LIDDA shall Clause Samples
LIDDA shall. 1.2.1 contact with the individual or LAR prior to the completion of Form 1049, Documentation of Provider Choice.
1.2.2 For an individual who is being enrolled in the TxHmL Program, ensure the LIDDA service coordinator facilitates the completion of Form 8586, TxHmL Service Coordination Notification.
1.2.3 Maintain the following completed forms in the record:
A. Form 8648, Identification of Preferences;
B. Form 8601, Verification of Freedom of Choice; C. Form 8001, Medicaid Estate Recovery Program; D. Form 1049, Documentation of Provider Choice; E. Form 8586, TxHmL Program Service Coordination Notification if applicable; and F. Form 8511, Understanding Program Eligibility.
1.2.4 LIDDA must request an extension for the enrollment if the designated time frames cannot be met. HHSC will review all request for an enrollment extension using Form 1045, Request for Extension of Enrollment Offer Due Date and notify LIDDA accordingly.
LIDDA shall. 1.2.1 Not allow any of the LIDDA’s staff from its provider operations to initiate contact with the individual or LAR prior to the completion of the Documentation of Provider Choice form.
1.2.2 For an individual who is being enrolled in the TxHmL Program, ensure the LIDDA service coordinator facilitates the completion of Form 8586 (TxHmL Program Service Coordination Notification).
(a) Verification of Freedom of Choice form;
(b) Documentation of Provider Choice form; and
(c) Texas Home Living Program Service Coordination Notification (Form 8586), if applicable.
(d) for an individual who is being enrolled in the HCS or TxHmL Program, ensure the LIDDA service coordinator facilitates the completion of form 8511 (Understanding Program Eligibility).
LIDDA shall contact with the individual or LAR prior to the completion of Form 1049, Documentation of Provider Choice.
LIDDA shall. Not allow any of the LIDDA’s staff from its provider operations to initiate contact with the individual or LAR prior to the completion of the Documentation of Provider Choice form.