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Texas - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Texas, Integrated Employment is funded through the Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) Medicaid waiver programs, which are administered by the Texas Health and Human Services Commission (HHSC). To become a provider, an agency must apply for an HCS or TxHmL contract through HHSC's open enrollment process, which requires completing a mandatory Provider Applicant Training (PAT) course and passing an in-person competency exam with a score of at least 85%.

The most significant structural precondition for this service is that Texas does not enroll standalone Integrated Employment providers; instead, an agency must become a comprehensive HCS or TxHmL program provider. This requires the applicant's designated Program Manager to have at least three years of paid work experience planning and providing services to individuals with intellectual disabilities or related conditions, verified by references, before the application can even be submitted.

1. Service Definition and Scope

Integrated Employment in Texas is defined as a service that provides job development, placement, and on-site coaching to help individuals with intellectual and developmental disabilities secure and maintain competitive work in a community setting at prevailing wages. The service is designed to support individuals in achieving independence and integration into the general workforce.

This service is delivered as a component of the broader Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) waiver programs. Providers must be capable of delivering or coordinating the full array of waiver services, rather than offering Integrated Employment as a standalone service.

2. Regulatory and Oversight Agencies

The Texas Health and Human Services Commission (HHSC) is the primary regulatory and oversight agency for the HCS and TxHmL waiver programs. HHSC manages provider contracting, certification, and compliance with state and federal regulations.

Texas Medicaid & Healthcare Partnership (TMHP) serves as the state's Medicaid claims administrator and manages the Provider Enrollment and Management System (PEMS), where all Medicaid providers must enroll and revalidate their status.

3. Gatekeeping Prerequisites: Who Can Even Apply

Texas utilizes an open enrollment process for HCS and TxHmL program providers, meaning applications are accepted year-round without a competitive procurement (RFP) process. However, the state imposes strict prerequisites on the applicant's leadership before an application is accepted.

The most critical prerequisite is the Program Manager requirement. The designated Program Manager must have at least three years of paid work experience planning and providing services to individuals with intellectual disabilities or related conditions. This experience must be verified in writing by former employers, and the Program Manager must pass a mandatory competency exam.

4. Licensure and Certification Requirements

Texas does not issue a specific "Integrated Employment License." Instead, providers must obtain a contract from HHSC to operate as an HCS or TxHmL program provider. This process involves submitting a comprehensive application packet that demonstrates the agency's capacity to meet all waiver certification principles.

Applicants must complete the application via the Contract Application and Management for Providers (CAMP) portal or by submitting the paper Waiver and Community-based Programs and Services Contract Application Packet Checklist (Form 5873). The agency must also designate a governing authority and provide proof of business organization.

5. Medicaid Provider Enrollment

All HCS and TxHmL applicants must enroll in Texas Medicaid through the Provider Enrollment and Management System (PEMS) managed by TMHP. Enrollment must be completed under the legal entity's name and tax identification number.

Providers must obtain a National Provider Identifier (NPI) before applying and submit the NPI verification email or letter with their application. During enrollment, providers must select the appropriate taxonomy codes that align with their services and organizational structure.

6. Staffing, Training and Background Checks

Staff providing Integrated Employment services must meet specific qualifications outlined in the HCS and TxHmL waiver appendices. This typically includes holding a high school diploma or GED, passing criminal history and registry checks, and completing required training on supported employment principles.

Agencies must conduct monthly checks of the Texas HHSC Office of Inspector General (OIG) exclusion list and the federal List of Excluded Individuals/Entities (LEIE) for all employees and contractors to ensure they are not prohibited from participating in Medicaid programs.

7. Documentation, Policies and Records

Providers must maintain comprehensive documentation to support their HCS/TxHmL certification. This includes customized policy manuals that align with Texas Administrative Code (TAC) Title 26, Chapter 52 requirements, covering incident reporting, quality assurance, and individual service planning.

For Integrated Employment specifically, records must document job development activities, employer contacts, on-site coaching hours, and progress toward the individual's employment goals as outlined in their Person-Directed Plan (PDP).

8. Billing, Rates and Claims

Billing for Integrated Employment (Supported Employment/Employment Assistance) is processed through TMHP. Providers submit claims based on the authorized units in the individual's service plan, typically billed in 15-minute increments or hourly rates as established by HHSC.

Rates are set by the HHSC Provider Finance Department and are published in the HCS and TxHmL rate schedules. Providers must ensure that claims are supported by accurate service logs and do not exceed the authorized limits.

9. Approval Sequence and Timeline

The approval process begins with the mandatory Provider Applicant Training (PAT) and the Program Manager passing the competency exam. Once these prerequisites are met, the agency submits the contract application via CAMP or paper Form 5873.

Simultaneously, the agency must enroll in Medicaid via PEMS. HHSC reviews the contract application for completeness and compliance. The entire process, from training to contract award and Medicaid enrollment, typically takes several months, depending on the completeness of the application and PEMS processing times.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete documentation, such as missing reference letters for the Program Manager, failure to provide the NPI verification, or discrepancies between the legal entity name on the IRS forms and the Secretary of State filings.

During initial and ongoing surveys, common findings include inadequate documentation of service delivery, failure to conduct monthly OIG/LEIE exclusion checks, and staff not meeting the required training or background check qualifications.

11. Key Contacts and Resources

Prospective providers should utilize the official HHSC and TMHP websites for the most current forms, training schedules, and enrollment portals. The HHSC Operations Mailbox is the primary contact for accessing the Provider Applicant Training.

For Medicaid enrollment technical assistance, providers can contact the TMHP Contact Center. The HHSC Provider Finance Department website is the source for current rate schedules.

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