Overview
The Health and Human Services Commission (HHSC) is requiring an attestation from all providers who receive additional funds through increased Medicaid reimbursement rates approved as a result of the COVID-19 federal emergency declaration. Providers shall attest that no portion of those additional funds will be used to increase hourly wages for any staff.

For additional information, please see the NF Information Letter and the HCS Information Letter sent by HHSC and/or posted on the TMHP Website.

Contacts
Due Date
September 30, 2020 at 11:59 PM

HHSC requires the attestation to be submitted as soon as possible, but no later than September 30, 2020. Failure to attest will result in recoupment of the additional funds paid during the emergency temporary rate increase period, from April 1, 2020 through the HHSC’s termination of the emergency temporary rate increases.

Instructions
Complete all fields below as appropriate for the provider/program type. Read the attestations and check the boxes to agree to the attestations. Click the Submit button when completed. Note: NF and HCS providers – please enter all contract number(s) and/or component code(s) being included in this attestation.

This attestation is submitted for:

Provider Name
Provider Doing Business As (DBA) Name
Provider Phone
Address
City
State
Zip
Question 1
Question 2
National Provider Identifier (NPI)
Texas Provider Identification (TPI)
First Name
Last Name
Title
Contact Phone
Contact Email