{"id":35621,"date":"2026-04-30T22:24:13","date_gmt":"2026-05-01T02:24:13","guid":{"rendered":"https:\/\/www.medicalofficeforce.com\/?p=35621"},"modified":"2026-04-30T23:13:06","modified_gmt":"2026-05-01T03:13:06","slug":"rider-32-medicaid-rpm-home-health","status":"publish","type":"post","link":"https:\/\/www.medicalofficeforce.com\/es\/rider-32-medicaid-rpm-home-health\/","title":{"rendered":"What Rider 32 Means for Home Health Agencies Delivering Telemonitoring in Texas"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"35621\" class=\"elementor elementor-35621\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5810223 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no e-con e-parent\" data-id=\"5810223\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-691dd03 elementor-widget elementor-widget-image\" data-id=\"691dd03\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1920\" height=\"1080\" src=\"https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring.webp\" class=\"attachment-full size-full wp-image-35622\" alt=\"Rider 32: What it means for Texas Home Health Agencies.\" srcset=\"https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring.webp 1920w, https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring-300x169.webp 300w, https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring-1024x576.webp 1024w, https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring-768x432.webp 768w, https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring-1536x864.webp 1536w, https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring-18x10.webp 18w, https:\/\/3.128.30.10\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring-685x385.webp 685w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-329a3c0 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no e-con e-parent\" data-id=\"329a3c0\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ac449dd elementor-widget elementor-widget-shortcode\" data-id=\"ac449dd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cef517a elementor-widget elementor-widget-heading\" data-id=\"cef517a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">What Rider 32 Means for Home Health Agencies Delivering Telemonitoring in Texas\n<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c305bf2 elementor-widget elementor-widget-shortcode\" data-id=\"c305bf2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n                \n                    <!--begin code -->\n\n                    \n                    <div class=\"pp-multiple-authors-boxes-wrapper pp-multiple-authors-wrapper pp-multiple-authors-layout-boxed multiple-authors-target-shortcode box-post-id-4775 box-instance-id-1 ppma_boxes_4775\"\n                    data-post_id=\"4775\"\n                    data-instance_id=\"1\"\n                    data-additional_class=\"pp-multiple-authors-layout-boxed.multiple-authors-target-shortcode\"\n                    data-original_class=\"pp-multiple-authors-boxes-wrapper pp-multiple-authors-wrapper box-post-id-4775 box-instance-id-1\">\n                                                <span class=\"ppma-layout-prefix\"><\/span>\n                        <div class=\"ppma-author-category-wrap\">\n                                                                                                                                    <span class=\"ppma-category-group ppma-category-group-1 category-index-0\">\n                                                                                                                        <ul class=\"pp-multiple-authors-boxes-ul author-ul-0\">\n                                                                                                                                                                                                                                                                                                                                                            \n                                                                                                                    <li class=\"pp-multiple-authors-boxes-li author_index_0 author_judahchws has-avatar\">\n                                                                                                                                                                                    <div class=\"pp-author-boxes-avatar\">\n                                                                    <div class=\"avatar-image\">\n                                                                                                                                                                                                                <img alt='Judah Coody' src='https:\/\/secure.gravatar.com\/avatar\/36ae827b88dff128b89150135ed0a2a7626311452909b67ac5e8a410c18db742?s=60&#038;d=https%3A%2F%2Fwww.ahcspc.com%2Fwp-content%2Fuploads%2F2025%2F11%2Favtar10.png&#038;r=g' srcset='https:\/\/secure.gravatar.com\/avatar\/36ae827b88dff128b89150135ed0a2a7626311452909b67ac5e8a410c18db742?s=120&#038;d=https%3A%2F%2Fwww.ahcspc.com%2Fwp-content%2Fuploads%2F2025%2F11%2Favtar10.png&#038;r=g 2x' class='avatar avatar-60 photo' height='60' width='60' \/>                                                                                                                                                                                                            <\/div>\n                                                                                                                                    <\/div>\n                                                            \n                                                            <div class=\"pp-author-boxes-avatar-details\">\n                                                                <div class=\"pp-author-boxes-name multiple-authors-name\"><a href=\"https:\/\/www.medicalofficeforce.com\/es\/author\/judahchws\/\" rel=\"author\" title=\"Judah Coody\" class=\"author url fn\">By Judah Coody<\/a><\/div>                                                                                                                                                                                                    \n                                                                                                                                            <div class=\"pp-author-boxes-description multiple-authors-description author-description-0\">\n                                                                                                                                                    <p>Judah is the Marketing Lead at Medical Office Force. He specializes in new technology growth and on practical insights that help clinics succeed in a rapidly changing healthcare landscape.<\/p>\n                                                                                                                                                <\/div>\n                                                                                                                                                                                                    \n                                                                                                                                \n                                                                                                                            <\/div>\n                                                                                                                                                                                                                        <\/li>\n                                                                                                                                                                                                                                                                                        <\/ul>\n                                                                            <\/span>\n                                                                                                                        <\/div>\n                        <span class=\"ppma-layout-suffix\"><\/span>\n                                            <\/div>\n                    <!--end code -->\n                    \n                \n                            \n        <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d9dc330 elementor-widget elementor-widget-shortcode\" data-id=\"d9dc330\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-97d9a90 elementor-widget elementor-widget-text-editor\" data-id=\"97d9a90\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">If your home health agency provides telemonitoring (also called Remote Patient Monitoring or RPM) to Texas Medicaid patients, you have probably already heard the words &#8220;Rider 32&#8221; tossed around in provider bulletins, MCO emails, and HHSC notices. And if you are like most agency owners and billing managers we talk to, you are still trying to figure out exactly what changed, who it affects, and what you need to do differently to keep getting paid.<\/span><\/p><p><span style=\"font-weight: 400;\">This post breaks Rider 32 down in plain English, with a specific focus on what it means for home health agencies running telemonitoring programs.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a5f029c elementor-widget elementor-widget-heading\" data-id=\"a5f029c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Summary\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6cb3aeb elementor-widget elementor-widget-text-editor\" data-id=\"6cb3aeb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Rider 32 is a budget instruction from the Texas Legislature that changed how certain Medicaid claims are processed for <\/span><b>dual-eligible<\/b><span style=\"font-weight: 400;\"> patients (people who have both Medicare and Medicaid). Effective <\/span><b>September 1, 2025<\/b><span style=\"font-weight: 400;\">, home health agencies can no longer bill these claims to traditional fee-for-service Medicaid through TMHP. Instead, those claims now go directly to the patient&#8217;s Medicaid Managed Care Organization (MCO), such as Superior HealthPlan, Community First, BCBSTX, UnitedHealthcare, Texas Children&#8217;s Health Plan, and others.<\/span><\/p><p><span style=\"font-weight: 400;\">For telemonitoring specifically, this means the workflow you used for years to get paid for procedure code S9110 on dual-eligible patients no longer works the same way. Same service. Different payer. Different rules.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9ffec9a elementor-widget elementor-widget-heading\" data-id=\"9ffec9a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">A Quick Refresher on Texas Medicaid Telemonitoring\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e1b0a52 elementor-widget elementor-widget-text-editor\" data-id=\"e1b0a52\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Before we go deeper, here is a quick refresher on the benefit itself.