Skip to main content

MCO LTSS Providers: Important Information for MCO LTSS PEMS Revalidation and Reenrollment With Acute Care Taxonomies

Last updated on

A Managed Care Organization (MCO) Long-Term Services and Supports (LTSS) provider is one that provides MCO LTSS under a specific National Provider Identifier (NPI) and taxonomy combination that contracts with and submits claims through an MCO.

An MCO LTSS provider must enroll with the MCO LTSS program through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS).

Note: The Long-Term Care (LTC) Services program is not the same as the MCO LTSS program. Enrolling in LTC enables a provider to contract with the state but not with an MCO. In PEMS, “MCO LTSS” is referred to as “LTSS.”

In August 2022, the MCO LTSS taxonomy codes that included Acute Care Fee-for-Service (FFS) taxonomy codes were removed from the PEMS Taxonomy Code Crosswalk for MCO LTSS providers. The following articles provide the list of MCO LTSS–specific taxonomy codes available for enrollment:

Any MCO LTSS provider currently enrolled with a taxonomy code that is no longer available to MCO LTSS providers must add a comparable MCO LTSS taxonomy code and/or enroll that taxonomy code in the Acute Care FFS program during the revalidation process in PEMS.

Note: To avoid MCO payment gaps, providers can disenroll the MCO LTSS taxonomy that is no longer available and add the new taxonomy and program at the same time. Separate transactions for disenrolling and adding, which may result in gaps in service, are not necessary because the tasks can be completed through a single PEMS Revalidation or Existing Enrollment transaction. Additionally, notify your MCO of any change in program or taxonomy code.

MCO LTSS Taxonomy Code by Category

Providers must enroll with the correct program based on licensure type. The following table lists the most common MCO LTSS taxonomy codes and the appropriate PEMS programs, service types, and license requirements:

Taxonomy CodePEMS ProgramPEMS Service TypeTexas Health and Human Services Commission (HHSC) License Category of Service

251E00000X

253Z00000X
251J00000X

Acute Care FFS

Home health (with Medicare) and

home and community support services agencies (HCSSA) (non-Medicare)

Licensed and certified home health (with Medicare) or licensed home health (non-Medicare)
3747P1801XAcute Care FFSPersonal assistant servicesLicensed personal assistance services
251C00000XLTSSHabilitationAny HHSC license is acceptable.
261QA0600XLTSSAdult day care/day activity and health servicesDay activity health service
251G00000XLTSS

Hospice, palliative care—community

hospice

Hospice

310400000X

385H00000X

LTSSRespite care/assisted livingAssisted living facility

Enrollment and MCO Requirements by Provider Type

Enrollment requirements vary based on provider type. The following table lists which providers must enroll with Acute Care FFS, MCO LTSS, or LTC programs, and whether separate enrollment is required to contract with MCOs.

Provider TypeEnrollment Requirement

MCO Contract

Requirement

Home Health; HCSSA; Personal Assistance ServicesEnroll with Acute Care FFS onlyCan contract with or continue to work with their MCOs if enrolled with Acute Care FFS
Day Activity Health Service; Adult Day Care; Assisted Living FacilitiesEnroll with LTSS or LTC onlyMust enroll with LTSS prior to contracting or continuing to work with their MCOs. Establishing a state contract through LTC program enrollment does not allow for MCO contracting.
HospiceEnroll with LTSS or LTC onlyCan contract with or continue to work with their MCOs if enrolled with LTSS. Establishing a state contract through LTC program enrollment does not allow for MCO contracting.

For more information, call the TMHP Contact Center at 800-925-9126.