Texas - Assistive Technology Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Texas Health and Human Services (HHSC) authorizes Assistive Technology Services through multiple Medicaid 1915(c) waivers, including Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Community Living Assistance and Support Services (CLASS), as well as 1115 managed care programs like STAR+PLUS. The service funds evaluations, specialized devices, and training to help individuals with disabilities increase their functional independence and reduce reliance on paid caregivers.

Texas does not issue a standalone license or direct Medicaid enrollment category for assistive technology providers. Entities seeking to bill Medicaid for these services must either complete the HHSC open enrollment process to become a comprehensive waiver program provider or secure subcontracts as a vendor under existing HCS/TxHmL providers and STAR+PLUS Managed Care Organizations (MCOs).

1. Service Definition and Scope

Assistive Technology Services in Texas encompass three main components: professional evaluations to determine the appropriate equipment, the purchase or lease of the devices themselves, and training for the individual or their caregivers on how to use the technology effectively.

The state imposes strict delivery parameters on how these services are conducted, particularly regarding staff-to-client ratios and the sequence of assessments required before high-tech items can be procured.

• Service Components: Evaluation, device acquisition, and training that meet the individual's independent living goals.
• Device Definition: Follows the federal definition of an assistive technology device outlined in 34 CFR §300.5.
• Evaluation Ratio: Assistive technology evaluations must be conducted one-on-one, with one evaluator assigned for each person.
• Training Ratio: For conducting group training on assistive technology, the staff-to-person ratio may not exceed one staff member to three people (1:3).
• High-Tech Assessments: High-tech items require an assessment from a rehabilitation professional prior to purchase, whereas low- or mid-tech items can often be purchased off the shelf.
• Exclusions: Services cannot duplicate items or therapies available through the Medicaid State Plan, Medicare, or the Texas Workforce Commission.

2. Regulatory and Oversight Agencies

The Texas Health and Human Services Commission (HHSC) is the primary operating agency for Medicaid waivers, responsible for setting service standards, certifying comprehensive providers, and managing open enrollment contracts.

Texas Medicaid & Healthcare Partnership (TMHP) acts as the state's Medicaid claims administrator and manages the centralized provider enrollment portal.

• Texas Health and Human Services Commission (HHSC): Administers waiver programs, sets assistive technology rules, and manages provider contracts (https://www.hhs.texas.gov).
• Texas Medicaid & Healthcare Partnership (TMHP): Processes Medicaid enrollment applications and manages the claims system (https://www.tmhp.com).
• HHSC Contract Administration and Provider Monitoring (CAPM): Reviews open enrollment applications for HCS and TxHmL waiver contracts (https://www.hhs.texas.gov/providers/long-term-care-providers/home-community-based-services-hcs/how-become-hcs-provider).
• Managed Care Organizations (MCOs): Oversee assistive technology delivery, prior authorizations, and vendor credentialing for the STAR+PLUS and STAR Kids programs (https://www.hhs.texas.gov/services/health/medicaid-chip/provider-information/managed-care-organization-mco-information).

3. Gatekeeping Prerequisites: Who Can Even Apply

Because Texas does not recognize "Assistive Technology Provider" as a standalone Medicaid enrollment type, applicants face a structural precondition: they must either become a comprehensive waiver provider or operate as a subcontractor.

Entities choosing to become comprehensive HCS or TxHmL providers must pass specific state training and competency exams before their contract application will even be reviewed.

• Structural Precondition: Texas does not enroll standalone assistive technology providers directly into Medicaid; applicants must either become a comprehensive waiver provider (e.g., HCS) or subcontract as a vendor.
• Vendor Subcontracting: Standalone AT vendors must secure contracts with existing HCS/TxHmL program providers or STAR+PLUS MCOs to receive payment.
• Provider Applicant Training (PAT): HCS/TxHmL comprehensive provider applicants must complete an online PAT course and pass an in-person competency exam per 26 TAC §52.31 before applying.
• Medicaid Enrollment Prerequisite: Contract applicants must successfully enroll in Texas Medicaid via the TMHP portal before HHSC will execute a waiver contract.

4. Licensure and Certification Requirements

Texas does not require a specific state license to sell or evaluate assistive technology. Instead, oversight is maintained through the certification of the comprehensive waiver providers and the credentialing standards applied to their staff and subcontractors.

Personnel conducting evaluations or training must meet specific educational and proficiency standards outlined in the HHSC waiver appendices.

• Licensure Exemption: Texas does not issue a specific state license for assistive technology vendors or evaluators.
• HCS/TxHmL Certification: Comprehensive providers delivering AT must maintain HHSC certification and comply with the Texas Administrative Code rules for their specific waiver.
• Evaluator Qualifications: Evaluators must have earned a degree from an accredited college or university with a specialization in computer science, education, rehabilitation engineering, or a related field.
• Trainer Proficiency: Staff providing training must demonstrate proficiency on specific assistive equipment per HHSC standards and pass any periodic proficiency tests required by HHSC.

