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1、DateNameOfADD1.iCanIAdd心SOfADD1.iCanICity.Sta1.e、ZiDCOdeOfADDIiCamRE:()11erofHomeandCommunity-basedServices(HCS)DearNaIneOfADorCant:TheTeXaSDepartmentofAgingandDisabi1.itySerViCeShasnotified(NameOf1.OCa1.IDDAUthoritY)thatfundingisavai1.ab1.etoofferHomeandCommunity-basedServices(HCS)toyou.TheHCSProgr
2、amhasmanyservicesinc1.udingresidentia1.services,hosthomeservices,dayhabi1.itatioi1.respite,supportedemp1.oyment,nursingservices,professiona1.therapies,denta1.,psycho1.ogica1.services,adaptiveaids,andminorhomemodifications.Ifyouenro1.1.inheHCSProgramyouwi1.1.a1.sobee1.igib1.etorCommunityFirstChoice(C
3、FC)services,whichinc1.udespersona1.attendantservicesandhabi1.itationSerViCeS.TheHCSProgramisa1.ife-1.ongprogramthatcanmeetyourchangingneeds.Inaddition,youareab1.etotransfertoanyHCSPrOgramproviderinthestate.Theenro1.1.mentprocessinc1.udessevera1.dead1.inesthatwi1.1.beimportanttoyou.Youmustcontact(Nam
4、eofStaf)at(StafrSPhoneNUInberWithA心COde)by(Date).whichis30ca1.endardaysafterthedateofthis1.etter,ortheoffertoenro1.1.inHCSmaybewithdrawn.IfyournameisonheHCSinterest1.istandyoudonotcontactuswithin3()ca1.endardaysafterthedateofthis1.etteroryoudec1.inethisoffertoenro1.1.intheHCSProgram,thenyournamewi1.
5、1.beremovedfromtheinterest1.ist.(*Sccaspecia1.noteaboutthisasshownbe1.ow.)IfyournameisremovedfromtheHCSinterest1.istyoucanhaveyournamereinstatedonthe1.istwithyourorigina1.dateofrequestifyoucontacttheStaff1.istedabovewithin90dayca1.endardays(ifferyournameisremoved.Ifyouarccurrent1.yreceivinggenera1.r
6、evenue-fundedservicesfromouragencyandyoudec1.inethisoffer,wcwi1.1.havetostopprovidingthoseservicesthatarcsimi1.artoHCSservices.Therearcotherstepsintheenro1.1.mentprocessandwcwi1.1.exp1.ainthemindetai1.whenwcmeetwithyou.Unti1.thenwchaveenc1.osedaDead1.ineNotificationFormthatdescribessomeoftheactionsy
7、oumusttakeandthedead1.inesforthoseactions.Thisinformationmayseemoverwhe1.ming,butwcwi1.1.he1.pyouthroughouttheprocess.P1.easeca1.1.ustodayatthephonenumber1.istedabove.Sincere1.y,(SignatureoStaffSigning1.eiter)(TypedNameofStaffSigning1.etter) Ifyouarcunder22yearsofageand1.ivinginoneofthetb1.1.owingin
8、stitutionsandyoudonocrespondtothisofferoryoudec1.inethisoffer,thenyournamewi1.1.bep1.acedbackontheHCSinterest1.istwithanewregistrationdate: anInIennedid1.eCareFaci1.ityforIndividua1.swithanInie1.1.eciua1.Disabi1.i1.yorRe1.atedConditions(ICF1ID): anursingfaci1.ity; aninstitutionfbrpersonswithinte1.1.ectua1.disabi1.ity1.icensedbytheDepartmentofFami1.yandProtectiveServices(DFPS); afostergrouphome1.icensedbyDFPS;or anotherresidentia1.arrangementthatprovidescaretofourormoreindividua1.sunder22yearsofageWhOareunre1.atedtoeachother.
