The TX HHS Form 3079, Facility Payment Rate Request, is a crucial document for healthcare facilities seeking reimbursement from the Texas Health and Human Services (HHS) County Indigent Health Care Program (CIHCP). This form helps solve the problem of determining payment rates for indigent health care services provided by facilities.
The TX HHS Form 3080, SSI Appellant Notification, helps resolve claims for Medicaid-covered services provided to Supplemental Security Income (SSI) appellants. This form is used in situations where a county or local government entity needs to notify the Texas Health and Human Services Commission (HHSC) of the services rendered to an SSI recipient.
The TX HHS Form 3081, Appellant Provider Assignment, is a crucial document for individuals appealing Social Security denial decisions. This form helps resolve the issue of recovering costs related to health care services provided by the county and any third-party providers.
The TX HHS Form 1042, Pre-Move Site Review, is a crucial tool for ensuring a smooth transition or diversion of individuals from nursing facilities, medium or large community ICF/IID settings, or those receiving Home and Community-based Services (HCS) crisis diversion slots. This form helps identify essential supports that must be in place before the individual's transition or diversion.
The TX HHS Form 1043, Post-Move Monitoring, is a crucial document that helps ensure the successful transition of individuals with intellectual or developmental disabilities from institutional settings to community-based care. This form is used in situations where individuals have transitioned or diverted from nursing facilities, medium or large community ICFIIID, or received Home and Community-based Services (HCS) crisis diversion slots.
The TX HHS Form 1044, Refusal of Habilitation Coordination, is a document used by individuals or their legally authorized representatives to decline habilitation coordination services. This form helps solve the problem of unwanted or unnecessary involvement in habilitation coordination processes, allowing individuals to opt out and maintain control over their care.
The TX HHS Form 1045, Request for Extension of Enrollment Offer Due Date, is a crucial document that helps individuals with intellectual and developmental disabilities (IDD) or related conditions request an extension on their enrollment offer due date. This form is typically used by the Local Intellectual and Developmental Disability Authority (LIDDA) to facilitate the enrollment process in Home and Community-based Services (HCS) and Texas Home Living (TxHmL). The form is usually completed by a representative of LIDDA or an individual with IDD.
Form 1046 is a standardized document used by Local Intellectual and Developmental Disability Authorities (LIDDAs) in Texas to request a Home and Community-based Services (HCS) Adult Nursing Facility (NF) Transition Slot for an eligible individual. The form is an essential part of the transition process for adults with intellectual or developmental disabilities who currently reside in a nursing facility but wish to move to a community-based setting. It provides HHSC with the key information required to determine eligibility and allocate available transition slots.
Form 3052, titled Practitioner’s Statement of Medical Need, is a required medical certification used in Texas Medicaid Personal Attendant Services programs, specifically Primary Home Care (PHC) and Community Attendant Services (CAS). The form documents that a person has a qualifying medical condition and related functional limitations that justify the need for non-skilled attendant services in the home.
Form 3040 is an official corrective action document used within the Home and Community-Based Services Adult Mental Health (HCBS-AMH) program in Texas. The form is used by providers to formally respond to review findings issued by oversight authorities and to document a clear, structured plan for correcting identified issues and preventing their recurrence.
This form serves as written evidence that a provider understands the findings, takes responsibility for remediation, and has established concrete steps to achieve and maintain compliance.