<\/span><\/p><p><span style=\"font-weight: 400;\">In Texas, home telemonitoring (synonymous with remote patient monitoring) is a covered Medicaid service for patients who meet specific clinical criteria, such as a diagnosis of diabetes or hypertension along with at least one risk factor (recent hospitalization, history of poor glycemic control, and so on). Pediatric patients aged 20 and under may also qualify under different criteria.<\/span><\/p><p><span style=\"font-weight: 400;\">Home health agencies bill telemonitoring using <\/span><b>procedure code S9110 with revenue code 780<\/b><span style=\"font-weight: 400;\">. The initial setup and equipment installation use S9110 with the U1 modifier. Prior authorization is required, and approvals are typically given for up to 90 days at a time. Agencies must establish a plan of care with measurable outcomes, share clinical data with the ordering physician, and report back at least once a month, or sooner if a patient&#8217;s readings fall outside the parameters set by the doctor.<\/span><\/p><p><span style=\"font-weight: 400;\">This benefit has been growing steadily since the legislature made many telehealth and telemonitoring expansions permanent through House Bill 4 in 2021, and it expanded again in September 2024 to allow FQHCs and RHCs to bill telemonitoring (using G0511 instead of S9110). In short: it is a strong, established benefit, and demand is growing.<\/span><\/p><p><span style=\"font-weight: 400;\">Rider 32 does not change the <\/span><b>clinical<\/b><span style=\"font-weight: 400;\"> rules for who qualifies or how you deliver the service. It changes the <\/span><b>payment rails<\/b><span style=\"font-weight: 400;\"> for one specific group of patients.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9131d0d elementor-widget elementor-widget-heading\" data-id=\"9131d0d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">What Rider 32 Actually Does\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9cdf31e elementor-widget elementor-widget-text-editor\" data-id=\"9cdf31e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Rider 32 was passed as part of the 2024\u20132025 General Appropriations Act (House Bill 1, 88th Texas Legislature, Regular Session, 2023, Article II, HHSC, Rider 32). The legislature instructed HHSC to move &#8220;Medicaid-only acute care services&#8221; for dual-eligible managed care members out of fee-for-service and into managed care.<\/span><\/p><p><span style=\"font-weight: 400;\">Here is what that means in practice.<\/span><\/p><p><span style=\"font-weight: 400;\">A dual-eligible patient has both Medicare and Medicaid. For most of their care, Medicare pays first, and Medicaid covers what Medicare does not, like the patient&#8217;s deductibles, coinsurance, and a handful of services Medicare simply does not cover. These &#8220;Medicaid wrap-around&#8221; services are the ones Rider 32 focuses on.<\/span><\/p><p><span style=\"font-weight: 400;\">Before September 1, 2025, when a home health agency provided one of these Medicaid-only services to a dual-eligible patient, the agency billed traditional fee-for-service Medicaid through TMHP, even if the patient was enrolled in a Medicaid MCO for their long-term care services.<\/span><\/p><p><span style=\"font-weight: 400;\">Now those claims go directly to the patient&#8217;s Medicaid MCO, just like claims for Medicaid-only members already do.<\/span><\/p><p><span style=\"font-weight: 400;\">HHSC&#8217;s reasoning is straightforward: a dual-eligible patient enrolled in a STAR+PLUS or other managed care plan should have all of their Medicaid services coordinated through one entity, not split between an MCO and FFS. It is meant to streamline coordination and improve oversight.<\/span><\/p><p><span style=\"font-weight: 400;\">For your agency, however, it means new processes, new payer relationships, and new places where things can go wrong.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3e4226b elementor-widget elementor-widget-heading\" data-id=\"3e4226b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">What This Means for Your Telemonitoring Program\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-294b3fb elementor-widget elementor-widget-text-editor\" data-id=\"294b3fb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Here is the specific impact on home health agencies running telemonitoring services.<\/span><\/p><ol><li style=\"list-style-type: none;\"><ol><li style=\"list-style-type: none;\"><ol style=\"list-style-type: number;\"><li><b> Identify your dual-eligible telemonitoring patients.<\/b><span style=\"font-weight: 400;\"> Not every Medicaid patient is dual-eligible, and not every dual-eligible is enrolled in an MCO. You need a clean way to flag patients who fall into the Rider 32 bucket. Their Medicaid ID, eligibility file, and MCO assignment all matter for billing.<\/span><\/li><li><b> Bill the MCO, not TMHP.<\/b><span style=\"font-weight: 400;\"> Telemonitoring claims (S9110 with revenue code 780) for these patients now go to the patient&#8217;s Medicaid MCO. If your billing team accidentally submits to TMHP, HHSC&#8217;s FFS claims administrator will forward those claims to the appropriate MCO during the transition, but you should not rely on that as a long-term workflow. The cleaner the front-end, the faster you get paid.<\/span><\/li><li><b> Re-check prior authorization rules per MCO.