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MCO Long-Term Services and Supports Providers: PEMS Enrollment and Taxonomies

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A managed care organization (MCO) Long-Term Services and Supports (LTSS) provider is any provider that provides LTSS under a specific National Provider Identifier (NPI) and taxonomy combination and submits claims through Medicaid Managed Care. An MCO-LTSS provider must enroll with the LTSS program through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS) when the NPI and taxonomy combination that they bill LTSS with does not have an active enrollment record in PEMS for the Acute Care program.

In August 2022, taxonomy codes that were available for Acute Care program enrollment were removed from the PEMS Taxonomy Code Crosswalk for LTSS providers. The following articles provide the list of LTSS-only taxonomy codes available for enrollment:

Any MCO-LTSS provider currently enrolled with a taxonomy that is no longer available to MCO-LTSS providers must add the correct MCO-LTSS taxonomy to their PEMS enrollment.

Note: To avoid MCO payment gaps, it is recommended that providers disenroll the previous MCO-LTSS taxonomy and add the new taxonomy at the same time. Separate transactions are not necessary as this can be done through a single PEMS Revalidation or Existing Enrollment transaction.

Providers must enroll with the correct program based on licensure type and category of service. The following table lists the most common MCO taxonomy codes for the appropriate PEMS programs, service types, and license requirements:

Taxonomy Code(s)PEMS Program(s)PEMS Service Type(s)HHSC License Category of Service
251E00000X
253Z00000X
251J00000X
Acute Care-Fee-for-Service

Home health (with Medicare)

Home and community support services agencies (HCSSA) (non-Medicare)

Licensed and certified home health (with Medicare) 
or
licensed home health (non-Medicare)
3747P1801XAcute Care-Fee-for-ServicePersonal assistant servicesLicensed personal assistance services
251C00000XLong-Term Services and SupportsHabilitationAny HHSC license is acceptable
261QA0600XLong-Term Services and SupportsAdult day care/day activity and health servicesDay activity health service
251G00000X

Long-Term Services and Supports

Children with Special Health Care Needs Services Program

Hospice, palliative care – community

Hospice

Hospice

310400000X

385H00000X

Long-Term Services and SupportsRespite care/assisted livingAssisted living facility

What Does This Mean for MCO Participation?

Licensed and certified home health and licensed personal assistance services providers that enroll with Acute Care-Fee-for-Service do not need to enroll with LTSS separately. If enrolled with Acute Care-Fee-for-Service as home health, HCSSA, or personal assistant services, providers can contract with or continue to work with their MCOs.

Licensed day activity health service, adult day care, and licensed assisted living facilities providers enroll with MCO-LTSS or Long-Term Care (LTC) only. These providers must enroll with MCO-LTSS prior to contracting or continuing to work with their MCOs. The establishment of a state contract through LTC program enrollment does not allow for MCO contracting.

Licensed hospice providers that enroll with the Children with Special Health Care Needs (CSHCN) Services Program do not need to enroll with MCO-LTSS separately. However, if they are not a children’s hospice, they should enroll with MCO-LTSS only. If enrolled with the CSHCN Services Program, hospice providers can contract with or continue to work with their MCOs.

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