February 1, 2023
HHSC has updated Texas Medicaid Hospice Forms 3071 and 3074 to align with the Texas Medicaid Hospice Policy Program rules in TAC, Title 26, Chapter 266, effective July 2022. Providers must begin using the new forms on Jan. 31, 2023. Please delete all previous versions of this form as soon as possible.
Read the revised versions below:
Form 3071, Individual Election/Cancellation/Update
Form 3074, Physician Certification of Terminal Illness
Email questions to HospicePolicy@hhsc.state.tx.us