Deadline Approaching: Avoid Medicaid Provider Disenrollment - The disenrollment process will begin shortly after September 24, 2016; however, a final disenrollment date has not yet been determined. Final disenrollment may occur as early as November 2016. Providers that do not meet the submission deadline should inform their Medicaid patients to begin seeking a new provider. PLEASE CLICK HERE HHSC NOTICE. In addition, please see more information below about Long Term Services and Support (LTSS) Community Care Providers contracted with Texas Department of Aging and Disability Services (DADS) and Managed Care Organizations (MCOs).
LTSS Medicaid providers that do not bill or intend to bill acute care services through TMHP and have an active Medicaid contract with DADS must enroll or re-enroll through DADS. This includes the following programs and services:
- Primary Home Care (PHC)
- Community Attendant Services (CAS)
- Community Living Assistance and Support Services (CLASS-DSA, CLASS-CMA, CLASS-SFS, CLASS-CFS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Medically Dependent Children Program (MDCP)
- Hospice
- Day Activity and Health Services (DAHS)
- Financial Management Services Agency (FMSA) [for all Consumer Directed Services]
- Home and Community-based Services (HCS)
- Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID)
- MDCP Adaptive Aids (AA)
- MDCP Minor Home Modifications (MHM)
- Nursing Facility (NF)
- Programs for All-Inclusive Care for the Elderly (PACE)
- Texas Home Living (TxHmL)
- Transition Assistance Services (TAS)
DADS LTSS Texas Medicaid provider enrollment application and other required forms may be accessed on DADS web page: https://www.dads.state.tx.us/providers/mpre/ Please be sure to carefully read the instructions to all forms because errors and omissions will delay processing.
To be considered fully enrolled or re-enrolled, with DADS providers must:
- Submit a completed Form 3684, LTSS Texas Medicaid Provider Application
- Submit a completed Attachment A, Application Payment Form
- Submit a completed Form 5871, Disclosure of Ownership and Control Statement, or Form 5871-S, Disclosure of Ownership and Control Statement — Short Form
- Submit a completed Form 2031, Governing Authority Resolution - Business Organization, or Form 2031-G, Governing Authority Resolution — Governmental Entity (if a current form has not been previously submitted)
- Provide fingerprints to the Texas Department of Public Safety (DPS) and request DPS send criminal history records to DADS for all individuals having a direct or indirect ownership interest of 5% or more in the provider's legal entity (high risk category providers only — see Provider Risk Categories and How to Obtain Criminal History Records)
- Submit an application fee in the amount of $554 or proof of fee payment and enrollment in Medicare or another state's Medicaid or CHIP program
- Receive notification from DADS that their application has been approved
Questions regarding DADS enrollment process may be submitted to the DADS Provider Enrollment Mailbox.
Providers who enroll or re-enroll their legal entity through TMHP and have an active Texas Provider Identifier (TPI) do not have to enroll or re-enroll through DADS; however, these providers must mail DADS a copy of TMHP's notification letter as proof of enrollment or re-enrollment through TMHP. The notification letter must state HHSC has approved the provider's legal entity's application to become a Texas State Health-Care Programs provider and must be dated Jan. 1, 2013, or after.
Mail copy of TMHP notification letter to:
Texas Department of Aging and Disability Services
Contract Oversight and Support, Mail Code W-340
P.O. Box 149030
Austin, TX 78714-9030
Providers should NOT assume their re-enrollment with TMHP is all they need for confirmation. DADS provider should request a written confirmation from DADS that their re-enrollment with TMHP is being recognized and meets the requirement for contract with DADS. Provider should include their agency legal name, DBA names, NPI, TPI (if applicable), TAX ID and DADS Vendor Contract number to ensure compliance. PLEASE retain all original notification letters you receive from TMHP, DADS and other communications for your records.
Information for Medicaid Managed Care Organization (MCO) LTSS Providers
There is a separate enrollment process for Medicaid MCO LTSS providers who bill MCOs, do not have an active TPI for the same provider type to bill TMHP for acute care services, and do not have an active DADS Medicaid contract. These providers are required to re-enroll through the HHSC Medicaid/CHIP Division (MCD) MCO LTSS provider re-enrollment process. These providers must contact the HHSC MCD MCO LTSS Provider Re-enrollment mailbox at MCO_LTSS_Provider_Re-Enrollment@hhsc.state.tx.us to request the HHSC MCD MCO LTSS Provider Re-enrollment application and additional information about the MCO LTSS Provider Re-enrollment process.
Providers should NOT assume their re-enrollment with TMHP or DADS is all they need for confirmation. MCO providers should request a written confirmation from MCOs that their re-enrollment with TMHP is being recognized and meets the requirement for their contract with the MCO. Providers should include their agency legal name, DBA names, NPI, TPI (if applicable), TAX ID and DADS Vendor Contract number to ensure compliance. PLEASE retain all original notification letters you receive from TMHP, DADS, MCOs and other communications for your records.