Rth by the Centers for Medicare and Medicaid Services (CMS) and the Texas Department of State Health Services (DSHS), a change in ownership of a facility does not terminate Medicare eligibility; therefore, Medicaid participation may be continued provided that the new owners comply with the following requirements: 1. Obtain recertification as a Title XVIII (Medicare) facility under the new ownership. 2. Complete a Medicaid provider enrollment packet that includes a Medicaid Provider Enrollment A.
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How to fill out the TX TMHP F00113 online
This guide provides users with a step-by-step approach to completing the TX TMHP F00113 form online. It aims to simplify the process and ensure that all necessary information is accurately provided for a successful submission.
Follow the steps to accurately complete the TX TMHP F00113 form online.
- Press the ‘Get Form’ button to access the TX TMHP F00113 form and open it in the online editor.
- Begin by entering the previous owner's information. This includes the Previous Provider’s Texas Provider Identifier (TPI) and the current and new fiscal year end dates.
- Circle the applicable reason for the change of ownership from the options provided, such as change in lease, merger, or termination.
- Input the effective date of the ownership change.
- Indicate whether the Centers for Medicare and Medicaid Services (CMS) has classified this situation as a change of ownership, and if so, fill out the details regarding the previous owner's information.
- Now move to the new owner's information section. Answer whether the new owner has assumed liability and provide details about the new owner, including their Medicare intermediary and contact information.
- Complete the Statement of Change of Ownership section by indicating whether the new owner assumes any assets and liabilities from the prior periods, providing their Texas Provider Identifier (TPI), and signing the declaration.
- Finally, review all entries for accuracy, then save, download, print, or share the filled form as needed.
Complete your TX TMHP F00113 form online today to ensure a smooth process.
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