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, revalidatio...
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).
Children’s Health Insurance Program (CHIP) 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 CHIP.
Of the CHIP providers requested during the fiscal year 2023 Statewide Single Audit, 59 of 60 samples had been
enrolled or revalidated through PEMS and the auditor received all requested documentation. The listed
exceptions only apply to one CHIP provider. The provider enrolled with CHIP before the implementation of PEMS.
HHSC operated under the public health emergency (PHE) between March 30, 2020, and May 11, 2023. In
response to the public health emergency (PHE), the Centers for Medicare and Medicaid Services waived
exclusion check requirements for provider reenrollments and revalidations. HHSC is in the process of revalidating
providers through PEMS; however, as a result of the PHE end date and provider revalidation requirements, the
projected completion date for the required revalidation of all CHIP providers is January 2027.
HHSC continues efforts to enroll CHIP providers through PEMS and expects to eliminate errors related to these
documents once all CHIP providers have revalidated.
Implementation dates: December 2021, PEMS implementation
January 2027, provider enrollment and revalidation completed
Responsible persons: Jordan Nichols, Deputy Associate Commissioner, Medicaid and CHIP Services
Operations Management