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Provider Enrollment on the Portal Instructions
Important: You must be enrolled in Traditional Medicaid before enrolling in CSHCN or Texas Health Steps. Select "Add to an Existing Enrollment," then click "Apply Filters" if you would like instructions for adding CSHCN or Texas Health Steps to your existing enrollment.
Page Filters
These pages will guide you through each stage of the enrollment process using PEP. To customize this page's content, use the filters below and click the Apply Filters button.

Application Type:

Program(s):

Enrolling As:

Disclosure of Ownership and Control Interest Statement (Continued)

Instructions for Completing the Disclosure of Ownership and Control Interest Statement (Continued).

Note: This page does not apply to Ordering and Referring Providers.

Note: This page does not apply to Performing Providers.

  • All providers must complete the Disclosure of Ownership and Control Interest Statement except for:
  • Performing providers who are joining a group that is already enrolled in Texas Medicaid.
  • Providers that are already enrolled in Texas Medicaid and are enrolling in Texas HealthSteps within one year of their TPI issue date.
  • SHARS providers.
  • Section IV.
    • Answer "Yes" or "No" to question (a) Has there been a change in ownerships or control within the last year?
    • If "Yes", provide the date.
    • Answer "Yes" or "No" to question (b) Are you seeking enrollment due to change of ownership?
    • Answer "Yes" or "No" to question (c) Do you anticipate any change of ownership or control within the year?
    • If "Yes", provide the date.
    • Answer "Yes" or "No" to question (d) Do you anticipate filing for bankruptcy within the year?
    • If "Yes", provide the date.
    • Answer "Yes" or "No" to question (e) Are any of the new owners related to any of the former owners?
    • Answer "Yes" or "No" to question (f) Did any former owners transfer their ownership interest to any new owners in anticipation of or following the assessment of a civil monetary penalty?
    • If "Yes", provide the former owner information
    • Last Name/Company Name
    • First Name
    • Middle Initial
    • TPI
    • Section V.
    • Answer "Yes" or "No" to question, Does the provider identified in section I. comprise or include a facility that is operated by a management company or a facility that is leased in whole or in part by another organization?
    • If "Yes", provide the date.
    • Section VI.
    • Answer "Yes" or "No" to question, Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?
    • Section VII.
    • Answer "Yes" or "No" to question, (a) Is the provider identified in section I. chain affiliated?
    • If "Yes", please provide the name, address, and EIN of the chain's corporate/home office.
    • Section VIII.
    • Answer "Yes" or "No" to question, Have you increased your bed capacity by 10 percent or more of by 10 beds, whichever is greater within the last two years?
    • If "Yes", provide year of change, current beds, and prior beds
    • Click Continue and Save.
     
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