The Texas Health and Human Services Commission has issued a new Long-Term Care Regulatory Provider Letter (PL 2021-02) regarding a change in the forms required for a change of ownership (CHOW) for various healthcare facilities, including nursing homes. The revised HHSC Form 1092, Change of Ownership Transfer Affidavit Form, will replace Forms 3604, 3604A, and 3725. Effective immediately, long-term care providers must complete and upload the revised HHSC Form 1092 in the Texas Unified Licensure Information Portal (TULIP) as part of the CHOW process. This form ensures that both outgoing and incoming licensees consent to the CHOW and outlines the transaction between both parties. The revised HHSC Form 1092 is available on the HHS website, and form instructions for each provider type are located in TULIP. This change aims to consolidate multiple CHOW affidavit forms into one for all long-term care provider types. Healthcare facilities must now use the revised form for any change of ownership transactions.

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