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.
This is an update to the article titled “Skilled Nursing Facility Enrollment Screen Risk Category Updated January 1, 2023,” which was published on this website May 12, 2023.
The screen risk category has been revised for skilled nursing facility (SNF) providers that are submitting a change of ownership (CHOW) application, as defined in 42 Code of Federal Regulations (CFR) §489.18. SNFs that are submitting a CHOW application are subject to the same high risk screening requirements as newly enrolling high categorical risk providers.
The requirements are as follows:
- The provider must undergo a preenrollment site visit. The purpose of the site visit is to verify that the information submitted in the enrollment application is accurate and to determine compliance with federal and state requirements.
- Any individuals who have a 5% or greater direct or indirect ownership interest in the provider must submit proof of fingerprint-based criminal background checks (FCBCs). The provider will be sent a deficiency letter with specific directions and information required to schedule a fingerprinting appointment.
For more information, call the TMHP Contact Center at 800-925-9126.