263), 21988 [30C] -————conduct a pilot program to improve access to health care for rural veterans (see H.R. 1741), 7321 [20AP] —conduct demonstration project to improve Veterans Health Administration business practices (see H.R. Europa 1400 Gold Crack here. 2988), 13275 [ZOIN] —continue mission of Kerrville, TX, medical center, including. Hospice Form 3071 and Form 3074 Physician Certification of Terminal Illness. Texas Medicaid Hospice Program. Form 3074 is used to capture the Medicaid. Fill Hospice Form 3074, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile with PDFfiller Instantly No software.

DADS issues a to inform Texas Medicaid Hospice providers of updates to the Form 3071, Individual Election/Cancellation/Update, and Form 3074, The Physician Certification of Terminal Illness, and the coinciding instructions for those forms. As a reminder, per Information Letter 14-50, effective July 1, 2014, Form 3071 and Form 3074 must be submitted electronically on the Texas Medicaid and Healthcare Partnership (TMHP) Long-Term Care (LTC) Portal. Paper forms will no longer be accepted by TMHP; however Hospice providers must continue to retain an original signed and dated Form 3071 and 3074 according to the instructions for these forms and the record retention requirements in Title 40 Texas Administrative Code (TAC), Chapter 49, Subchapter C, Section 49.307, Contracting for Community Care Services. Categories • (7) • (9) • (4) • (1) • (6) • (4) • (115) • (14) • (28) • (71) • (6) • (22) • (7) • (20) • (38) • (52) • (5) • (13) • (7) • (72) • (11) • (341) • (5) • (31) • (34) • (10) • (130) • (152) • (46) • (331) • (10) • (1) • (19) • (16) • (213) • (123) • (11) • (2) • (843) • (3) • (348) • (70) • (2) • (227) • (545) • (53) • (415) • (5) • (58) • (6) • (301) • (2) • (7) • (2) • (107) • (42) • (14) • (14) • (4) • (2) • (2) • (3) • (10) • (20) • (84) • (6) • (8) • (14) • (8) • (19) • (1) • (2) • (3) • (7) • (6).

(1) The signature and title of each licensed nurse or health care professional completing any section of the MDS assessment for Medicaid reimbursement; and (2) The section(s) and completion date(s) corresponding to the signature of the nurse or health care professional. (e) Each individual signing the signature section on the Basic Tracking Form is certifying that the information entered on the MDS assessment is accurate.

A facility that submits false or inaccurate in- formation is subject to sanctions under 371.1643 of this title (relating to Use of Sanctions). (f) If the nursing facility recipient is a hospice recipient, the nursing facility must comply with the requirements of 40 TAC 19.1926 (relating to Medicaid Hospice Services) and maintain in the recipient's clinical record, copies of the completed Texas Medicaid Hospice Program Recipient Election/Cancellation/Discharge Notice (Form 3071), and the DADS Medicaid/Medicare Hospice Program Physician Certification of Terminal Illness (Form 3074). (1) The nursing facility must acknowledge a recipient's ad- mission to hospice services on the Special Treatments, Procedures, and Programs section when completing an MDS full, comprehensive, or quarterly assessment. (2) An MDS assessment indicating that a recipient has elected hospice services will not be processed until the Texas Medicaid Hospice Program Recipient Election/Cancellation/Discharge Notice (Form 3071), and the DADS Medicaid/Medicare Hospice Program Physician Certification of Terminal Illness (Form 3074) are received by the Texas Medicaid Claims Administrator (MCA). (3) When a recipient is admitted to hospice and there has not been a significant change in condition, a significant change in status assessment does not have to be completed.