<\/b><span style=\"font-weight: 400;\"> This is where many agencies get tripped up. Each MCO has its own prior authorization rules, forms, portals, and timelines. They may differ from FFS Medicaid requirements. The 90-day prior authorization you got under FFS does not automatically transfer. After the initial 90-day continuity-of-care period, services that previously bypassed authorization must obtain prior auth from the MCO, or claims may be denied.<\/span><\/li><li><b> Confirm network status.<\/b><span style=\"font-weight: 400;\"> If your agency is out-of-network with a particular MCO, you may need to either join the network or transition the patient to an in-network provider before the continuity-of-care window ends. Out-of-network providers will need prior authorization to keep serving the member.<\/span><\/li><li><b> EVV still applies.<\/b><span style=\"font-weight: 400;\"> For telemonitoring services that require Electronic Visit Verification, providers still submit EVV claims to TMHP for matching, but TMHP no longer pays them. TMHP forwards the matched claims to the MCO for adjudication. So you have two systems to reconcile: EVV match status with TMHP, and payment status with the MCO.<\/span><\/li><li><b>Update your authorizations in your EVV system.<\/b><span style=\"font-weight: 400;\"> Authorizations that moved from TMHP to an MCO need to be updated in the EVV system, or your EVV matches will fail.<\/span><\/li><\/ol><\/li><\/ol><\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-690976f elementor-widget elementor-widget-heading\" data-id=\"690976f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Why This Matters for Telemonitoring Specifically\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-40c2bc0 elementor-widget elementor-widget-text-editor\" data-id=\"40c2bc0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Telemonitoring is a recurring monthly service. Unlike a one-time visit, you are submitting claims month after month for the same patient over a 90-day authorization period, then renewing. That recurring billing pattern means a small misconfiguration, like sending claims to the wrong payer or missing a prior auth renewal under new MCO rules, can compound across dozens or hundreds of patients before anyone notices.<\/span><\/p><p><span style=\"font-weight: 400;\">Telemonitoring also has a unique documentation burden. You need at least 16 days of data collection per month for FQHCs and RHCs billing G0511, and home health agencies must hit their plan-of-care reporting requirements regardless of payer. If your software is not tracking which patient belongs to which payer, which prior auth is expiring under which MCO, and which claim has gone out where, the operational complexity will eat your margin.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c832f21 elementor-widget elementor-widget-heading\" data-id=\"c832f21\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">How Software Can Help You Stay Ahead\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e807e93 elementor-widget elementor-widget-text-editor\" data-id=\"e807e93\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">This is exactly the kind of change where good software earns its keep. A modern RPM and telemonitoring platform should:<\/span><\/p><ul><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Flag dual-eligible Medicaid patients automatically based on eligibility data and route their claims to the right MCO.<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Track prior authorizations by payer, so renewals are triggered well before the 90-day window expires.<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Map S9110, revenue code 780, U1 modifiers, and EVV requirements correctly per payer, so your billers do not have to memorize who wants what.<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Surface clean reports on missed reading days, plan-of-care reviews, and physician reporting events, so compliance is documented automatically rather than reconstructed at audit time.<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reconcile EVV match results from TMHP with claim status from the MCO, since those now live in two different places.<\/span><\/li><\/ul><p><span style=\"font-weight: 400;\">If your team is still managing this in spreadsheets, a payer change like Rider 32 is the kind of event that quietly creates weeks of denied claims, lost revenue, and frustrated staff before anyone realizes what happened.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-931c166 elementor-widget elementor-widget-heading\" data-id=\"931c166\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Texas Rider 32: Frequently Asked Questions\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8944f9c elementor-widget elementor-widget-text-editor\" data-id=\"8944f9c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> What exactly is Rider 32?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">Rider 32 is a budget instruction from the Texas Legislature that moves &#8220;Medicaid-only acute care services&#8221; for dual-eligible members (those with both Medicare and Medicaid) from traditional fee-for-service (TMHP) into Managed Care Organizations (MCOs).<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"2\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> When does this change take effect for telemonitoring services?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">The transition officially became effective on <\/span><b>September 1, 2025<\/b><span style=\"font-weight: 400;\">. Home health agencies should have updated their billing workflows by this date to ensure claims reach the correct payer.