Corrective action plan: In December 2021, the Texas Health and Human Services Commission (HHSC)
implemented the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment Management System
(PEMS), an automated system that is the single tool for provider enrollment, re-enrollment, revalidat...
Corrective action plan: In December 2021, the Texas Health and Human Services Commission (HHSC)
implemented the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment Management System
(PEMS), an automated system that is the single tool for provider enrollment, re-enrollment, revalidation, and
maintenance requests (maintaining and updating provider enrollment record information).
Medicaid provider enrollment, revalidation, and re-enrollment documentation, including risk-based screenings, are
tracked in PEMS. Additionally, the relevant federal databases are checked at least monthly for all providers
currently enrolled in Medicaid.
HHSC continues efforts to enroll Medicaid providers, including LTC providers, through the PEMS. HHSC
continued to operate under the public health emergency (PHE) waiver through May 11, 2023. As a result of the
PHE end date and provider revalidation requirements, the projected end date for required revalidation of Medicaid
providers is January 11, 2027.
Of the Medicaid providers requested during the fiscal year 2024 Statewide Single Audit, the listed exceptions only
apply to two LTC providers. The PEMS automated disenrollment process for providers who did not complete their
revalidation was disabled during the PHE and had not yet been reenabled at the time these providers were due
for revalidation. Manual disenrollment batches occurred through July 2024 with approved disenrollment
exclusions based on a providers in-flight application, receipt of paid claims, and missing revalidation reminder
notifications.
The PEMS automatic disenrollment process was re-enabled in August 2024.
Implementation dates: December 2021, PEMS implementation (Implemented)
January 2027, provider enrollment and revalidation completed
Responsible persons: Jordan Nichols, Deputy Associate Commissioner, Medicaid and CHIP Services
Operations Management