HHSC Notifications

2025 Notifications

PEMS+ Project Go-Live Plan posted May 15, 2025
Update on Revisions to the VDP Uniform Opioid Policy; Changes Due May 1, 2025 posted May 1, 2025
Reminder: ECI Providers Are Not Required to Have Site Visits Conducted by the State Medicaid Agency posted April 18, 2025
Rural Emergency Hospital (REH) Provider Type posted April 18, 2025
MMR Vaccine Recommendations in the Context of Local Outbreak posted April 18, 2025
Coming Soon: PEMS to Be Updated to Allow Provider Credentialing Effective May 30, 2025
LTC Claims Record Resource Information for the 2024 Cost Report posted April 09, 2025
Electronic Funds Transfer (EFT) Fraud Scheme posted April 09, 2025
Cetirizine HCL NDC Classification Correction posted April 02, 2025
Wegovy Clinical Prior Authorization Criteria Revision Implements May 2, 2025 posted April 02, 2025
COVID Test Kit and Vaccine Coverage in the Pharmacy Benefit effective April 07, 2025
Revisions to the Uniform Opioid Policy; Changes Required by April 1, 2025 posted April 02, 2025
Separate Reimbursement of Certain Inpatient High-Cost Drug and Biologics (HCCADs) Effective 06/02/2025
RSV Season and Synagis Prior Authorization Ends March 31 for Most Regions posted March 24, 2025
Provider Enrollment Revalidation Flexibilities: Enrollment Gap Closures, Claims Reprocessing, and MC posted March 24, 2025
Doula and Community Health Worker Enrollment through the Provider Enrollment System posted 03/12/2025
2025 Appointment Availability Prenatal Study Raw Data Now Available posted 2/24/2025
Correction to Dec. 19, 2024, “Urgent Changes to COVID for the Pharmacy Benefit” Notice posted 2/24/2025
Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonist Agents, Prophylaxis Clinical Prior Author posted 2/24/2025
Tirzepatide (Zepbound) Clinical Prior Authorization Criteria Proposals Due Feb. 14, 2025 posted 2/14/2025
Reminder: Rider 32 Implementation Information Available Effective 09/01/2025
January 2025 JW Modifier Eligible Drug List Available posted February 7, 2025
2025 Appointment Availability Primary Care Study – Provider Directory Request Due Jan. 31, 2025 posted January 27, 2025
The Certified Family Partner (CFP) Services New Medicaid Benefit Effective March 1, 2025 posted January 27, 2025
VDP to Begin Mailing “Under-Treatment of Chronic Hepatitis C Virus Infections” Retrospective DUR Intervention Information posted January 27, 2025
MCO Feedback on CPW Services Needed for Federally Required Evaluation posted January 27, 2025
Change in PDL Status for the Antiemetic-Antivertigo Agents, Drug Class, Effective Jan. 15, 2025 posted January 27, 2025
CoCM Services Provided by FQHCs and RHCs posted March 1, 2025
Certain Non-Surgical Services Procedure Codes No Longer Reimbursed Separately for HASC & ASC Providers posted January 17, 2025
Change In Preferred Drug List Status For Beta Agonist Drug Class, Effective January 3, 2025 posted January 8, 2025

