TX HHS Form H2065-D. Notification of Managed Care Program Services

The TX HHS Form H2065-D, Notification of Managed Care Program Services, is a crucial document for individuals who are eligible to receive services from the Home and Community Based Services (HCBS) Program or the Medically Dependent Children Program (MDCP). This form serves as a notification of the services identified on an individual's Individual Service Plan (ISP), which are effective through a specified date, as long as they remain eligible for the program.

The form requires specific information from the individual, including their name and address, as well as details about the services they will receive. Key features include the requirement to pay for room and board by a certain date, followed by monthly payments; similarly, copayments must be paid starting at a specified date, with subsequent monthly payments. The form also outlines the reason for denial of services if an individual is no longer eligible.

The TX HHS Form H2065-D provides important information about an individual's eligibility and responsibilities regarding managed care program services. Key points to note include:

• Eligibility for HCBS or MDCP programs
• Notification of services identified on the ISP
• Payment requirements for room and board, as well as copayments
• Reasons for denial of services if eligibility is lost