Submitting Contract Applications and Contract Information for LTC Programs and Services

For Waiver and Community-based Programs enrolled by Medicaid and CHIP Services – Contract Administration and Provider Monitoring, submit contract applications and other contract information by email or fax to 512-206-3916.

Click on the hyperlinks for each program or service type below to review the list of required forms that must be submitted for each contract application:

• Consumer Directed Services-CLASS (PDF)
• CDS-DBMD (PDF)
• CDS-HCS (PDF)
• CDS-PHC (PDF)
• CDS-TxHmL (PDF)
• CLASS-CFS (PDF)
• CLASS-CMA (PDF)
• CLASS-DSA (PDF)
• CLASS-SFS (PDF)
• DBMD (PDF)
• HCS (PDF)
• Hospice (PDF)
• TAS (PDF)
• TxHmL (PDF)

Important Note: People who sign the contract application or any other contract documents must be referenced on either the Form 2031, Designation of Authorized Individual(s) - Business Entity, or Form 2031-G, Designation of Authorized Individual(s) – Governmental Entity.