Beginning December 14, 2019, Opioid Treatment Providers May Submit Texas Medicaid Enrollment Applications

Beginning December 14, 2019, Substance Abuse and Mental Health Services Administration certified (SAMHSA-certified) Opioid Treatment Programs (OTPs) who are licensed as Narcotic Treatment Programs may submit provider enrollment applications for Texas Medicaid through TMHP.

For all providers that desire to be eligible to receive payment from Medicare for opioid treatment services delivered to Medicare eligible clients, the OTP must be actively enrolled in Medicare. Upon submission of Medicare enrollment information through TMHP provider enrollment, a new provider identifier will be rendered. The provider identifier will be associated with the new provider type 14. This new provider type and identifier information will be included on the master provider file upon completion and will need to be accepted for processing of appropriate claims for related services. The bundled services payable to Medicare enrolled OTPs will be reimbursed fully by Medicare for the initial coverage period. Additional information is forthcoming on the claims processing and deductible payment for these providers and services.

Required Licenses and Certifications

The OTP must be licensed by the Health and Human Services Commission (HHSC) as a Narcotic Treatment Program. All OTPs must be actively enrolled in Medicare no later than their revalidation date. OTP enrollment requires a Principal Information Form (PIF-2) for a Medical Director who is actively licensed as a physician by the Texas Medical Board or the appropriate state board where services are rendered.

Enrollment in Texas Medicaid Using Provider Enrollment on the Portal

OTPs are encouraged to enroll on TMHP’s Provider Enrollment on the Portal. Provider Enrollment on the Portal (PEP) will be available for enrollment on December 14, 2019. A checkbox for the OTP provider type and the requirements for OTP will be added to PEP.

Online enrollment has the following advantages:

• Applications are validated immediately to ensure that all fields have been completed.

• Most of the application can be completed online so that only a few forms must be printed, completed, and mailed to TMHP.

• Applicants can view both incomplete and complete applications that have been submitted online.

• Providers can complete the Provider Information Change form online.

Using the Paper Texas Medicaid Enrollment Application

The paper Texas Medicaid Provider Enrollment Application for Facilities will include OTP beginning January 1, 2020. A checkbox for the OTP provider type and the requirements for OTP will be added to the updated version of the paper application.