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NEW 2018 Nursing Facility
Admission and Financial Agreement Packet

The 2018 NF Admissions Packet is now available. It contains template for Nursing Facility Admission and Financial Agreement, sample policies, forms, authorizations and notices to be provided or completed at the time of admission, with instructions for use.

  • Admission and Financial Agreement

Contains template form for Medicaid and Medicare compliant agreement with fillable fields to insert facility and resident information. Includes instructions for use. 

  • Resident Guide

Contains information to be provided at admission, including overview of application process for Medicaid and Medicare, resident rights statements, sample facility policies, advance directive forms and information, privacy compliance forms, electronic monitoring authorization and information, placeholders for facility-specific information, and form for acknowledgement of receipt. Includes instructions for use.

  • Facility Guide

Forms to be completed and returned to facility at admission, including application for admission, financial and payor questionnaires, authorizations, acknowledgments, and inventory form. Includes instructions for use.

  • Authorizations and Forms

Forms for use on as-needed basis, including forms for arbitration agreement, amendment of previous designations, irrevocable assignment of benefits, and information for notice of discharge.

  • Miscellaneous

Includes current published forms and instructions for use on as-needed basis for Medicare Advanced Beneficiary Notices provided in English and Spanish, as well as large print English and Spanish; Survey and Certification Issues Related to Liability Notices and Beneficiary Appeal Rights in Nursing Homes; Notices of Denial of Medical Coverage provided in English and Spanish with instructions; and list of all current nursing facility posting requirements to include the HHSC Statement of Resident Rights poster.

To Order Contact Dorothy Crawford via email: dcrawford@txhca.org or Call 512-458-1257