Thanks in part to the Texas Medical Association’s efforts, the state’s Health and Human Services Commission (HHSC) has provided an extension for physicians due for revalidation between Dec. 13 and May 31 through Texas Medicaid & Health Partnership’s (TMHP’s) Provider Enrollment and Management System (PEMS).
While the extension grants an additional 180 days to physicians due for revalidation between those dates, TMA advises physicians who are due for revalidation over the next six months to file online with HHSC as soon as possible.
The association and four other statewide health care organizations sent HHSC Executive Commissioner Cecile Young a letter on Nov. 1, detailing myriad issues Texas physicians experience with Medicaid credentialing and revalidation.
“Since its deployment in December 2021, the flaws in [PEMS] have become widespread and severe,” the letter asserted. “Enrollment processes are time-consuming, cumbersome and confusing to even the most sophisticated practices and facilities. Administrative support is inadequate and is forced to focus on resolving issues on a case-by-case basis rather than addressing systemic failings which seem to be ubiquitous across every provider type.”
The letter acknowledged HHSC’s prior efforts to help physicians navigate PEMS, including instructional videos and town hall events, yet advocated for further change.
“Tackling individual cases, while helpful, does not address the comprehensive challenges that providers have in navigating PEMS complexities,” the co-signers continued. “We maintain the unreasonable delays in enrolling physicians and facility providers has jeopardized millions in payment for appropriately furnished care.”
For D. Maneesh Kumar, DO, a Houston pediatrician, frustrations with Medicaid have only accelerated from his initial enrollment in 2010 – an 18-month process involving repeated attempts to make HHSC-requested corrections, conflicting information from multiple staffers about what was required, and the eventual intervention of a supervisor.
“Resources utilized for these unnecessary bureaucracies are resources not applied to caring for patients,” Dr. Kumar said. With time and effort diverted from his practice’s physicians and staff to revalidating, “it again calls into question whether or not we can continue seeing Medicaid patients,” who comprise two-thirds of the practice’s patients.
“This is just going to be another reason why somebody doesn't want to hassle with Medicaid,” said Cynthia Peacock, MD, chair of TMA’s Committee on Medicaid, CHIP and the Uninsured and an associate professor at Baylor College of Medicine in Houston.
“The state Medicaid system needs a deep bench when it comes to providers,” Dr. Peacock noted, terming PEMS “antiquated” and its inherent challenges “another nail in the coffin when it comes to trying to keep physicians in their system.”
In addition to the extension, HHSC pledged to address Medicaid provider enrollment gaps between Nov. 1, 2023, and December 12, 2024, by retroactively enrolling physicians “that have been disenrolled for failing to revalidate timely ... [and] successfully reenroll in Texas Medicaid.”
TMA is also alerting Texas physicians to a new federal requirement, effective Nov. 22, requiring physicians with Medicaid patients to report whether practice locations are physically accessible to people with disabilities, and if they maintain a website.
HHSC added new fields to PEMS enabling the reporting now required by the Consolidated Appropriations Act, introduced in Congress by Rep. John Carter (R-Round Rock) in June 2023 and made law this past March.
“This is applicable for all PEMS request types, including new enrollment, revalidation, reenrollments, existing enrollments, and maintenance,” HHSC clarified. A TMHP notice on its website states that a request type of “PEMS maintenance-practice location-demographics” will allow users to navigate to the “program specific questions” section of the “programs and services participation details” sub-page and report.
HHSC has provided a grace period for those federally mandated updates through June 30, 2025; after that date, providers will only be able to update the information upon reenrollment or revalidation.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.