5. Medicaid Provider Enrollment

Enrollment is a bifurcated process in Texas. Applicants must first enroll in Medicaid through TMHP's system, then apply for a specific waiver contract through HHSC's portal.

The state has transitioned to online portals for both steps, though paper forms are still utilized for certain legal entity designations.

• Enrollment System: Provider Enrollment and Management System (PEMS) operated by TMHP (https://secure.tmhp.com/pems/).
• Contract Portal: Contract Application and Management for Providers (CAMP) portal for submitting HHSC waiver applications (https://camp.hhs.texas.gov/).
• Required Form 5873: Waiver and Community-based Programs and Services Contract Application Packet Checklist, used to ensure all required documents are submitted.
• Required Form 2031: Governing Authority Resolution - Business Organization, used to designate the authorized representative for the legal entity.

6. Staffing, Training and Background Checks

All personnel interacting with waiver participants or managing their data must undergo comprehensive background screening.

Beyond basic background checks, the state requires specialized education for evaluators to ensure they can properly match technology to a participant's functional needs.

• Criminal History: Providers must submit copies of receipts for criminal history records requests for all required individuals during the application process.
• OIG Exclusion Checks: Staff and subcontracted vendors must be screened against the Texas OIG and federal LEIE databases to ensure they are not excluded from Medicaid participation.
• Evaluator Education: Must possess a specialized degree (e.g., rehabilitation engineering, special education, computer science).
• Training Competency: Staff providing AT training must pass HHSC periodic proficiency tests for the specific devices they are teaching participants to use.

7. Documentation, Policies and Records

Providers must maintain detailed records justifying the need for specific devices, particularly high-tech items, and documenting the time spent on evaluations and training.

Information security is also a major focus during the contracting phase, requiring specific agreements regarding the handling of protected health information.

• Evaluation Records: Must document the specific evaluation requirements for the type of AT evaluated and the length of time required based on the person's circumstances.
• Professional Assessments: High-tech items require documented assessments from rehabilitation professionals prior to purchase.
• Information Security: Applicants must submit the Texas HHS Information Security and Privacy Initial Inquiry form.
• Data Use: Providers must sign and maintain the HHSC Data Use Agreement.
• Application Integrity: Application forms must not use correction tape or fluid; mistakes must be marked through with a single line, initialed, and dated.

8. Billing, Rates and Claims

Assistive technology is billed either through the state's fee-for-service claims system for programs like HCS, or directly to MCOs for managed care programs.

All items and services must be prior-authorized and listed on the participant's approved service plan before delivery.

• Claims System: TMHP Claims Management System for fee-for-service waivers like HCS and TxHmL.
• Prior Authorization: AT devices and evaluations require prior authorization and inclusion in the individual's approved Individual Plan of Care (IPC).
• MCO Billing: For STAR+PLUS and STAR Kids, claims are submitted directly to the contracted MCO's clearinghouse according to their specific billing guidelines.
• Rate Setting: Reimbursed according to the HHSC fee schedule for evaluations/training, or based on the authorized invoice cost for specific devices.

9. Approval Sequence and Timeline

Texas utilizes an open enrollment process for HCS and TxHmL contracts, meaning applications are accepted year-round without competitive procurement deadlines.

The sequence requires completing training, securing Medicaid enrollment, and then submitting the contract packet.

• Step 1: Complete the Provider Applicant Training (PAT) online and pass the in-person competency exam.
• Step 2: Enroll the legal entity in Texas Medicaid via the TMHP PEMS portal.
• Step 3: Submit the contract application and required legal entity documents via the CAMP portal or by email to [email protected].
• Timeline: Applications are accepted year-round with no deadline under the open enrollment process.

10. Common Denials and Survey Findings

Contract applications are frequently delayed or denied due to administrative errors on the required forms or failure to provide proper legal entity documentation.

During audits, providers often face recoupments for failing to maintain the required staff-to-client ratios or lacking proper professional assessments for high-tech devices.

• Unqualified Evaluators: Using staff who lack the required specialized degree for AT evaluations.
• Ratio Violations: Exceeding the 1:3 staff-to-person ratio for group training or failing to conduct evaluations one-on-one.
• Incomplete Packets: Failing to notarize required forms, missing signatures, or using correction fluid on application documents.
• Missing Prior Approval: Purchasing high-tech devices without a documented rehabilitation professional assessment and HHSC/MCO prior authorization.

11. Key Contacts and Resources

Prospective providers should utilize TMHP for enrollment system issues and direct contract-specific questions to HHSC's Contract Administration and Provider Monitoring division.

The CAMP portal is the primary hub for managing the actual contract application once Medicaid enrollment is complete.

• TMHP Provider Enrollment: 800-925-9126 (Option 3) (https://www.tmhp.com/topics/provider-enrollment).
• HHSC IDD Waiver Contract Enrollment: [email protected].
• CAMP Portal: Contract Application and Management for Providers (https://camp.hhs.texas.gov/).
• HHSC Provider Applicant Training (PAT): [email protected].

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