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Rider 32 – Continuity of Care

Date: 12/12/25

Effective September 1, 2025, the Texas Health and Human Services Commission (HHSC) has transitioned Medicaid-only services for dual eligible members from the Fee-for-Service (FFS) model to a managed care delivery system. This change follows the implementation of Rider 32, as required by the 2024–2025 General Appropriations Act (House Bill 1, 88th Texas Legislature, Regular Session, 2023 – Article II, HHSC, Rider 32).

As  of September 1, 2025:

  • Providers will bill Medicaid Managed Care Organizations (MCOs), including Superior HealthPlan, directly for Medicaid wrap-around services.
  • These wrap-around services are limited to the managed care services already covered for members who are Medicaid-only and do not have Medicare.
  • Members will continue to receive the same services, now coordinated and paid by Superior instead of traditional Medicaid FFS.

Authorization and Billing Requirements

  • Prior Authorizations:
    • Post Continuity of Care (COC) timeframe: After the initial 90-day COC period, all services impacted by the temporary authorization bypass must obtain prior authorization.
      • Claims submitted without the required authorization after the COC period may be denied.
      • Providers should refer to the Authorization Requirements webpage for guidance on services requiring authorization.
      • Out of Network (OON) providers will be required to obtain a prior authorization if the provider remains out of network.
    • This guidance applies specifically to the wrap-around services impacted by the Rider 32 transition. Providers should plan accordingly to ensure smooth compliance once the COC period ends.
  • Billing:
    • Submit Rider 32 wrap-around claims directly to Superior. These claims will be processed like any other MCO claim.
    • For billing guidance, refer to the Claims and Billing section of the Superior Provider Toolkit.
  • Transition Support:
    • HHSC’s FFS Medicaid claims administrator will forward any Medicaid-only acute care claims mistakenly submitted under FFS to the appropriate MCOs during the transition period.
  • Provider Network:
    • OON providers continuing to provide services to members during the COC period must either join the network or assist in transitioning the member to an In-Network provider prior to the expiration of the COC period.

For further questions or details, contact Provider Services at 1-877-391-5921.

Please note: This article is related to the previously posted article: Rider 32 Implementation Reminder