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HHS Provider Alerts — Adult Day Care/Day Activity and Health Services (ADC/DAHS)

DADS Deploys LTSS Texas Medicaid Provider Enrollment Application Forms

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:

  • Primary Home Care (PHC)
  • Community Attendant Services (CAS)
  • Community Living Assistance and Support Services (CLASS-DSA, CLASS-CMA, CLASS-CFS, CLASS-SFS)
  • Deaf Blind with Multiple Disabilities (DBMD)
  • Medically Dependent Children Program (MDCP)
  • Hospice
  • Day Activity and Health Services (DAHS)
  • Financial Management Services Agency (FMSA) [for all Consumer Directed Services]
  • Home and Community-based Services (HCS)
  • Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID)
  • MDCP – Adaptive Aids (AA)
  • MDCP – Minor Home Modifications (MHM)
  • Nursing Facility (NF)
  • Programs for All-Inclusive Care for the Elderly (PACE)
  • Texas Home Living (TxHmL)
  • Transition Assistance Services (TAS)

Questions can be emailed to Texas.Medicaid.Enrollment@dads.state.tx.us.


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