TX HHS Form H3676. Managed Care Pre-Enrollment Assessment Authorization

The Managed Care Pre-Enrollment Assessment Authorization Form H3676 is a crucial tool for healthcare providers in Texas. This form helps solve the problem of ensuring that individuals are properly assessed and authorized for managed care services before enrollment. It is typically used by Program Support Unit Staff to facilitate the pre-enrollment process, particularly for individuals with complex needs.

The form requires various pieces of information, including applicant details, current living address, phone number, and Medicaid/Medicare numbers. It also includes sections for waiver assessment reports, ISP tracking tools, and medical necessity approvals. The form is designed to capture essential data that enables healthcare providers to make informed decisions about patient care and treatment.

Key features of the Form H3676 include the need for a referral/assessment authorization completed by Program Support Unit Staff, as well as waiver assessment reports and ISP tracking tools. The form also highlights the importance of medical necessity approvals and community first choice eligibility. By using this form, healthcare providers can ensure that individuals receive the necessary care and services to meet their unique needs.

• The Form H3676 is used for managed care pre-enrollment assessment authorization.
• It requires applicant details, current living address, phone number, and Medicaid/Medicare numbers.
• The form is designed to facilitate the pre-enrollment process for individuals with complex needs.