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"3\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> Does Rider 32 change the clinical eligibility for telemonitoring?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">No. The clinical requirements remain the same. Patients still qualify based on diagnoses like diabetes or hypertension with specific risk factors, and the documentation requirements for physician reporting and plan-of-care outcomes have not changed.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"4\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> Which patients are affected by this change?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">Rider 32 specifically impacts <\/span><b>dual-eligible patients<\/b><span style=\"font-weight: 400;\"> enrolled in a Medicaid Managed Care plan (such as STAR+PLUS). Medicaid-only patients or those not in an MCO are not affected by this specific shift in payment rails.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"5\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> Where do I send my S9110 claims now?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">Instead of billing traditional fee-for-service through TMHP, you must now submit claims for dual-eligible managed care members directly to their assigned <\/span><b>MCO<\/b><span style=\"font-weight: 400;\"> (e.g., Superior HealthPlan, UnitedHealthcare, Community First, etc.).<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"6\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> Will my existing prior authorizations transfer to the MCO automatically?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">While there is an initial 90-day &#8220;continuity-of-care&#8221; period, authorizations do not permanently transfer. After this window, you must obtain a new prior authorization directly from the patient\u2019s MCO according to their specific forms and portals.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"7\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> How does Rider 32 affect Electronic Visit Verification (EVV)?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">The process is split: you still submit EVV claims to TMHP for matching, but TMHP no longer pays the claim. Once matched, TMHP forwards the claim to the MCO for payment. You must reconcile the match status at TMHP and the payment status at the MCO.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"8\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> What happens if I accidentally bill TMHP for a dual-eligible patient?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">During the transition period, TMHP may forward these claims to the correct MCO. However, this is not a permanent solution and can lead to significant payment delays. You should update your internal systems to route these claims correctly from the start.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"9\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> Do I need to be in-network with the MCO to get paid?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">Yes. If you are out-of-network, you may need to join the MCO\u2019s provider network or transition the patient to an in-network provider before the continuity-of-care window expires to avoid claim denials.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: number;\" start=\"10\">\n \t<li>\n<h3 style=\"font-size: 18px; text-transform: capitalize; font-family: poppins; margin: 10px 0px;\"><b> Why is this change particularly risky for telemonitoring programs?<\/b><\/h3>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">Because telemonitoring is a recurring monthly service (code S9110), a single billing error or an expired authorization can lead to a &#8220;domino effect&#8221; of denials across several months of service before the error is caught, creating a significant loss in revenue.<\/span>\n<ol>\n \t<li style=\"list-style-type: none;\"><\/li>\n<\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0e0e518 elementor-widget elementor-widget-heading\" data-id=\"0e0e518\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Bottom Line\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d39b51e elementor-widget elementor-widget-text-editor\" data-id=\"d39b51e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Rider 32 did not change Texas Medicaid telemonitoring as a benefit. The clinical criteria, the codes, the documentation requirements, and the patient population all stayed the same. What changed is who you bill, how you get authorization, and how your administrative systems need to be set up for dual-eligible managed care patients.<\/span><\/p><p><span style=\"font-weight: 400;\">For home health agencies serving Medicaid populations, this is the moment to audit your telemonitoring billing workflow, identify your dual-eligible patients, confirm your MCO network status, and make sure your software is doing the heavy lifting on payer routing, authorizations, and EVV reconciliation. The agencies that get ahead of this transition will keep cash flowing smoothly. The ones that wait are likely to spend the next year cleaning up denials.<\/span><\/p><p><span style=\"font-weight: 400;\">If you have questions about how Medical Office Force supports your RPM and telemonitoring billing under Rider 32, we are happy to walk you through it.