Note: The Health and Human Services Commission (HHSC) has requested that TMHP publish the following information:
Starting April 1, 2021, Texas Medicaid & Healthcare Partnership (TMHP) will take over all Vendor Drug Program (VDP) pharmacy enrollment operations following the launch of the Provider Enrollment and Management System (PEMS). The system will automate and streamline the provider enrollment process for new enrollment, re-enrollment, revalidation, and ownership change.
On April 1, 2021, all pharmacy providers will use PEMS to enroll, re-enroll, and revalidate in Texas Medicaid.
Though federal law requires all providers to revalidate their Medicaid enrollment at least every five years, the Centers for Medicare & Medicaid Services (CMS) provided extensions to the revalidation date due to the public health emergency. TMHP will contact pharmacies 120 days before their enrollment end date with the CMS revalidation flexibility. Refer to the CMS guidance titled, “Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency,” to learn more.
VDP will extend pharmacies with revalidation dates between January 1, 2021, and February 28, 2021, by six months. VDP will continue to accept and process new applications until TMHP takes over pharmacy enrollment operations via the PEMS system starting April 1, 2021.
What to do now
Pharmacy staff must create an online account as soon as possible to prepare for the automated system. The online account will allow providers to access and utilize PEMS.
PEMS will be a single tool for enrollment, re-enrollment, revalidation, and file maintenance requests. HHSC will continue to administer claims and payment functions.
For further support with PEMS, contact the TMHP Contact Center at 800-925-9126, or refer to the TMHP website for information on how to create a portal account.
What to do in the coming weeks
Beginning in March 2021, TMHP will provide training on the new PEMS system. VDP and TMHP will announce training opportunities once finalized.
VDP and TMHP will communicate with pharmacies via fax, email, and updates to the VDP and TMHP websites regarding revalidation due dates based on state and federal flexibilities.
Failure to complete the revalidation process by the enrollment end date may result in disenrollment and a loss of eligibility to receive Medicaid reimbursement. Providers may use the new PEMS system to complete their revalidation during the public health emergency. All revalidations and other enrollment actions will occur in PEMS starting April 1, 2021.
For pharmacy enrollment support not related to PEMS, email firstname.lastname@example.org or call the HHSC Pharmacy Benefits Access Help Desk at 1-800-435-4165 and ask for the pharmacy enrollment section.