TX HHS Form H0090-I. Notice of Admission. Departure. Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Medical Assistance Only in a State Institution

The TX HHS Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Medical Assistance Only in a State Institution, is a crucial document used to protect the rights of patients receiving benefits under Title XVI of the Social Security Act. This form helps ensure that patients' rights are respected when they move into, out of, or between state institutions.

The form requires key information such as the patient's name, address before and after moving into the institution, and details about their admission, departure, readmission, or death. It also specifies the responsibilities of the institution staff to complete the form within 72 hours. The document does not obligate the institution to file as a payee on behalf of the patient but rather serves as a notification mechanism to protect patients' rights.

This form is typically completed by institution staff and submitted for review and processing. Key points to note include:

• The form must be completed within 72 hours of admission, departure, readmission, or death
• It requires information about the patient's name, address, and institutional details
• It serves as a notification mechanism to protect patients' rights under Title XVI of the Social Security Act