Answer all the questions on each required form.
Have the signature authority the owner or authorized representative of the legal entity sign and date each form. (An authorized representative is the person named on Form 2031, Governing Authority Resolution Business Organization).
Have the applicable forms notarized.
Complete each required form accurately in accordance with HHSC instructions.
Not use correction tape or fluid. (If a mistake is made, mark through it with a single line and initial the change.)
Review the completed application packet.
Retain a copy of the completed application packet.
Required Forms
The following forms should be completed in accordance with HHSC instructions. Please do not send instructions or blank form pages with an application packet.
Examples of fraud may include:
Giving someone a generic drug but billing for the name-brand drug
Billing a person for services already paid for by someone else
Misusing someone’s money
Who can report fraud?
Anyone can report fraud, waste or abuse. Texas Health and Human Services is required by law to refer suspected provider fraud to the Office of Inspector General.
How can I report suspected Medicare or Medicaid fraud?
Call 800-581-1790 to report healthcare fraud. You also can report it online through the Medicare and Medicaid Fraud Reporting Center.
Child Day Care Provider
Child day care includes center-based and home-based operations that provide care for children 13 years or younger for less than 24 hours a day while parents or guardians are at work or school. This includes Child Care Centers, School-age Program, Before or After-School Programs, Licensed Child Care Homes, Registered Child Care Homes, and Listed Family Homes.
Clarification of Minimum Standards Related to CCDBG Requirements
(Each lasts approximately 10 minutes and do not count towards annual training hours)
PASRR Admission Processes
There are four types of PASRR admission processes:
Exempted hospital discharge happens when a physician at an acute care hospital (a medical acute care hospital,
not a psychiatric hospital) has determined the person might need a nursing facility stay of 30 days or less for rehabilitation purposes.
Expedited admission is for those discharged from a medical acute care hospital or a nursing facility transfer. There are seven expedited admission categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite and coma. For definitions of each category, visit the forms page.
Preadmission happens when a person is coming from the community (psychiatric hospital, home, group home, jail, assisted living, etc.). This includes anywhere other than a medical acute care hospital or another nursing facility. The person, coming from the community with a PASRR Level 1 that indicates suspicion of IDD, and/or ment
Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
Right Click for PC or
Ctrl + Click for Mac on the PDF link and click “
Save link as” from the menu.
Select the folder you want to save the file in and then click
Save.
Right Click for PC or
Ctrl + Click for Mac, then select
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC.
Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.