10801
This form is used for requesting authorization for Pcsk9 inhibitors under Medicaid Fee-For-Service in Texas.
This Form is used for adding the Medicaid Fee-For-Service standard for Pcsk9 Inhibitors in Texas.
This form is used for adding Medicaid coverage for Increlex Standard Pa in Texas.
This document is for Physician Assistants in Texas who want to participate in the Medicaid Electronic Health Record (EHR) Incentive - Promoting Interoperability (PI) Program. It is a form used to attest their eligibility for certain incentives and benefits.
This Form is used for certifying debarment, suspension, ineligibility, and voluntary exclusion for covered contracts in Texas. It ensures that individuals or entities are eligible to participate in government contracts.
This form is used for federal lobbying certification in the state of Texas. It is required for individuals or organizations engaged in lobbying activities at the federal level in Texas to disclose certain information.
This Form is used for implementing value-based agreements in the healthcare industry in Texas. It outlines the terms and conditions for providers and payers to collaborate in delivering healthcare services based on the value and outcomes achieved.
This document is used for requesting a medical need assessment or verification of Rug-III category in Texas.
This form is used for designating a representative in the state of Texas. It is typically used in legal or administrative proceedings where someone else is authorized to act on your behalf.
This type of document is used for designating a representative in Texas.
This Form is used for providing evidence of correction for residential reviews in the state of Texas.
This form is used for screening nursing tasks in Texas. It helps determine the level of nursing care required for patients.
This form is used for the Medicaid Estate Recovery Program in Texas. It is a worksheet that helps determine the amount of money owed to Medicaid from the estate of an individual who received Medicaid benefits.
This form is used for requesting partial reimbursement for the cost of installing a fire sprinkler system in a four-person residence in Texas.
This document is used for a Qualified Income Trust (QIT) copayment agreement in Texas.
This Form is used for requesting a due process hearing or mediation in the state of Texas.
This form is used for referring individuals or families to relocation services in the state of Texas. It helps facilitate the process of relocating to a new area within the state.
This form is used for the remission to transportation services in Texas. (Spanish)
This form is used for providing an overview of the Consumer Directed Services (CDS) option in Texas.
This form is used for entering into an agreement of participation in the state of Texas.
This form is used in Texas to provide an overview of the Service Responsibility Option (SRO) for Form 1581-SRO. It explains the responsibilities and options available for the SRO program.
This form is used for outlining the responsibilities and requirements for Consumer Directed Services in Texas.
This Form is used for documenting responsibilities when participating in client-administered services in Texas.
This form is used for outlining the roles and responsibilities of the Service Responsibility Option (SRO) in Texas. It details the options available to the SRO and their duties in providing services.
This form is used for consumer participation choice in Texas. It allows consumers to indicate their preference for participating in certain programs or services.
This form is used for acknowledging responsibility for exemption from nursing licensure for certain services delivered through Consumer Directed Services (CDS) in Texas.
This form is used for acknowledging information about support consultation services in the Consumer Directed Services (CDS) option in Texas.
This form is used for the Hcs Review Report in Texas. It is a document that reviews the Health and Human Services Commission's compliance with regulations and standards.
This Form is used for revising the Consumer Directed Services in Texas.