Participation in the Medicaid Administrative Claiming (MAC) program requires an executed contract between HHSC and the entity and an approved MAC Program Operating Plan. The actions below provide more detail on the contract documents and the Program Operating Plan requirements.
Contracting Actions:
The entity submits all required forms and information to the HHSC Medicaid/CHIP Services Department (MCS), Contract Administration & Provider Monitoring (CAPM) office at the following e-mail address:
CAPM_MedicaidAdministrativeClaimsContracts@hhsc.state.tx.us
CAPM will use the information submitted by the entity to complete a contract packet that will be routed via DocuSign to the Signature Authority with copy to the Contract Point of Contact. After HHSC signs the contract in DocuSign, a contract number will be assigned, and the executed contract will be sent to the Signature Authority and Contract Point of Contact.
If your entity requires additional contract reviewers or signers in addition to the Signature Authority and Contract Point of Contact, please let us know via email and we will do our best to accommodate you.
The required list of forms and information to assemble the contract packet includes items 1-5 listed below. (Item 6 is to be completed by ISDs only.) You may direct any questions regarding documents 1-5 to Contract Administration & Provider Monitoring (CAPM):
CAPM_MedicaidAdministrativeClaimsContracts@hhsc.state.tx.us
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Security and Privacy Inquiry (SPI) Form
Each MAC Contract must be accompanied with a completed Security and Privacy Inquiry (SPI) form. The SPI is a questionnaire that includes a list of minimum HHS information security and privacy requirements needed for accessing HHS confidential information.
The form, with instructions for completion, can be downloaded from the HHS SPI web page.
Notes:
• If you are answering No to #1, please skip the end of the form and sign/date at the end.
• If you are answering Yes to #1, each subcontractor you total in #4 must sign a subcontractor Data Use Agreement. Please let us know as soon as possible about subcontractors and we will send the current version.
• If you have questions completing the document, please review the instructions on pages 13 – 18. -
Unique Entity ID (UEID)
As of April 4, 2022, the federal government is no longer using the DUNS number to uniquely identify entities registered in SAM. Entities doing business with the federal government will now use a Unique Entity ID (UEID) created in SAM.gov and will no longer have to go to a third-party website to obtain their identifier. New entities will send their UEID instead of DUNS as of this date.
Active registrants will have their UEID assigned and viewable within SAM.gov; there is no action for registered entities to take at this time.
The stated effect of this transition is to allow the U.S. General Services Administration (GSA) to streamline the entity identification and validation process, making it easier and less burdensome for entities to do business with the federal government. See https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-systems-information-kit/unique-entity-identifier-update for more information.
Register or check the status of your UEID on the System for Award Management (SAM) website.
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Application for Texas Identification Number (.pdf)
A Texas Identification Number (TIN) is a number assigned by the Texas Comptroller of Public Accounts for the purpose of identifying any party receiving a payment from the State of Texas. The use of this number on all billings will reduce the time required to process billings to the State of Texas.
Print, review, and complete the Application for Texas Identification Number. The instructions for completing the document are included with the document.
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Vendor Direct Deposit Form (.pdf)
Print and complete the Vendor Direct Deposit Form. The form must be resubmitted if the entity changes financial institution, accounts, and/or account type. Instructions for completing the form are included with the document.
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Vendor Information Form (.doc)
Print and complete the Vendor Information Form.
View the Vendor Information Form Instructions (.pdf).
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Program Operating Plan (for ISDs only):
An approved MAC Program Operating Plan (POP) is required for Independent School Districts (ISDs) choosing to participate and receive reimbursement from the MAC program. In addition to submitting the MAC POP, the ISD is required to update and maintain all contact information in the Fairbanks cost reporting system (Fairbanks LLC MAC Login). Once a MAC POP has been approved, the ISD is required to update Fairbanks should program contacts change.
View the MAC POP with Instructions (.pdf).
Review the instructions. Draft a cover letter and complete the POP as indicated. Send the completed and signed cover letter and MAC POP to the HHSC Provider Finance Department at the following e-mail address:
MedicaidAdministrativeClaiming@hhs.texas.gov
NOTE: You may send questions regarding the cover letter, POP, or other MAC non-contract related questions to the HHSC Provider Finance Department email listed above.