Skip to main content

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

Rural Emergency Hospital New Provider Type Coming Soon to PEMS

Last updated on

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.

Beginning June 3, 2024, Centers for Medicare & Medicaid Services (CMS)-designated rural emergency hospitals (REHs) may enroll in Texas Medicaid to provide outpatient services. 

For more information, providers may refer to CMS guidance for REHs at Rural Emergency Hospitals | CMS.

The new REH provider type will be available in the Provider Enrollment and Management System (PEMS) to allow providers to complete new enrollment, revalidation, reenrollments, and existing enrollments for designated REH providers.

Providers can refer to the PEMS Instructional Site for additional guidance on completing their enrollment.

Providers will be notified on the TMHP website regarding REH benefits, corresponding reimbursement rates, and claims filing. New benefits that are adopted by Texas Medicaid must complete the rate hearing process to receive a public comment on proposed Texas Medicaid reimbursement rates. Rates are pending until the Texas Health and Human Services (HHSC) rate hearing is held.

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