Beginning May 1, 2020, Medicare-Enrolled Speech-Language Pathologists May Apply to Enroll as Texas Medicaid Providers

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client’s specific MCO for details.

Beginning May 1, 2020, Medicare-enrolled speech-language pathologists (SLPs) may apply to enroll as Texas Medicaid providers through TMHP. After enrollment, each SLP will be assigned a new SLP provider identifier; this will enable SLPs to bill for services to clients of all ages, including those who are Medicare-Medicaid dual eligible.

Important: SLPs assigned the new provider identifier will not be eligible to bill for services until June 1, 2020.

Prior to this change, SLPs could only enroll as Comprehensive Care Program (CCP) providers and bill for services to clients who are 20 years of age and younger.

Reminder: For clients 21 years of age and older, SLP services will not be reimbursed when delivered in the home setting.

Once the SLP is enrolled under this new option, the new SLP provider identifier will be used for all future Medicaid claims for all clients. SLPs who are Medicarecertified and currently enrolled as CCP providers must submit a new Medicaid enrollment application to obtain the new SLP provider identifier if they wish to provide services to clients outside of CCP.

SLPs currently enrolled as CCP providers who do not wish to provide services to clients outside of CCP are not required to submit a new Medicaid enrollment application.

Provider Enrollment on the Portal (PEP) will be available for SLP enrollment on May 1, 2020.

A checkbox for the SLP provider type and the requirements for SLP will be added to PEP.

Required Licenses

The SLP must have a license from the State Board of Examiners for Speech-Language Pathology and Audiology or the appropriate state board for the state in which services are rendered.

The SLP must be actively enrolled in Medicare.

Note: Speech-language pathology interns and assistants are not eligible for enrollment.

Enrollment in Texas Medicaid Using Provider Enrollment on the Portal

SLPs are encouraged to enroll through 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; only a few forms must be printed, completed, and mailed to TMHP.
  • Applicants can view incomplete and complete applications that have been submitted online.
  • Providers can complete the Provider Information Change form online.

Texas Medicaid Enrollment Applications

Effective May 1, 2020, the paper Texas Medicaid Provider Enrollment Applications and Instructions for Groups, Performing Providers, and Individuals for Traditional Services will include SLP.

A checkbox for the SLP provider type and the requirements for SLP will be added to the updated versions of the paper applications.

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

You can find the full announcement here.