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Texas Medicaid and CHIP

Overview

Managed care initiatives

Learn about the new managed care expansion.

Enroll as a Medicaid provider, submit fee-for-service claims, and more at Texas Medicaid and Healthcare Partnership.

Texas Medicaid/CHIP Vendor Drug Program

The Texas Medicaid/CHIP Vendor Drug Program (VDP) provides services for over 4,000 Texas pharmacies.

Medicaid and the Children’s Health Insurance Program (CHIP) provide medical coverage for more than 4 million low-income Texans.

The programs cover half of all children in the state and help provide care for two-thirds of people in nursing homes. In Texas, all CHIP services and most Medicaid services are delivered through managed care health plans under contract with the state.

News

TMHP Contract Changes, Services Continue

HHSC is making a change in the Texas Medicaid & Healthcare Partnership (TMHP) contract. The change affects the businesses working on the contract, but it does not affect the Medicaid and CHIP consumers and providers who rely on services provided by TMHP. Claims payments, prior authorizations, provider enrollment and other TMHP functions will continue as usual without disruption. All claims and other business sent to TMHP before this change will continue to be processed by TMHP staff, and payments and decisions will remain on the same schedule.

Nursing Home Transition to STAR+PLUS Moved to 2015

To allow more time to address stakeholder concerns, HHSC has postponed moving nursing facility residents into STAR+PLUS Medicaid managed care to March 1, 2015. HHSC will continue working with stakeholders to ensure a successful transition. HHSC is hosting a series of information sessions on several Medicaid managed care initiatives. Visit the Medicaid Managed Care Initiatives page for more information, including frequently asked questions, timelines and maps.

ACA PCP Rate Increase Payment Increase Payment

The Affordable Care Act provides a rate increase for certain primary care Medicaid services in 2013 and 2014.  Texas is issuing quarterly supplemental payments to providers to cover the difference between the regular Medicaid rate for the service and the temporary increase.
To get the rate increase payments, physicians must meet one of these standards:

  1. Be board certified in family medicine, general internal medicine, pediatric medicine or a subspecialists within those designations as recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties.

    Or
  2. Have 60 percent of their Medicaid billings for the prior year from the Evaluation and Management (E&M) codes specified in federal regulation.  Services eligible for the rate increase are E&M codes 99201 through 99499, and services related to the Administration of Vaccines (90465, 90466, 90467, 90468, 90471, 90472, 90473 and 90474).

To get the rate increase payments, providers must complete this form: Texas Medicaid Attestation for ACA Primary Care Services Rate Increase Form (PDF)

Those who complete the form after April 1 will get the rate increase payments only for services provided from the date they complete the form.

ACA PCP Rate Increase Frequently Asked Questions

For a list of providers whose forms have been received through October 16, 2013, please review: Providers With Attestation Forms on File (PDF). Physicians who submitted an attestation form, but whose name is not on the list or information is incorrect, should contact TMHP at ACARateForm@tmhp.com