Rider 32 Update: EVV Required for Medicaid-Only Services for Dual Eligible Members

Aug 25, 2025 | EVV News, Provider News

Beginning Sept. 1, the Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually eligible clients (clients who are eligible for both Medicare and Medicaid) enrolled in Medicaid managed care from a fee-for-service (FFS) to a managed care service delivery system. Managed Care Organizations (MCOs) will be responsible for the adjudication of these claims.

Key Provider Responsibilities:

In line with this transition, Providers must:

  • Update authorizations in their EVV System for Rider 32 services requiring an EVV visit
  • Submit claims for EVV-required Medicaid-only services for dual eligible Community First Members directly to TMHP for EVV claim matching.
  • TMHP will forward these claims to Community First Health Plans with the EVV claims matching results.
  • TMHP will no longer pay these claims.

Please contact Community First Provider Services at 210-358-6030 for claim status updates and adjudication questions.

Who This Applies To:

This requirement applies to Providers who:

  • Deliver personal care or home health services listed in the EVV Bill Code Tables
  • Serve dual eligible Community First Members
  • Are billing for services that are not covered by Medicare but instead authorized by Community First under Medicaid.

These services are considered “Medicaid-only” for the purposes of EVV and are now subject to EVV requirements under Rider 32.

For more information on which services fall under this requirement, please review the most current versions of the EVV Bill Code Tables:

Action:

Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.

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