Community First Health Plans would like to inform Providers that effective September 1, 2025, House Bill 1, Article II, Rider 32 (88th Legislature, Regular Session, 2023) will be implemented.
Rider 32 mandates Texas Health and Human Services (HHSC) to transition Medicaid-only services for dually eligible people enrolled in managed care from a Fee-For-Services (FFS) delivery model to a managed care service delivery model without imposing cost-sharing on dually eligible members.
What Providers and Staff Need to Know
Starting September 1, 2025, Providers will be required to bill Community First Health Plans directly for the Medicaid-only acute care services provided to dually eligible members that MCOs cover for members who do not have Medicare.
HHSC anticipates that these changes will streamline claims processing and improve MCO’s ability to coordinate services for their dually eligible members.
What’s Next?
Community First is actively preparing for the changes Rider 32 will bring and will keep our Provider network informed. Please check back soon for more information about impacted provider types, relevant CPT codes, and billing guidance.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
Resources:
Texas Medicaid Provider Procedures Manual
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter