Texas - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Texas Health and Human Services Commission (HHSC) funds Transition Assistance Services (TAS) through the STAR+PLUS Home and Community Based Services (HCBS) program to help Medicaid members discharge from nursing facilities into community households. The service provides up to $2,500 for one-time household set-up expenses, authorized exclusively via Form 8604 by the member's Managed Care Organization (MCO).

Providers cannot enroll to bill HHSC directly for TAS; they must secure active network contracts with the specific STAR+PLUS MCOs operating in their service delivery area. Approval requires enrolling as a Medicaid provider through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS) and passing MCO credentialing to receive direct referrals from MCO service coordinators.

1. Service Definition and Scope

TAS covers one-time, non-recurring expenses necessary for a Medicaid member to establish a basic household when transitioning from a nursing facility to a community setting under the STAR+PLUS HCBS program. The MCO service coordinator identifies needs and authorizes specific purchases.

The TAS agency purchases the authorized items or services and arranges and pays for the delivery of the purchased items, staying strictly within the dollar amount authorized by the MCO.

• Maximum Cap: $2,500 per transition.
• Covered Items: Security deposits, utility deposits, essential furnishings, and moving expenses.
• Authorization Form: Form 8604, Transition Assistance Services (TAS) Assessment and Authorization.
• Exclusions: Monthly rental or mortgage payments, food, and items provided by other programs.

2. Regulatory and Oversight Agencies

HHSC oversees the STAR+PLUS program and sets the policy for TAS. TMHP handles the Medicaid enrollment, while the individual MCOs manage the daily authorization and provider network.

Providers must interact with both the state enrollment broker and the specific managed care plans in their region.

• State Medicaid Agency: Texas Health and Human Services Commission (HHSC) (https://www.hhs.texas.gov)
• Enrollment Administrator: Texas Medicaid & Healthcare Partnership (TMHP) (https://www.tmhp.com)
• Program Division: STAR+PLUS Managed Care (https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus)
• Provider Portal: TMHP Provider Enrollment and Management System (PEMS) (https://www.tmhp.com/topics/provider-enrollment)

3. Gatekeeping Prerequisites: Who Can Even Apply

Texas does not operate an open fee-for-service network for TAS. Providers must be selected and contracted by STAR+PLUS MCOs.

Without an MCO contract, a provider cannot receive Form 8604 authorizations or bill for TAS services.

• MCO Contracting: Must secure a network contract with at least one STAR+PLUS MCO (e.g., Superior HealthPlan, Amerigroup).
• Medicaid Enrollment: Must have an active Texas Medicaid Provider Number (TPI) via TMHP.
• Business Entity: Must be a legally established entity in Texas with a valid Tax ID.
• Service Area: Must demonstrate capacity to serve the specific MCO's regional service area.

4. Licensure and Certification Requirements

Texas does not issue a distinct "TAS Provider License." Providers are typically existing licensed entities (like Home and Community Support Services Agencies - HCSSAs) or community organizations that meet MCO credentialing standards.

Approval is based on Medicaid enrollment and MCO network credentialing rather than a specific facility license.

• Facility License: No specific TAS license required by HHSC.
• Alternative Licensure: Often provided by licensed HCSSAs or local community organizations.
• MCO Credentialing: Must pass the specific credentialing requirements of the contracting MCO.
• Secretary of State: Must maintain active, good standing business registration with the Texas Secretary of State.

5. Medicaid Provider Enrollment

Providers must enroll through TMHP's PEMS portal. This is a prerequisite to MCO contracting.

The enrollment process verifies the provider's basic eligibility to participate in Texas Medicaid.

• System: TMHP Provider Enrollment and Management System (PEMS).
• Application Fee: Subject to standard Medicaid application fee unless waived.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) if applicable to the provider type.
• Revalidation: Required every 3 to 5 years depending on provider type.

6. Staffing, Training and Background Checks

Staff must meet basic Medicaid and MCO requirements for interacting with vulnerable populations.

While clinical degrees are not required for purchasing staff, strict background checks are mandatory.

• Background Checks: Must clear Texas Department of Public Safety (DPS) criminal history checks.
• OIG Exclusion: Staff must be screened monthly against the HHSC and federal OIG exclusion lists.
• Training: Must complete MCO-specific orientation and TAS billing procedures.
• Qualifications: No specific clinical degree required for TAS purchasing staff.

7. Documentation, Policies and Records

Strict documentation is required to prove that authorized funds were spent exactly as detailed on Form 8604.

Providers must maintain a clear audit trail from authorization to purchase and delivery.

• Authorization Record: Must retain the MCO-approved Form 8604.
• Receipts: Must maintain original receipts for all purchased items and deposits.
• Delivery Confirmation: Must document the date items were delivered to the member's new residence.
• Record Retention: Must keep all records for a minimum of 5 years.

8. Billing, Rates and Claims

TAS is not billed as a flat rate. Providers bill the MCO for the exact authorized amounts up to the $2,500 limit.

Any deviation from the authorized amount requires prior approval from the MCO.

• Maximum Limit: $2,500 per member transition.
• Billing Basis: Actual cost of items/services as authorized on Form 8604.
• Claims Submission: Submitted directly to the authorizing MCO, not TMHP.
• Prior Approval: Any changes to the authorized amount require an amended Form 8604 from the MCO before purchase.

9. Approval Sequence and Timeline

The process starts with TMHP enrollment, followed by MCO contracting, and finally receiving individual member authorizations.

Timely communication with the MCO is critical once an authorization is received.

• TMHP Enrollment: Typically takes 60-90 days through PEMS.
• MCO Contracting: Can take 90-120 days depending on MCO network needs.
• Authorization Receipt: TAS agency must contact MCO by the next business day after receiving Form 8604.
• Amended Authorization: MCO provides revised Form 8604 within 2 business days if changes are needed.

10. Common Denials and Survey Findings

Providers often face issues with unauthorized purchases or failing to secure MCO contracts.

Audits frequently target missing receipts or purchases that exceed the authorized cap.

• Network Closed: MCO denies contract because their TAS network is adequate.
• Unauthorized Purchases: Denials for buying items not explicitly listed on Form 8604.
• Exceeding Cap: Claims rejected for exceeding the $2,500 limit without prior MCO approval.
• Missing Receipts: Recoupment of funds during audits due to lack of original purchase receipts.

11. Key Contacts and Resources

Essential contacts for becoming a TAS provider in Texas.

Providers should regularly consult the STAR+PLUS Handbook for policy updates.

• TMHP Provider Enrollment: https://www.tmhp.com/topics/provider-enrollment
• HHSC STAR+PLUS Program: https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus
• STAR+PLUS Handbook (TAS Section): https://www.hhs.texas.gov/handbooks/starplus-handbook/7600-transition-assistance-services
• Texas Medicaid Provider Procedures Manual: https://www.tmhp.com/resources/provider-manuals/tmppm

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