Rider 32 EVV Provider Impacts

Date: August 14, 2025

Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers

Call to action: Texas Children Health Plan (TCHP) would like to remind providers that beginning September 1 2025, 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.

Provider Responsibilities

Providers must update authorizations in their Electronic Visit Verification (EVV) System for Rider 32 services requiring an EVV visit that are transitioned from TMHP to TCHP for payment. Providers must submit claims for EVV Required Medicaid-only services for dual eligible clients enrolled in Medicaid managed care directly to TMHP for EVV claim matching.

• TMHP will forward these claims to TCHP with the EVV claims matching results.
• TMHP will no longer pay these claims.

Providers should contact TCHP directly for claim status updates and questions related to adjudication.

For reference, the EVV Service Bill Codes Tables are listed below:

• EVV PCS Service Bill Codes Table – version 12.0 (Excel)
• EVV HHCS Service Bill Codes Table – version 2.1 (Excel)

Additional Resources

• Rider 32 Implementation Reminder(Provider Alert)
• Rider 32 Overview Video
• FAQ Document

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

For access to all provider alerts,log into: www.texaschildrenshealthplan.org/provideralerts.