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Texas Licensed Provider Out-of-State Enrollment Information for Telemedicine or Telehealth Services

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Texas licensed providers that offer telemedicine or telehealth services using an out-of-state practice address must have a designated office space where they provide services, and they must use that physical office address on the Texas Medicaid Provider Enrollment and Management System (PEMS) enrollment application.

Providers that render services through telemedicine or telehealth at a client’s home or at any other temporary venue selected by the client must designate, on the PEMS enrollment application, a physical address that reflects the place where client files and records are kept.

The following are examples of a physical address where client files and records may be kept:

  • An office location (office space where the provider works, even if client visits are held elsewhere)
  • The provider’s home address
  • The location of business headquarters, if records are stored electronically

If the physical address is outside the state of Texas, the provider must meet one of the following conditions:

  • The provider must include on the application the licensure issued by the state board that aligns with the physical office location.
  • The provider must be licensed within the state of Texas and confirm that services are primarily rendered at a client’s home.

If the provider is licensed in Texas and has an out-of-state practice address, the provider must do the following on the PEMS enrollment application:

  • Include a “dummy” segment for the out-of-state license using the “TELE” prefix and their Texas state license number
  • Indicate that they offer telemedicine or telehealth services
  • Attach a waiver statement to request a waiver of out-of-state licensure requirements, including the following declarations:
    • That services are being rendered through telemedicine or telehealth or at a client’s home
    • That the provider has an active Texas state license

For more information, call the TMHP Contact Center at 800-925-9126 or TMHP-CSHCN Services Contact Center at 800-568-2413.