IMPORTANT NOTICE: Rider 32 Implementation Information

Date: 05/20/25

On September 1, 2025, the Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually eligible members in Medicaid Managed Care Organization (MCO) from a Fee-For-Service (FFS) model to a managed care delivery system.

Superior HealthPlan would like to inform providers that beginning September 1, 2025, providers will bill MCOs directly for Medicaid wrap-around services for their dually eligible members which are all covered Medicaid services that are not covered by Medicare. These services are limited to the managed care services that MCOs already cover for their members   who are only Medicaid eligible and do not have Medicare.

To help facilitate this transition, HHSC’s FFS Medicaid claims administrator will forward any Medicaid-only acute care claims mistakenly submitted by FFS providers to the appropriate MCOs.

Superior would like to ensure providers have the most up-to-date information related to the transition of Rider 32.  For updates and information, please continue to check the Superior Provider News webpage.

For further questions or details, contact your dedicated Provider Representative. To access their information, visit the Find My Provider Representative webpage.