LTC-only Billing Medicaid Provider Enrollment

New applicants that do not intend to bill acute care services through TMHP must enroll through HHSC. 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 the Texas Medicaid application fee payment. These items must be included in the applicant's Community Services contract enrollment application packet. Other forms and documents that also must be included in the contract enrollment application packet are listed on Form 5830, Application Checklist, State Office Enrolled.

For HCS and TxHmL, see Form 5873, HCS/TxHmL Waiver Program Provider Application Packet Checklist.

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

Texas Health and Human Services Commission
Contracted Community Services
Mail Code W-357
P.O. Box 149030
Austin, TX 78714-9030

The mailing address for HCS and TxHmL contract enrollment application packets is:

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 conjunction with the HHSC Regulatory Services licensing process. New applicants must complete and submit Form 3684, Texas Medicaid Provider Enrollment Application, Attachment A, Application Fee Payment Form, and the Texas Medicaid application fee payment. These items must be included in the applicant's application packet for a license from HHSC. Other forms and documents must also be included in the application packet for a license 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

Application Fee for LTC Providers Enrolling Through HHSC

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 2017 is $560. The fee for calendar year 2018 is $569.00.

Payment must be made by check, money order or cashier's check. Do not send cash. Make check or money order payable to "HHSC." Enter "Medicaid Enrollment" on memo line of check. A Texas Medicaid provider enrollment application is applicable to 1 legal entity and 1 IRS tax ID number. An application fee is required for each application submitted.

An application fee is not required if the applicant already has paid the fee to Medicare or another state's Medicaid or CHIP program and has been approved for enrollment in Medicare or another state's Medicaid or CHIP program. Providers will be required to submit proof of enrollment in other programs to HHSC with submission of the enrollment application (see FAQ for LTC Applicants).

Frequently Asked Questions for LTC-only Applicants

What does HHSC Medicaid provider enrollment entail?

Enrollment includes submitting the appropriate Texas Medicaid provider enrollment application form, additional forms and documentation as required for contract enrollment or licensing, and the Texas Medicaid enrollment application fee. Receipt of a complete application packet and the application fee will initiate the provider screening process.

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 Serviceshas 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 CCS contract monitoring staff. A pre-enrollment site visit is required for unlicensed entities.

HHSC CSS leverages criminal history background checks performed by HHSC Regulatory Services licensing staff to comply with ACA fingerprint submission requirements for high risk providers.

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 for either your application to enroll in Medicare or your application for revalidation. Your Medicare enrollment term must be current. HHSC will also accept a receipt for payment from the PECOS system or a pay.gov email as proof of payment.