2024 Notifications

Urgent Changes to COVID for the Pharmacy Benefit posted January 3, 2025
Ingrezza Drug Coverage Changes posted December 31, 2024
Prior Authorization Criteria for Kisunla Effective Feb. 1, 2025 posted December 31, 2024
Prior Authorization Criteria for Rytelo Effective Feb. 1, 2025 posted December 23, 2024
HHSC Updates Clinical Prior Authorization Criteria Guides posted December 23, 2024
Wegovy Coverage and Implementation of Clinical Prior Authorization for Medicaid effective December 27, 2024
VDP Changes For COVID-19 Post-Public Health Emergency posted December 23, 2024
Oct. 2024 JW Modifier Eligible Drugs List Available November 11, 2024
Revisions to the Uniform Opioid Policy; Changes Required by March 1, 2025 October 28, 2024
Oct. 2024 Specialty Drug List Now Available posted October 28, 2024
HHSC Will No Longer Cover Oxbryta Products As Of Oct. 17, 2024 posted October 28, 2024
PPECC Benefit Criteria Updates for Texas Medicaid Effective December 1, 2024 posted October 28, 2024
Prior Authorization Criteria for Imdelltra Effective Nov. 1, 2024 posted October 28, 2024
Prior Authorization Criteria for Anktiva Effective Nov. 1, 2024 posted October 28, 2024
SFY 2025 Appointment Availability Vision Provider Study – Provider Directory Request Due Oct. 1 posted October 9, 2024
HHSC to Remove Oxbryta Products from all Formularies as of Oct. 10, 2024 posted October 9, 2024
Enfamil Gentlease, Enfamil A.R and Enfamil Reguline Possible Shortages posted October 9, 2024
Coverage of the HPV Vaccine and ASN Updates posted October 9, 2024
Additional 2023 CPC Cost Report Training Information for LTSS STAR+PLUS Providers posted October 9, 2024
Change in Preferred Drug List Status for Generic Sildenafil Oral Suspension posted October 2, 2024
RSV Vaccine Procedure Code 90683 to Become a Benefit of Texas Medicaid Effective October 1, 2024 posted October 2, 2024
2024–25 RSV Season and Synagis Prior Authorization for All State Health Service Regions posted October 2, 2024
Adult Foster Care Residential Agreement Checklist posted October 2, 2024
Some COVID-19 Vaccine Procedure Codes No Longer a Benefit of Texas Medicaid & CHIP Effective October 1, 2024
Change in Preferred Drug List Status for Glucocorticoids, Inhaled Drug Class Takes Effect August 22 posted October 2, 2024
SFY 2025 Appointment Availability Prenatal Provider Study – Provider Directory Request Due Sept. 22 posted September 27, 2024
Updated Texas Administrative Code (TAC) References in CDS Forms Effective September 01, 2024
Home Telemonitoring Services Adding Federally Qualified Health Centers and Rural Health Clinics as Providers effective September 1, 2024
Co-pays for CHIP COVID-19 services will resume starting October 1, 2024 posted August 20, 2024
Proof of Delivery for Durable Medical Equipment (DME), Supplies, and Nutritional Products posted August 19, 2024
CHIP MCOs: Reinstatement of CHIP Co-pays for COVID-19 Vaccines, Treatment, and Testing Services effective October 1, 2024
HB 1575 New Provider Type Codes for Community Health Workers and Doulas posted August 19, 2024
Influenza Vaccine Procedure Code 90653 to Become a Benefit of Texas Medicaid effective Sept. 1, 2024
COVID-19 Vaccine and Vaccine Administration Medicaid and CHIP Updates effective October 1, 2024
New Provider Type and Specialty for Rural Emergency Hospitals effective June 3, 2024
Update and Revision to National Drug Codes (NDCs) Added to Medicaid, CHIP Formularies posted July 24, 2024
Enfamil Reguline 12.4 oz Powder Limited Availability in Retail Stores Until Mid-July 2024 posted July 12, 2024
Texas Medicaid HepCure posted June 7, 2024
CHIP MCOs: Reinstatement of CHIP Co-pays for COVID-19 Vaccines, Treatment, and Testing Services posted June 7, 2024
Maximum Allowable Amount For Non-Risk Based Drugs Billed With ‘Unclassified’ Procedure Codes posted May 29, 2024
Newly Required PDMP Data Information for CMS Annual Drug Utilization Review Survey for Federal Fiscal Year 2024
posted April 30, 2024
Hepatitis C Educational Webinar for Prescribers Occurs March 6, 2024
Release Date January 30, 2024
Updates to Vaccine Administration Procedure Code M0201
effective February 05, 2024
Provider Type and Places of Service Update for Procedure Code 96372
effective January 1, 2024.

