What Rider 32 Means for Home Health Agencies Delivering Telemonitoring in Texas
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 “Rider 32” 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.
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’s Medicaid Managed Care Organization (MCO), such as Superior HealthPlan, Community First, BCBSTX, UnitedHealthcare, Texas Children’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’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 2024–2025 General Appropriations Act (House Bill 1, 88th Texas Legislature, Regular Session, 2023, Article II, HHSC, Rider 32). The legislature instructed HHSC to move “Medicaid-only acute care services” 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’s deductibles, coinsurance, and a handful of services Medicare simply does not cover. These “Medicaid wrap-around” 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’s Medicaid MCO, just like claims for Medicaid-only members already do.
HHSC’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’s Medicaid MCO. If your billing team accidentally submits to TMHP, HHSC’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 from TMHP to an MCO need to be updated in the EVV system, or your EVV matches will fail.
Why This Matters for Telemonitoring Specifically
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.
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.
How Software Can Help You Stay Ahead
This is exactly the kind of change where good software earns its keep. A modern RPM and telemonitoring platform should:
- Flag dual-eligible Medicaid patients automatically based on eligibility data and route their claims to the right MCO.
- Track prior authorizations by payer, so renewals are triggered well before the 90-day window expires.
- Map S9110, revenue code 780, U1 modifiers, and EVV requirements correctly per payer, so your billers do not have to memorize who wants what.
- 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.
- Reconcile EVV match results from TMHP with claim status from the MCO, since those now live in two different places.
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.
Texas Rider 32: Frequently Asked Questions
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What exactly is Rider 32?
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When does this change take effect for telemonitoring services?
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Does Rider 32 change the clinical eligibility for telemonitoring?
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Which patients are affected by this change?
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Where do I send my S9110 claims now?
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Will my existing prior authorizations transfer to the MCO automatically?
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How does Rider 32 affect Electronic Visit Verification (EVV)?
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What happens if I accidentally bill TMHP for a dual-eligible patient?
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Do I need to be in-network with the MCO to get paid?
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Why is this change particularly risky for telemonitoring programs?
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Bottom Line
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.
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.
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.
For more information, write to contact@medicalofficeforce.com
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