be requested to appeal the denial decision.
• The deadline for requesting a hearing is 90 days from the notice date.