Note: All applicants seeking to obtain a contract must enroll in Texas Medicaid. Please visit the Texas Medicaid LTSS Provider Enrollment/Re-Enrollment website to view the enrollment requirements.

Medicaid Enrollment applications will not be processed until applicants pass the Provider Applicant test. Only applicants with approved HCS or TxHmL provider applications will be invited to attend the Provider Applicant Training to take the test.

Open Enrollment Process

The Texas Health and Human Services Commission accepts applications from applicants through its open enrollment process to contract for the Home and Community-Based Services Medicaid waiver program. Under the open enrollment process, HHSC awards contracts on a noncompetitive basis to eligible applicants meeting the qualifications and other requirements.

There is no deadline to submit an application packet for the HCS program. Applications can be submitted anytime year round.

HCS program provider applicants are required to:

  • Properly complete the application packet and include all required documents in accordance with HHSC instructions.
  • Once HHSC has preliminarily approved an application packet, applicants will be further required to complete the provider competency examination and the provider application training in accordance with Texas Administrative Code, Title 40, Part 1, Chapter 49, Subchapter B, Rule §49.204 (c).

Application Packet Information

Application packets must be sent to:

Regular mail:
HHSC
Contract Administration and Provider Monitoring
Mail Code W-359
P.O. Box 149030
Austin, TX 78714-9030

Overnight delivery:
HHSC
Contract Administration and Provider Monitoring
Mail Code W-359
701 West 51st St.
Austin, TX 78751

Note to all applicants: Please do not submit applications with stapled forms, within binders or with cover sheets.

Form 5873, HCS/TxHmL Waiver Program Application Packet Checklist, includes all required forms and documents of an application packet. Program provider applicants should use this as a guide and final checklist to ensure their application packets are complete.

Applicants should:

  • Read all instructions carefully.
  • Use the application packet checklist (Form 5873) as a guide.
  • Answer all the questions on each required form.
  • Have the signature authority —  the owner or authorized representative of the legal entity — sign and date each form. (An authorized representative is the person named on Form 2031, Governing Authority Resolution — Business Organization).
  • Have the applicable forms notarized.
  • Complete each required form accurately in accordance with HHSC instructions.
  • Not use correction tape or fluid. (If a mistake is made, mark through it with a single line and initial the change.)
  • Review the completed application packet.
  • Retain a copy of the completed application packet.

Read the Texas Administrative Code, Title 40, Part 1, Chapter 49, Subchapter B, §49.203 as it relates to the provisional contract application process.

Required Forms

Required Documents

The following documents must be completed and submitted with the application packet in accordance with HHSC instructions:

  • A copy of National Provider Identifier verification email or letter
  • A copy of the Employer Identification Number (EIN) (IRS Form CP-575 or Letter 147c)
  • The program manager's resume.
    • As indicated in Section 7b of Form 3681, this individual must attend the provider competency examination and receive a score of at least 85 percent.
    • The resume must reflect:
      • At least three years paid work experience in planning and providing HCS Program services to a person with an intellectual disability or related condition, verified in writing by their person's employer
        OR
      • Have both:
        1. At least three years of experience planning and providing services similar to HCS Program services to a person with an intellectual disability or related condition, verified in writing from organizations or agencies that provided services to the person; and
        2. Participation as a member of a microboard, verified in writing by:
          1. The certificate of formation of the non-profit corporation under which the microboard operates filed with the Texas Secretary of State.
          2. The bylaws of the non-profit corporation.
          3. A statement by the board of directors of the non-profit corporation that the person is a member of the microboard.
      • Places of employment.
      • Month and year of employment.
  • Three letters of reference for the program manager.
    • Each reference letter must:
      • Attest to the following:
        1. At least three years of experience planning and providing services similar to HCS Program services to a person with an intellectual disability or related condition as verified by written statements from organizations or agencies that provided services to the person
          OR
        2. Participation as a member of a microboard, verified in writing by:
          1. The certificate of formation of the non-profit corporation under which the microboard operates filed with the Texas Secretary of State;
          2. The bylaws of the non-profit corporation; and
          3. A statement by the board of directors of the non-profit corporation that the person is a member of the microboard.
      • Be signed.
      • Be verifiable by address or phone number.
  • Copies of receipts for criminal history records requests must be submitted for all required individuals.
  • Copy of Assumed Name Certificate, if applicable.

Required Legal Entity Documents

  • Sole proprietor
    • Copy of signed Social Security card
    • Copy of driver's license, state-issued identification card or U.S. passport
    • Certificate of assumed business name filed with the county
  • Corporation
    • Certificate of formation filed with the Secretary of State
    • Articles of incorporation
    • Bylaws if applicable
    • Any certificates of amendments to original filing
    • Certificate of assumed business name filed with the Secretary of State
  • A certificate of registration, filed with the Secretary of State, is also required for foreign entities.

  • Limited partnership
    • Certificate of formation filed with the Secretary of State
    • Limited partnership agreement or regulations of limited partnership
    • Any certificates of amendments to original filing
    • Certificate of assumed business name filed with the Secretary of State
    • Copy of each partner's Social Security card
    • Copy of each partner's driver's license, state-issued identification card or U.S. passport
  • A certificate of registration, filed with the Secretary of State, is also required for foreign entities.