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4d87ec4 elementor-widget elementor-widget-html\" data-id=\"4d87ec4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script type=\"application\/ld+json\">\r\n{\r\n  \"@context\": \"https:\/\/schema.org\",\r\n  \"@type\": \"BlogPosting\",\r\n  \"mainEntityOfPage\": {\r\n    \"@type\": \"WebPage\",\r\n    \"@id\": \"https:\/\/www.medicalofficeforce.com\/rider-32-medicaid-rpm-home-health\"\r\n  },\r\n  \"headline\": \"How Rider 32 Affects Texas Home Health Telemonitoring\",\r\n  \"description\": \"Texas Rider 32 changed how home health agencies bill Medicaid telemonitoring claims for dual-eligible patients. Learn what changed September 1, 2025, and how to keep your RPM program compliant and paid.\",\r\n  \"image\": {\r\n    \"@type\": \"ImageObject\",\r\n    \"url\": \"https:\/\/www.medicalofficeforce.com\/wp-content\/uploads\/2026\/04\/rider-32-texas-home-health-telemonitoring.webp\",\r\n    \"width\": 1200,\r\n    \"height\": 630\r\n  },\r\n  \"author\": {\r\n    \"@type\": \"Organization\",\r\n    \"name\": \"Medical Office Force\",\r\n    \"url\": \"https:\/\/www.medicalofficeforce.com\"\r\n  },\r\n  \"publisher\": {\r\n    \"@type\": \"Organization\",\r\n    \"name\": \"Medical Office Force\",\r\n    \"logo\": {\r\n      \"@type\": \"ImageObject\",\r\n      \"url\": \"https:\/\/www.medicalofficeforce.com\/wp-content\/uploads\/2025\/02\/Group-451.png\",\r\n      \"width\": 600,\r\n      \"height\": 60\r\n    }\r\n  },\r\n  \"datePublished\": \"2026-04-30\",\r\n  \"dateModified\": \"2026-04-30\",\r\n  \"url\": \"https:\/\/www.medicalofficeforce.com\/Rider-32-medicaid-rpm-home-health\",\r\n  \"keywords\": \"Rider 32, Texas Medicaid, home telemonitoring, remote patient monitoring, RPM, home health agency, dual eligible, Medicaid MCO, S9110, telemonitoring billing\",\r\n  \"articleSection\": \"Home Health\",\r\n  \"inLanguage\": \"en-US\",\r\n  \"about\": [\r\n    {\r\n      \"@type\": \"Thing\",\r\n      \"name\": \"Texas Medicaid Rider 32\"\r\n    },\r\n    {\r\n      \"@type\": \"Thing\",\r\n      \"name\": \"Home Telemonitoring\"\r\n    },\r\n    {\r\n      \"@type\": \"Thing\",\r\n      \"name\": \"Remote Patient Monitoring\"\r\n    }\r\n  ],\r\n  \"audience\": {\r\n    \"@type\": \"Audience\",\r\n    \"audienceType\": \"Home Health Agencies, Medicaid Providers, RPM Program Administrators\"\r\n  },\r\n  \"mainEntity\": [\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What exactly is Rider 32?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Rider 32 is a budget instruction from the Texas Legislature that moves 'Medicaid-only acute care services' for dual-eligible members (those with both Medicare and Medicaid) from traditional fee-for-service (TMHP) into Managed Care Organizations (MCOs).\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"When does this change take effect for telemonitoring services?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"The transition officially became effective on September 1, 2025. Home health agencies should have updated their billing workflows by this date to ensure claims reach the correct payer.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Does Rider 32 change the clinical eligibility for telemonitoring?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"No. The clinical requirements remain the same. Patients still qualify based on diagnoses like diabetes or hypertension with specific risk factors, and the documentation requirements for physician reporting and plan-of-care outcomes have not changed.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Which patients are affected by this change?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Rider 32 specifically impacts dual-eligible patients enrolled in a Medicaid Managed Care plan (such as STAR+PLUS). 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And if you are like most agency owners and billing managers we talk to, you are still trying to figure out exactly what changed, who it affects, and what you need to do differently to keep getting paid. This post breaks Rider 32 down in plain English, with a specific focus on what it means for home health agencies running telemonitoring programs. Summary Rider 32 is a budget instruction from the Texas Legislature that changed how certain Medicaid claims are processed for dual-eligible patients (people who have both Medicare and Medicaid). Effective September 1, 2025, home health agencies can no longer bill these claims to traditional fee-for-service Medicaid through TMHP. Instead, those claims now go directly to the patient&#8217;s Medicaid Managed Care Organization (MCO), such as Superior HealthPlan, Community First, BCBSTX, UnitedHealthcare, Texas Children&#8217;s Health Plan, and others. For telemonitoring specifically, this means the workflow you used for years to get paid for procedure code S9110 on dual-eligible patients no longer works the same way. Same service. Different payer. Different rules. A Quick Refresher on Texas Medicaid Telemonitoring Before we go deeper, here is a quick refresher on the benefit itself. In Texas, home telemonitoring (synonymous with remote patient monitoring) is a covered Medicaid service for patients who meet specific clinical criteria, such as a diagnosis of diabetes or hypertension along with at least one risk factor (recent hospitalization, history of poor glycemic control, and so on). Pediatric patients aged 20 and under may also qualify under different criteria. Home health agencies bill telemonitoring using procedure code S9110 with revenue code 780. The initial setup and equipment installation use S9110 with the U1 modifier. Prior authorization is required, and approvals are typically given for up to 90 days at a