The Clinical Oversight and Administrative Simplification Subcommittee Seeks to strengthen the oversight of utilization management practices to include prior authorization policies and processes used by managed care organizations (MCOs). Focuses on reducing Medicaid provider burden through administrative improvements in four areas: claims payments, eligibility information, provider enrollment processes and prior authorization submissions.
Prior authorization discussions will focus on provider process issues and Health and Human Services Commission (HHSC) oversight of MCO prior authorization data. Also discusses specific Medicaid medical benefits as needed.
In attendance. Marcella Ford, Yolanda Haynes-Mims, Dr. Lindsey Vasquez
- Call to order, introductions, and roll call. The meeting was convened by Marcella Ford. A quorum was not present.
- Consideration of February 13, 2025, and May 8, 2025, draft meeting minutes. The minutes could not be approved due to the absence of a quorum.
- Provider Enrollment and Management System (PEMS) and PEMS+ update. Caryl Chambliss Director, Provider Services Caryl.Chambliss@hhs.texas.gov
The Texas Legislature invested in PEMS during the past session to improve the provider experience. This includes additional staffing and funding to improve the system.
PEMS and Provider Enrollment Process Improvements
Process and policy changes
- Agency and the Texas Medicaid & Healthcare Partnership (TMHP) staff are working to streamline the enrollment process.
- Provider workgroups to solicit stakeholder feedback
System changes
- Integration and performance improvements in progress
- Prioritization of system enhancements for PEMS development is in progress
Provider workgroups and focus groups began in April and will continue through August to gather provider input.
Surveys and workgroups in development for input from internal users.
TMHP vendors are providing input and suggestions for PEMS improvements.
Discussion.
What is the frequency and FAQs for the PEMS process? HHSC stated they are getting a lot of information from providers involved in the process and that data will inform the effort going forward (including FAQS).
- Public comment. There was no public comment offered.
- Review of action items and agenda items for next meeting.
Next meeting: November 6, 2025
No action items.
- Adjourn. There being no further business, the meeting was adjourned.
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