  • General partnership
    • General partnership agreement
    • Any amendments to the general partnership agreement
    • Certificate of assumed business name filed with the Secretary of State
    • Copy of each partner's Social Security card
    • Copy of each partner's driver's license, state-issued identification card or U.S. passport
  • Limited liability company
    • Certificate of formation from the Secretary of State
    • Articles of organization
    • Any certificates of amendments to original filing
    • Certificate of registration (if not formed in Texas, authority to transact business in Texas) as filed with the Secretary of State
    • Certificate of assumed business name, filed with the Secretary of State

Criminal History Records Requests

HHSC requires an HCS provider program applicant to submit criminal history record information in accordance with 42 Code of the Federal Regulations §455.106. To comply with this requirement, HHSC must receive criminal history record information from the Texas Department of Public Safety for each person described below.

Program provider applicants must disclose criminal history record information for all people with an ownership or control interest. A person with an ownership or control interest means a person or corporation who:

  1. Has direct or indirect ownership interest equal to or totaling 5 percent or more in the disclosing entity;
  2. Has a combination of direct and indirect ownership interests equal to 5 percent or more in the disclosing entity;
  3. Owns an interest of 5 percent or more in any mortgage, deed of trust, note or other obligation secured by the disclosing entity if that interest equals at least 5 percent of the value of the property or assets of the disclosing entity;
  4. Is an agent, officer, director or managing employee of an applicant that is organized as a corporation; or
  5. Is an agent, officer, director or managing employee of an applicant that is organized as partnership.
    • An "agent" is defined as someone who has been delegated the authority to obligate or act on behalf of an applicant.
    • A "managing employee" or "director" is defined as a general manager, business manager, administrator, director, program manager or someone who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of the disclosing entity.
    • An "officer" is defined as someone who is a member of the disclosing entity's board of directors such as the president, secretary, treasurer or board member.

DPS has an exclusive contract with MorphoTrust USA to provide statewide electronic fingerprinting for criminal history record requests. Applicants must go to a Fingerprint Applicant Services of Texas location operated by IdentoGO to complete their criminal history record request. When scheduling an appointment, use Service Code 11FT12 for a state history check and make sure results are sent to the address below.

  • Call 888-467-2080 to schedule an appointment.
  • Visit https://uenroll.identogo.com/ to schedule online.
  • Have results sent to:
    HHSC
    ATTN: Daile Stout
    Mail Code W-359
    P.O. Box 149030
    Austin, Texas 78714

Note: The cost of this service is $10 plus a $15 fee for the criminal history. In addition, DPS will not expedite last minute requests for criminal history record information. Once results are in, FAST will electronically send the results to DPS, which will send them to HHSC.

HHSC may require an applicant to provide additional information regarding the certification of criminal history information. Furthermore, HHSC may deny a contract application packet based on:

  • The results of the criminal history record information submitted.
  • An applicant's failure to comply with the requirements.

Per federal statute, DPS must capture and retain prior conviction information for fingerprint applicants. Applicants using FAST will be asked if they have been convicted of a crime. If the applicant answers yes, they must list the details of each conviction when scheduling a FAST fingerprint appointment. This information helps ensure all criminal history record information stored is complete and accurate.

Note: HHSC, at its discretion, may deny an application if the applicant or any person with an ownership or control interest in the applicant, or an agent or managing employee of the applicant has been convicted of any criminal offense listed in the Texas Administrative Code §49.206.

How Out-of-State Applicants Submit Criminal History Records

  1. Go to http://www.dps.texas.gov.
  2. Click on "Crime Records" on right side of webpage.
  3. Click on “Fingerprints Submitted by Mail Through MorphoTrust.”
  4. Scroll down to "Alternate Option: Fingerprint Cards Submitted by Mail."
  5. Choose to pre-enroll your hard fingerprint card submission either on-line or by telephone.
  6. You will be required to provide the Designated Recipient of your criminal history check. All requests should be sent to HHSC, not to the person being fingerprinted. Provide the following information:
    1. Designated Recipient Name: “HHSC ATTN: Daile Stout Mail Code W-359.”
    2. Do not check "Use My Address" if pre-enrolling on-line.
    3. Country name is “United States.”
    4. Address Line 1 is “P.O. Box 149030.”
    5. City is “Austin.”
    6. Postal code is “78714-9030.”
  7. If you are asked to provide an "ORI," please respond "txireview."
  8. Complete Steps 2 and 3. Scroll down to view and print Personal Review Service Code Form.

National Provider Identifier

The Health Insurance Portability and Accountability Act of 1996 requires that each health care entity use an assigned National Provider Identifiers on standard health care transactions. As of Dec. 1, 2006, HHSC has required all health care entities applying to contract with HHSC to obtain and report their NPI in order to comply with this HIPAA requirement.

An applicant must submit an NPI assignment letter or an email from the National Plan and Provider Enumeration System to HHSC verifying the NPI that corresponds with the legal entity of the applicant. The NPPES verification must be submitted to HHSC along with the application packet.

The NPI is a nationally recognized ten-digit number that is used to identify healthcare providers when conducting standard transactions with multiple health plans. The National Plan and Provider Enumeration System issues an NPI at the direction of the Centers for Medicare and Medicaid Services. HIPAA requires all healthcare providers to apply for an NPI. A healthcare provider is someone who provides health care services. An example of health care services includes professional therapies, nursing services, dental or physician services. An NPI is not automatically assigned: there is an application process.

The NPI application process

  • The online application and instructions are available at: NPI online application.
  • The application is available for download at: Download NPI application.
  • Taxonomy codes are available online at NPI taxonomy codes. The taxonomy codes for the majority of HHSC providers are found in the non-individual section of the health care provider taxonomy guide. Select the taxonomy that best describes your business.
  • For application help please visit: Help with the NPI application

Questions?

Call 512-438-3234, or for a quicker response, email
IDDWaiverContractEnrollment@hhsc.state.tx.us.