time. Agencies must establish a plan of care with measurable outcomes, share clinical data with the ordering physician, and report back at least once a month, or sooner if a patient&#8217;s readings fall outside the parameters set by the doctor. This benefit has been growing steadily since the legislature made many telehealth and telemonitoring expansions permanent through House Bill 4 in 2021, and it expanded again in September 2024 to allow FQHCs and RHCs to bill telemonitoring (using G0511 instead of S9110). In short: it is a strong, established benefit, and demand is growing. Rider 32 does not change the clinical rules for who qualifies or how you deliver the service. It changes the payment rails for one specific group of patients. What Rider 32 Actually Does Rider 32 was passed as part of the 2024\u20132025 General Appropriations Act (House Bill 1, 88th Texas Legislature, Regular Session, 2023, Article II, HHSC, Rider 32). The legislature instructed HHSC to move &#8220;Medicaid-only acute care services&#8221; for dual-eligible managed care members out of fee-for-service and into managed care. Here is what that means in practice. A dual-eligible patient has both Medicare and Medicaid. For most of their care, Medicare pays first, and Medicaid covers what Medicare does not, like the patient&#8217;s deductibles, coinsurance, and a handful of services Medicare simply does not cover. These &#8220;Medicaid wrap-around&#8221; services are the ones Rider 32 focuses on. Before September 1, 2025, when a home health agency provided one of these Medicaid-only services to a dual-eligible patient, the agency billed traditional fee-for-service Medicaid through TMHP, even if the patient was enrolled in a Medicaid MCO for their long-term care services. Now those claims go directly to the patient&#8217;s Medicaid MCO, just like claims for Medicaid-only members already do. HHSC&#8217;s reasoning is straightforward: a dual-eligible patient enrolled in a STAR+PLUS or other managed care plan should have all of their Medicaid services coordinated through one entity, not split between an MCO and FFS. It is meant to streamline coordination and improve oversight. For your agency, however, it means new processes, new payer relationships, and new places where things can go wrong. What This Means for Your Telemonitoring Program Here is the specific impact on home health agencies running telemonitoring services. Identify your dual-eligible telemonitoring patients. Not every Medicaid patient is dual-eligible, and not every dual-eligible is enrolled in an MCO. You need a clean way to flag patients who fall into the Rider 32 bucket. Their Medicaid ID, eligibility file, and MCO assignment all matter for billing. Bill the MCO, not TMHP. Telemonitoring claims (S9110 with revenue code 780) for these patients now go to the patient&#8217;s Medicaid MCO. If your billing team accidentally submits to TMHP, HHSC&#8217;s FFS claims administrator will forward those claims to the appropriate MCO during the transition, but you should not rely on that as a long-term workflow. The cleaner the front-end, the faster you get paid. Re-check prior authorization rules per MCO. This is where many agencies get tripped up. Each MCO has its own prior authorization rules, forms, portals, and timelines. They may differ from FFS Medicaid requirements. The 90-day prior authorization you got under FFS does not automatically transfer. After the initial 90-day continuity-of-care period, services that previously bypassed authorization must obtain prior auth from the MCO, or claims may be denied. Confirm network status. If your agency is out-of-network with a particular MCO, you may need to either join the network or transition the patient to an in-network provider before the continuity-of-care window ends. Out-of-network providers will need prior authorization to keep serving the member. EVV still applies. For telemonitoring services that require Electronic Visit Verification, providers still submit EVV claims to TMHP for matching, but TMHP no longer pays them. TMHP forwards the matched claims to the MCO for adjudication. So you have two systems to reconcile: EVV match status with TMHP, and payment status with the MCO. Update your authorizations in your EVV system. Authorizations that moved &hellip; <a href=\"https:\/\/www.medicalofficeforce.com\/es\/rider-32-medicaid-rpm-home-health\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">What Rider 32 Means for Home Health Agencies Delivering Telemonitoring in Texas<\/span><\/a><\/p>","protected":false},"author":208464285,"featured_media":35622,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"ppma_author":[1444],"class_list":["post-35621","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-rcm"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Rider 32 &amp; Texas Medicaid RPM: A Home Health Guide<\/title>\n<meta name=\"description\" content=\"Texas Rider 32 changed how home health agencies bill Medicaid telemonitoring claims for dual-eligible patients. Learn what changed September 1, 2025, and how to keep your RPM program compliant and paid.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalofficeforce.com\/es\/rider-32-medicaid-rpm-home-health\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rider 32 &amp; Texas Medicaid RPM: A Home Health Guide\" \/>\n<meta property=\"og:description\" content=\"Texas Rider 32 changed how home health agencies bill Medicaid telemonitoring claims for dual-eligible patients. 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