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Correction to the Extension of Medicare Workaround for Nursing Facility Providers Notification

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Note: This message originally posted with an incorrect date. The effective date is September 1, 2025.

HHSC is rescinding guidance communicated in GovDelivery, “Update: Requirement for Medicaid Nursing Facilities to Enroll in Medicare Prior to Medicaid Enrollment”, to update the effective date of the policy guidance.

Effective September 1, 2025, the Texas Health and Human Services Commission (HHSC) will no longer accept letters from Medicare administrative contractors containing Medicare enrollment status updates as evidence of Medicare enrollment.

Applications submitted in the Provider Enrollment and Management System (PEMS) September 1, 2025, and forward will require evidence of Medicare enrollment prior to approving Medicaid enrollment.

As a reminder, Texas Administrative Code, Title 26, Rule section 554.101(136) defines a skilled nursing facility as, “A skilled nursing facility or distinct part of a facility that participates in the Medicare program.” Therefore, a nursing facility participating in Medicare in not eligible to select the option “long term care only” during the enrollment process.

Pursuant to 42 CFR Section 455.416(g)(1), the state Medicaid agency may terminate or deny a provider’s enrollment if the Centers for Medicare and Medicaid Services or the state Medicaid agency determines that a provider has falsified any information provided on the application.