Corrective action plan: In December 2021, 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 upda...
Corrective action plan: In December 2021, 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.
Of the Medicaid providers requested during the fiscal year 2023 Statewide Single Audit, 47 of 60 samples had
been enrolled or revalidated through PEMS and the auditor received all requested documentation. The listed
exceptions only apply to Medicaid long-term care (LTC) providers whose enrollment and/or revalidation have not
yet been processed through PEMS. The LTC enrollment and revalidation process mirrors the sampled acute care
providers which were found to be 100 percent compliant during this review, further supporting that the process is
working.
HHSC operated under the public health emergency (PHE) between March 30, 2020, and May 11, 2023. In
response to the 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 LTC providers is January 2027.
HHSC continues efforts to enroll LTC providers through PEMS and expects to eliminate errors related to these
documents once all LTC providers have revalidated.
Implementation dates: December 2021, PEMS implementation
January 2027, LTC provider enrollment and revalidation completed
Responsible persons: Jordan Nichols, Deputy Associate Commissioner, Medicaid and CHIP Services
Operations Management