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UPDATED NOTICE: Rider 32 Implementation Information

Date: 06/25/25

On September 1, 2025, the Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually-eligible members in a Medicaid Managed Care Organization (MCO) from a 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 (Art. II, HHSC, Rider 32).

Starting September 1, 2025, providers will bill MCOs, including Superior HealthPlan, directly for Medicaid wrap-around services. These services are limited to the managed care services that MCOs already cover for their members who are only Medicaid eligible and do not have Medicare.

As a reminder, these are services members are already eligible for, that are being coordinated through Superior and paid by traditional Medicaid FFS.

Rider 32 does NOT impact the following:

  • How providers bill for Medicare services provided to dual-eligible members.
  • Which services are covered by Medicare for dual-eligible members; or
  • Which services are covered by Medicaid MCOs for non-dual-eligible members.

There are no changes to member Medicare or Medicaid coverage or costs. Members will continue to receive long-term care benefits through Superior.

Authorization and Billing Requirements:

  • Prior authorizations must still be obtained from Superior for services that require them. Refer to Superior's Authorization Requirements webpage for specific services. Please note: These may differ from FFS Medicaid requirements.
  • Providers must bill Rider 32 wrap-around service 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 Superior’s Provider Toolkit.

To support a smooth transition, HHSC’s FFS Medicaid claims administrator will forward any Medicaid-only acute care claims mistakenly submitted by FFS providers to the appropriate MCOs.

Superior would like to ensure providers have the most up-to-date information related to the transition of Rider 32. For updates and information, please continue to check the Superior Provider News webpage.

For further questions or details, contact your dedicated Provider Representative. To access their information, visit the  Find My Provider Representative webpage.

Please note: This article is an update from the previously posted article: IMPORTANT NOTICE: Rider 32 Implementation Information