Providers Must Disclose in PEMS Whether Their Practice Location Is Physically Accessible to People With Disabilities and If Their Practice Has a Website

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.

Effective November 22, 2024, and mandated by the Consolidated Appropriations Act (CAA), Section 5123, Texas Medicaid providers must disclose whether their practice location is physically accessible to people with disabilities and whether their practice has a website. This applies to all provider types and practice locations.

New fields will be added to the Provider Enrollment and Management System (PEMS) to capture this information. This is applicable for all PEMS request types, including new enrollment, revalidation, reenrollments, existing enrollments, and maintenance.

PEMS Updates

The following questions will be added to PEMS for providers to update their demographic information. To navigate to the questions in PEMS:

1. Enter a request type of PEMS Maintenance-Practice Location-Demographics.
2. Go to the Program Specific Questions section of the Programs and Services Participation Details sub-page.
3. Select one of the following questions:

• Is your practice location physically accessible to people with disabilities?
• Providers can choose Yes or No with a radio button to indicate whether the practice location is physically accessible.

Note: This does not apply to providers who ONLY perform their services through telehealth, telemedicine, and telemonitoring.

• Does your practice have a website?
• If the response is Yes, an additional field will appear to enter the website information. If the response is No, the additional field for entering website information will not be displayed.

Timeframe to Complete Demographic Update

After November 22, 2024, providers will be granted a grace period through June 30, 2025, to update their demographic information in PEMS. After this period, providers will only be able to update the information upon reenrollment or revalidation.

For instructions on updating demographic information, providers can refer to the PEMS Instructional Site and select Maintenance-Practice Location-Demographics.

Providers may refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Section 1: “Provider Enrollment and Responsibilities,” section 1.7, “Provider Responsibilities,” subsection 1.7.2.3, “Online Provider Lookup (OPL)” for additional information.

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