LTC-only Billing Medicaid Provider Enrollment

New applicants that do not intend to bill acute care services through TMHP must enroll LTC-only services through Provider Enrollment and Management System (PEMS) on the TMHP website. This includes new applicants that want to obtain a contract to provide community services, nursing facility services and ICF/IID services.

Community Services

New applicants enroll in Texas Medicaid as part of the contract enrollment process. Applicants must complete Form 3681, Community Services Contract Application, Attachment A, Application Fee Payment Form, and Proof of Texas Medicaid enrollment must be included in the applicant's Community Services contract enrollment application packet. Forms and documents that must be included in the contract enrollment application packet are listed on Form 5830, Application Checklist, State Office Enrolled.

The mailing address for Community Services contract enrollment application packets (except as noted below), is:

Texas Health and Human Services Commission
Eligibility Operations Provider Contract Management

Email: hhseopcm@hhsc.state.tx.us; or

eFax: (512) 206-3979; or

Mail:
Mail Code W-357
909 W. 45th Street-Bldg. II
Austin, TX 78751-2803

For HCS, TxHmL, CLASS, CDS, TAS, Hospice, DBMD, see Form 5873, Waiver and Community-based Programs and Services – Medicaid and CHIP Services Contract Application Packet Checklist.

Submit contract enrollment application packet and proof of Medicaid enrollment for HCS, TxHmL, CLASS, CDS, TAS, Hospice, and DBMD to:

Email: IDDWaiverContractEnrollment@hhsc.state.tx.us; or

Fax: (512) 206-3916; or

Mail:

Texas Health and Human Services Commission
Contract Administration and Provider Monitoring
Mail Code W-359
P.O. Box 149030
Austin, TX 78714-9030

Nursing Facility Services and ICF/IID Services

New NF and ICF/IID applicants enroll in Texas Medicaid in addition to the HHSC Regulatory Services licensing and HHSC contracting process. New applicants must complete Texas Medicaid enrollment through PEMS and provide verification of enrollment to HHSC. Other forms and documents must also be included in the application packets for a license and a contract from HHSC. For more information, visit the How To Become a Nursing Facility Provider or the How to Become an ICF/IID Provider webpages at the HHS website.

The mailing address for HHSC license application packets is:
Texas Health and Human Services ARTS
Mail Code 1470
P.O. Box 149055
Austin. TX 78714

Submit contract enrollment application packet and proof of Medicaid enrollment for nursing facility and ICF/IID to:

Email: CAPM_NF_ICF_Contracts@hhsc.state.tx.us

TMHP Application Fee for LTC Providers

Texas Medicaid must comply with 42 CFR §455.460, which requires states to collect an applicable application fee from a prospective or re-enrolling provider. The amount of the application fee is subject to change every calendar year. Each year, the Centers for Medicare & Medicaid Services publishes the application fee in the Federal Register 60 days before the new calendar year. 

  • The fee for calendar year 2022 is $631.
  • The fee for calendar year 2021 is $599.
  • The fee for calendar year 2020 is $595.
  • The fee for calendar year 2019 is $586.
  • The fee for calendar year 2018 is $569.
  • The fee for calendar year 2017 is $560.

Payment must be made through PEMS.

Frequently Asked Questions for LTC-only Applicants

What does Texas Medicaid provider enrollment entail?

As of December 13, 2021, Medicaid enrollment for LTC providers is completed through Texas Medicaid & Healthcare Partnership’s (TMHP) Provider Enrollment and Management System (PEMS). Providers must use the new system to enroll in Texas Medicaid. The new system will be the single tool for provider enrollment, reenrollment, revalidation, and maintenance requests (maintaining and updating provider enrollment record information). For more information about the Medicaid enrollment process and PEMS Visit the TMHP website at www.tmhp.com.

What will the provider screening process entail?

Texas Medicaid providers are screened according to their risk category to fulfill requirements for enrollment as mandated by Section 6401 of the Affordable Care Act. The Center for Medicare & Medicaid Services has established 3 categories of risk: limited, moderate and high. Screening activities associated with each risk category are shown in the table below.

CMS Risk Categories and Screening Activities

Risk

Screen Activities

Limited

Verification of provider-specific requirements, including:

  • License verification
  • National Provider Identifier verification
  • Federal and state database checks
  • Ownership/controlling interest information verification

Moderate

All screening activities for limited risk providers

Unannounced site visits before and after enrollment or re-enrollment

High

All screening activities for limited and moderate risk providers

Submission of fingerprints for all individuals with ownership in the entity of 5 percent or more

HHSC Contracted Community Services leverages site visits performed by HHSC Regulatory Services survey operations staff to comply with ACA site visit requirements. HHSC CCS also leverages site visits performed by TMHP contract monitoring staff. A pre-enrollment site visit is required for unlicensed entities.

I have already paid an application fee to enroll in Medicare. What will HHSC accept as my proof of payment?

HHSC will accept a CMS approval letter. Your Medicare enrollment term must be current. HHSC will also accept a receipt of payment or an email of active Texas Medicaid enrollment from the TMHP PEMS system.