TX HHS Form H1551. Treatment Verification

The Treatment Verification Form H1551, issued by Texas Health and Human Services (HHS), is a crucial document for individuals receiving Medicaid benefits for breast and cervical cancer treatment. This form helps verify the patient's medical needs to determine continued eligibility for services.

To use this form, patients should take it with them to their doctor's appointments and have the doctor fill out the required information. The doctor must certify that the patient is receiving "active treatment" for breast or cervical cancer, which may include surgery, chemotherapy, radiotherapy, medication, or active disease surveillance. Additionally, the doctor must confirm that they are no longer providing "active treatment" if the patient's condition has improved.

Once completed, the doctor should return the form to the patient or fax it toll-free to 1-877-447-2839. Failure to submit this form may result in delayed or terminated Medicaid benefits for breast and cervical cancer. Key points to note include:

• The form is used to verify a patient's medical needs for continued eligibility of Medicaid services.
• The doctor must certify that the patient is receiving "active treatment" for breast or cervical cancer.
• The doctor must confirm that they are no longer providing "active treatment" if the patient's condition has improved.