EVV Impacts Due to Dual Integration Project, Phase II Effective January 1, 2027

Community First Health Plans is sharing important information from the Texas Health and Human Services Commission (HHSC) regarding Electronic Visit Verification (EVV) impacts related to Phase II of the Integrated Dual Eligible Special Needs Plan (Integrated D-SNP) model.

Beginning January 1, 2027, additional STAR+PLUS managed care organizations (MCOs) in Bexar, Dallas, El Paso, Harris, and Hidalgo counties will begin operating Integrated D-SNPs. This includes Community First Health Plans. As part of this transition, dual-eligible Members may transition to a different STAR+PLUS MCO operating an Integrated D-SNP.

STAR+PLUS MCOs and Plan Codes Effective January 1, 2027

Program Providers, Financial Management Services Agencies (FMSAs), Proprietary System Operators (PSOs), and Consumer Directed Services (CDS) Employers should be aware of the STAR+PLUS MCO and applicable plan code for the Members they serve.

Payment of Services as of January 1, 2027

If a dual-eligible Member transitions to a different MCO, Program Providers, FMSAs, and PSOs must update the MCO payer plan code in the EVV system for the affected Member. Providers must also bill the new payer for dates of service on or after January 1, 2027.

Program Providers, FMSAs, and PSOs that use a third-party billing vendor should notify the vendor of these changes.

EVV Authorization Requirements

Program Providers, FMSAs, and PSOs should continue to use the Member’s current authorization in the EVV system through December 31, 2026. For dates of service beginning January 1, 2027, if a Member transitions to a different MCO, Program Providers, FMSAs, and PSOs should:

1. Identify the STAR+PLUS MCO operating an Integrated D-SNP and the plan code to which the Member transitioned.
2. Create a new authorization using the new STAR+PLUS MCO’s plan code and applicable information from the authorization ending December 31, 2026.
3. Manually enter the Member’s new STAR+PLUS authorization into the EVV system.

Verify Member Eligibility and MCO Assignment

Program providers, FMSAs, and PSOs can check their dual eligible members’ eligibility and MCO assignment using one of the following methods:

• The C21/SAVERR-based TMC EV and 270/271 eligibility inquiry is limited to access only current month eligibility information.
• The EaaS/TIERS-based 270/271 or Medicaid Client Portal supports eligibility inquiry for future dates up to the end of the following month. Providers can use this to check eligibility.

Program Providers, FMSAs, and PSOs must continue to submit claims for EVV-required services directly to TMHP for EVV claims matching.

Additional Information

Providers are strongly encouraged to review the full HHSC notice for complete EVV instructions, eligibility verification information, MCO plan codes, and additional resources:

Action

•  Log into the Community First Provider Portal
• Go to CommunityFirstHealthPlans.com/Provider-News
• Sign up for the Community First Provider E-Newsletter