The TX HHS Form 3624, Termination, Reduction or Denial of CLASS, helps resolve situations where an individual's eligibility for the Community Living Assistance and Support Services (CLASS) program is being terminated, reduced, or denied. This form is typically used by case managers to notify individuals of changes to their CLASS benefits.
The TX HHS Form 3625, CLASS and CFC Documentation of Services Delivered, is a crucial tool for service providers to document the services they deliver to individuals with disabilities or chronic conditions. This form helps solve the problem of tracking and recording the services provided, ensuring that accurate records are kept for billing, reimbursement, and compliance purposes.
The Specialized Nursing Certification Form 3627 helps healthcare professionals determine the need for specialized nursing care for individuals with specific medical conditions. This form is typically filled out by registered nurses (RNs) to certify that a participant in the Deaf Blind with Multiple Disabilities Program requires specialized nursing due to certain criteria.
The TX HHS Form 3628, Provider Agency Model Service Backup Plan, is a crucial document that helps solve the problem of ensuring continuity of service delivery in case of an absence or emergency. This form is typically used by provider agencies, such as Community Living Assistance Deaf Bind with Multiple Disabilities (CLASS) and Direct Services Agency, to develop a backup plan for their services.
The TX HHS Form 3629, Individual Program Plan Addendum, helps address the needs of individuals participating in Community Living Assistance and Support Services (CLASS) or Community First Choice (CFC). This form is used to document individualized plans and track progress. Typically, participants, caregivers, or healthcare professionals fill out this addendum.
The TX HHS Form 3632, Withdrawal Confirmation, is a crucial document that helps individuals withdraw from the Texas Money Follows the Person Demonstration Program. This form is typically used when an individual decides to opt out of the program, which provides financial assistance for long-term care services.
The Prescribed Pediatric Extended Care Center Informal Dispute Resolution Request (TX HHS Form 3639) is a crucial document for prescribed pediatric extended care centers (PPECCs) to resolve disputes in a timely and efficient manner. This form enables PPECCs to request an informal dispute resolution (IDR) process when faced with a statement of violations from the Texas Health and Human Services Commission.
The TX HHS Form 3641, Alzheimer's Assisted Living Disclosure Statement, is a crucial document that helps individuals and families make informed decisions about care for loved ones with Alzheimer's disease or related disorders. This form is typically used by assisted living facilities in Texas to disclose the services they provide and how these services cater to the unique needs of residents with dementia.
The TX HHS Form 3641-A, Alzheimer's Disclosure Statement for Nursing Facilities, helps solve the problem of providing transparent information about dementia care services to residents. This form is used by nursing facilities that advertise or promote specialized services for individuals with Alzheimer's disease or related disorders. The administrator of the facility typically completes this form.
The TX HHS Form 3642, ICF/IID Medicaid Bed Reallocation Application, is a crucial tool for healthcare providers in Texas. This form helps solve the problem of insufficient Medicaid bed capacity by allowing applicants to request reallocated beds for their facilities. The application is typically filled out by healthcare providers, such as corporations, LLCs, partnerships, or individuals/sole proprietors, who need to increase their Medicaid bed capacity.