2023 Notifications

End of Continuous Medicaid Coverage FAQ
effective December 1, 2023
RSV Vaccine Procedure Code 90678 is Now a Benefit for Pregnant Individuals
effective October 1, 2023
End of Continuous Medicaid Coverage FAQ 30-Day Extension
Click here
Fee-for-Service Telemedicine Services for Non Behavior Health Conditions
effective November 1, 2023
Telemedicine and Telehealth Services Provided by Rural Health Clinics
effective April 1, 2022
Telemedicine and Telehealth Benefit Updates For RHC’s and FQHC’s
effective Nov. 1, 2023
End of Continuous Medicaid Coverage FAQ 30-Day Extension
FAQ 30-Day Extension
Fee-for-Service Telemedicine Services for Non Behavior Health Conditions
effective November 1, 2023
Rate Changes for Ambulatory Surgical Centers and Interest Owed to Providers
effective June 1, 2023
Coverage of Commercialized COVID-19 Vaccines Begins as a Pharmacy Benefit
effective Sept 11, 2023 (Pfizer & Moderna) and Oct 3, 2023 (Novavax)
Update to COVID-19 Accommodations for the Member State Fair Hearing Process
Ending on May 11, 2023
Co-Pays For Some CHIP Services Will Resume
Starting May 12, 2023
Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers
Ending on May 11, 2023
Signature Requirement for Medicaid Home Health Services
effective April 22, 2023
Hepatitis C Treatment Coverage and PDL Update
Hepatitis C Treatment Coverage and PDL Update Scheduled for January 1, 2023
EVV Cures Act Home Health Care Services Implementation
Confirmed for January 1, 2024
Potential Electronic Visit Verification Changes Coming in 2023
Scheduled to expire on Aug. 31, 2023

2022 Notifications

Case Management for Children and Pregnant Women
Case Management for Children and Pregnant Women – Changes effective September 1, 2022
CHIP Vaccine Updates
CHIP Vaccine Updates effective September 1, 2022
Hepatitis C Treatment Coverage and PDL Update
Hepatitis C Treatment Coverage and PDL Update Scheduled for September 1, 2022
Provider Enrollment Effective Dates
Provider Enrollment Effective Dates
Changes for Client Access to Mosquito Repellent Benefit
Changes for Client Access to Mosquito Repellent Benefit Beginning June 1, 2022
HHSC To Request Extension Of EVV
HHSC To Request Extension Of EVV Cures Act Home Health Care Services Implementation to January 1, 2024
External Medical Review (EMR)
Overview of the External Medical Review (EMR) Process
Hurricane Ida Information for Medicaid Providers
Reimbursement for services rendered to Louisiana Medicaid clients for fee-for-services program
21st Century Cares Act
Home Health Care Services Required to Use EVV by Jan. 1, 2023
Hurricanes Laura and Delta Information for Medicaid Providers
Reimbursement for services rendered to Louisiana Medicaid clients for the fee-for-service program
Congenital Syphilis
Congenital Syphilis Health Advisory
Infant Botulism Alert
Preventing Lead Exposure
Preventing Lead Exposure – an online course
Preventing Lead Exposure
WIC and Postpartum Depression Resources
WIC and Postpartum Depression Resources
Prenatal Screening for Domestic Violence and Substance Use
Prenatal Screening for Domestic Violence and Substance Use
Medicaid Fraud Notice 10/23/2017
Fraud, Waste and Abuse
THSteps Notices from HHSC
Provider Letter Texas Health Steps Documentation Improvement
Texas Health Steps Clinical Record Review Tool with Instructions
Texas Health Steps Clinical Record Review Tool
Texas Health Steps Regional Contacts
Texas Health Steps Regional Provider Representatives
Postpartum Depression Screening
Texas Health Steps Mental Health Screening Change for 12 to 18 Year Olds

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