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Update to “Beginning July 30, 2021, Licensed Behavior Analyst Providers Can Submit Texas Medicaid Enrollment Applications”

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Note: Texas Medicaid managed care organizations (MCOs) must follow all aspects of the Medicaid Autism Services Policy. MCOs must provide all medically necessary, Medicaid-covered services to eligible clients. Providers should contact the client's specific MCO for details.

This is an update to the article titled “Beginning July 30, 2021, Licensed Behavior Analyst Providers Can Submit Texas Medicaid Enrollment Applications,” which was posted on this website on July 13, 2021.

Licensed behavior analyst (LBA) provider enrollment in Texas Medicaid now includes group enrollment with LBAs as performing providers with groups. It continues to include individual LBA enrollment.

Enrollment in Texas Medicaid

Effective December 13, 2021, enrollment in Texas Medicaid is now done through the Provider Enrollment & Management System (PEMS):

  • PEMS has replaced Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS). PEP and PIMS are no longer available.
  • Paper applications for Texas Medicaid provider enrollment have been eliminated.
  • Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues.
  • Log on to the TMHP.com Provider Enrollment webpage to begin the online enrollment activities after December 13, 2021.

National Provider Identifier

Individual LBA providers and LBA performing providers with a group will be required to have an individual (Entity Type 1) National Provider Identifier (NPI) before enrolling in Texas Medicaid. Additionally, group providers will be required to have an organization (Entity Type 2) NPI before enrolling in Texas Medicaid.

Required Licenses and Certifications

To enroll in Texas Medicaid, individual LBAs and LBA performing providers with a group must be currently licensed in good standing as an LBA by the Texas Department of Licensing and Regulation (TDLR). Group applications will not be prompted to provide license information because groups are not licensed through the TDLR.

Refer to the Quick Reference Guide (QRG) for more details: LBA Enrollment in Texas Medicaid with TMHP.

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