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.
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Samples: Local Intellectual and Developmental Disability Authority Performance Contract, Local Intellectual and Developmental Disability Authority Performance Contract, Local Intellectual and Developmental Disability Authority Performance Contract
