Volume XXXI, Number 4
Avoid Being Dis-enrolled from Medicaid
As a requirement of the Patient Protection and Affordable Care Act (“PPACA”), all Texas Medicaid providers, including ordering and referring providers, must revalidate their enrollment in the Texas Medicaid program if they initially enrolled before January 1, 2013. This applies to providers who participate in Medicaid managed care, traditional fee-for-service Medicaid (each active TPI Suffix), the Texas Vendor Drug Program, and in long-term care services administered through the Texas Department of Aging and Disability Services (DADS). Providers can re-enroll through the Texas Medicaid and Healthcare Partnership (TMHP) or through the Texas Health and Human Services Commission.
Medicaid providers are encouraged to submit Medicaid re-enrollment application on or before June 17, 2016. If your application is submitted after June 17, Texas Medicaid can’t guarantee that it will be processed and revalidated by the Sept. 24 deadline, which means you will be dis-enrolled from Texas Medicaid and suffer a gap in enrollment (and thus reimbursements) from September 25, 2016 to the date the application is finally approved.
To avoid potential disruption in payment, a complete re-enrollment application must be received on or before June 17, 2016 in order to be re-validated by September 24, 2016. Complete applications that are received on or before June 17, 2016, will most likely complete the re-enrollment process by September 24, 2016. In the event that the re-enrollment process is not completed by September 24, 2016, and the provider is still working toward addressing identified deficiencies at that time, the provider will continue to remain enrolled in Texas Medicaid as long as the provider continues to respond to deficiency notifications within the defined timeframe for response. Continued enrollment is contingent upon continuing to meet deficiency correction timelines and receiving final application approval.
Commitment to Care
If you have any questions about the THCA Commitment to Care Initiative or would like to share your facilities successes please contact Gloria Bean-Williams by email or call (512) 458-1257.
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