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Revision to “MCO LTSS Providers: Important Information for MCO LTSS PEMS Revalidation and Reenrollment With Acute Care Taxonomies”

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This is a revision to the article titled MCO LTSS Providers: Important Information for MCO LTSS PEMS Revalidation and Reenrollment With Acute Care Taxonomies, which was published on this website on May 1, 2025. The revised language clarifies information provided in the previous article.

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.

MCO LTSS providers must enroll through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS). MCO LTSS refers to the delivery of long-term services and supports through capitated Medicaid-managed care programs. In PEMS, this is labeled Long-Term Services and Supports. When enrolling, providers should select LTSS in PEMS. The LTSS enrollment is not dependent on a separate enrollment type such as Acute Care Fee-For-Service (FFS).

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 August 2022, the MCO LTSS taxonomy codes that included Acute Care 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:

Providers currently enrolled under the LTSS program in PEMS must:

  • Review their enrolled taxonomies in the LTSS taxonomy crosswalk.
  • Remove any taxonomies that do not exist in the crosswalk.
  • Add the equivalent taxonomies under their LTSS enrollment record in PEMS.

During the provider revalidation process in PEMS, providers can add the removed taxonomies to their Acute Care FFS program enrollment record, if applicable.

Note: To avoid MCO payment gaps, providers should disenroll the outdated MCO LTSS taxonomy and add the new taxonomy and program within the same PEMS revalidation or reenrollment transaction. Submitting separate transactions to disenroll and update taxonomy may result in gaps in service. Additionally, providers must notify their MCO of any change in program or taxonomy code.

MCO LTSS Taxonomy Code by Category

The most common MCO LTSS taxonomy codes, the appropriate program to select in PEMS for enrollment for each code, the associated service types, and the corresponding license requirements are as follows:

Note: This is not an exhaustive list.

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

251E00000X

253Z00000X

251J00000X

Acute Care FFSHome 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
251G00000XLTSSHospice, palliative care—community hospiceHospice

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.