How to Become a TxHmL Provider

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Note: An applicant seeking to obtain a contract must enroll in Texas Medicaid. Please visit the Medicaid Provider Enrollment web page to view the enrollment requirements.

Open Enrollment Process

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

Applications for TxHmL can be submitted year round with no deadline. TxHmL program provider applicants must 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 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

    Applications 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 in 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 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 person 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 TxHmL Program services to a person with an intellectual disability or related condition, verified in writing by their employer
          OR
        • Have both:
          1. At least three years of experience planning and providing services similar to TxHmL 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
          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 TxHmL 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.
          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 people with an ownership or control interest, as listed in the Criminal History Records Request section.
    • 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

    A certificate of registration, filed with the Secretary of State, is also required for foreign entities.

    • 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

    A certificate of registration, filed with the Secretary of State, is also required for foreign entities.

    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 health-care 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 health-care providers to apply for an NPI. A health-care 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 the NPI application.
    • Taxonomy codes are available online at 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.