TX HHS Form 8578-CFC. Intellectual Disability/Related Condition Assessment for CFC

The TX HHS Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC, is a crucial tool for determining eligibility for Community First Choice (CFC) services in Texas. This form helps solve the problem of assessing individuals with intellectual disabilities or related conditions to determine their level of care and support needs.

This assessment form requires specific information from the individual being evaluated, including their name, date of birth, mailing address, Medicaid number, and CARE ID. The form also includes sections for documenting cognitive or adaptive functioning, adaptive behavior levels, and related conditions. The LIDDA representative is responsible for completing this form and certifying that all information is true and accurate.

The TX HHS Form 8578-CFC is used in situations where an individual's level of care and support needs must be assessed to determine their eligibility for CFC services. This form is typically filled out by the LIDDA representative, who must also obtain a physician's attestation if the primary diagnosis is a related condition. Key features of this form include the required information sections, the adaptive behavior levels assessment, and the certification process.

• This form is used to determine eligibility for Community First Choice (CFC) services in Texas.
• The LIDDA representative is responsible for completing and certifying the form.
• The form requires specific information from the individual being evaluated, including their name, date of birth, mailing address, Medicaid number, and CARE ID.