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Reminder: Providers Must Enroll in Medicare Before Medicaid Enrollment

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Providers that are enrolling in Texas Medicaid must first enroll in Medicare if they provide services to Medicare beneficiaries. This requirement applies to new enrollments, revalidations, and updates to existing enrollments in the Provider Enrollment and Management System (PEMS).

PEMS Update

When providers are completing the Program Specific Questions page in PEMS, those that select No to answer the question, "Are you using a Medicare certification number for this location?" will now see the following warning message:

As described in Texas Administrative Code, Title 1, Part 15, Section 352.13, Medicare Certification or Enrollment in Medicare, HHSC requires all Medicaid providers to be enrolled in Medicare or certified by Medicare (if applicable) prior to submitting a Medicaid enrollment application. Pursuant to Texas Administrative Code, Title 1, Part 15, Section 371.1703(c)(4), a Medicaid provider’s enrollment contract may be denied or terminated if the HHSC Office of Inspector General determines that a provider has falsified any information provided on the application.

If a provider selects No and later provides Medicare services without prior Medicare enrollment, they may be subject to penalties, including termination from Texas Medicaid, as outlined in 42 CFR Section 455.416(g)(1).

Action Required

Providers should verify their Medicare enrollment status before completing their Medicaid enrollment in PEMS. If a provider delivers services to Medicare beneficiaries, they must obtain a Medicare ID and update their PEMS record accordingly.

For more information, providers can refer to the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment web page or call the TMHP Contact Center at 800-925-9126.