Update: CLIA Implementation Delayed

Date: May 7, 2026

Attention: All Providers

Texas Children’s Health Plan would like to inform providers of an important update from the Texas Health and Human Services Commission (HHSC) regarding Clinical Laboratory Improvement Amendments (CLIA) requirements.

Key Updates

• The previously scheduled June 1, 2026 implementation of CLIA-related claim denials based on PEMS data has been delayed until further notice
• HHSC anticipates a delay of at least three months; a new implementation date will be communicated in a future notice

What This Means for Providers

• Claims will not be denied based on CLIA data from PEMS at this time
• Providers may continue to see warning (soft edit) messages, if applicable

Provider Responsibilities (Unchanged)

All providers performing laboratory services must continue to:

• Submit and update CLIA certification information in PEMS
• Update CLIA information during provider enrollment revalidation, as applicable, by completing the License/Certification/Accreditation section in PEMS
• Guidance is available at:
  www.tmhp.com/topics/provider-enrollment/pems/licenses

Updating CLIA Certifications in PEMS

Providers can update their CLIA information in PEMS through PEMS Maintenance – License transactions, PEMS Existing Enrollment transactions, or PEMS Revalidation transactions.

• If providers are disenrolled, they must update their CLIA information through a PEMS Reenrollment request.
• If providers are enrolled and outside of their revalidation window, they can update it through a PEMS Maintenance or PEMS Existing Enrollment request.
• If providers are enrolled and within their revalidation window, they can update their CLIA information through a PEMS Revalidation or PEMS Maintenance request if they have not yet submitted a Revalidation application. Providers that have already submitted a Revalidation application cannot access a PEMS Maintenance request.

Important Note

Due to ongoing delays in provider enrollment processing (90-120 business days), updates submitted through PEMS - including CLIA information - may not be reflected until enrollment or revalidation requests are fully approved.

Resources

• Texas Medicaid Providers Manual (TMPPM), Radiology and Laboratory Services Handbook: 2.1.1 Clinical Laboratory Improvement Amendments (CLIA) and 2.1.2 CLIA Requirements.
• The full list of CLIA certification specialty type codes from CMS can be found in the following link: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/lccodes.pdf
• Previously published Provider Alerts on this topic:
  • CLIA Certification Types and Specialty and Subspecialty Codes (April 30, 2026)
  • Action Required: CLIA Certification Required to Avoid Claim Denials Starting June 1, 2026 (March 27, 2026)
  • Reminder: CLIA Certification Required for Laboratory Service Claims (February 23, 2026)
  • Action Required: Clinical Laboratory Improvement Amendment (CLIA) Revalidation in Provider Enrollment and Management System (December 17, 2025)

Next steps: Providers are strongly advised to share this information with their staff and ensure CLIA certifications are current in PEMS.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org. 

For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.