The Long-term Services and Supports (LTSS) Texas Medicaid Provider Enrollment Application (Form 3684), and other required forms are now available on DADS Texas Medicaid LTSS Provider Re-enrollment forms page.
Providers who do not bill or do not intend to bill for acute care services through the Texas Medicaid Healthcare Partnership (TMHP) and have an active Medicaid contract with DADS must re-enroll through DADS by March 24, 2016. This includes the following programs and services:
Questions can be emailed to Texas.Medicaid.Enrollment@dads.state.tx.us.(11/13/2015)
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