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Update to HTW Provider Types and Provider Specialties Effective November 1, 2021

Last updated on 10/28/2021

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after November 1, 2021, to align more closely with the intent and scope of the Healthy Texas Women (HTW) program, some provider types and provider specialties will no longer be eligible to enroll as HTW providers and will no longer be reimbursed because the services they provide are not covered under the HTW program.

The following provider types and provider specialties will no longer be eligible to enroll as HTW providers and will no longer be reimbursed for HTW services:

Provider Type

Provider Specialty

Case Management

Maternity Service Clinic/CPM CM

SHARS

Multispecialty Clinic

Physician (D.O.) and Physician (M.D.)

Allergy

Physician (D.O.) and Physician (M.D.)

Otorhinolaryngology (E.N.T.)

Physician (D.O.) and Physician (M.D.)

Dermatology

Physician (D.O.) and Physician (M.D.)

Neurology

Physician (D.O.) and Physician (M.D.)

Neurosurgery

Physician (D.O.)

E.E.N.T. (D.O.)

Physician (D.O.) and Physician (M.D.)

Ophthalmology

Physician (D.O.) and Physician (M.D.)

Orthopedic Surgery

Physician (D.O.) and Physician (M.D.)

Plastic Surgery

Physician (D.O.) and Physician (M.D.)

Radiation Therapy

Physician (D.O.) and Physician (M.D.)

Thoracic Surgery

Physician (D.O.) and Physician (M.D.)

Geriatrics

Physician (D.O.) and Physician (M.D.)

Nephrology

Physician (D.O.) and Physician (M.D.)

Hand Surgery

Dentist

Dentists/Orthodontists

Podiatrist

Podiatry

Certified Nurse Midwife/Registered Nurse/Licensed Midwife

Licensed Midwife

Audiologist

Audiologist

Medical Supplier (DME); LMSW-ACP

In-Home Hyperalimentation Supplies

Medical Supplier (DME); LMSW-ACP

Specialized Custom Wheeled Mobility

Radiation Treatment Centers

Radiation Treatment Center

CCP Provider

CCP Provider (WIC-Immunizations Only, Milk Donor)

CCP Provider

Speech Therapy (CCP)

CCP Provider

Registered Nurse (CCP)

CCP Provider

Licensed Vocational Nurse (CCP)

Birthing Center

Birthing Center

Hyperalimentation

In-Home Hyperalimentation Supplies

Indian Health Services

Dentists/Orthodontists (D.M.D., D.D.S.)

Nephrology (Hemodialysis, Renal Dialysis)

Nephrology

Nephrology (Hemodialysis, Renal Dialysis)

Freestanding Renal Dialysis Facility

Renal Dialysis Facility

Nephrology

Renal Dialysis Facility

Hospital – Long Term or Specialized Care

Optometric Group

Optometrist

Podiatry Group

Podiatry

Dentist Group

Dentists/Orthodontists

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