Having trouble viewing this email? View it as a Web page.

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

On Jan. 1, 2026, the Texas Health and Human Services Commission implemented Phase I of the Integrated Dual Special Needs Plans (Integrated D-SNP) model by discontinuing the Dual Demonstration Program with the Medicare-Medicaid Plans (MMPs) in multiple demonstration counties.

Counties included in the Phase I implementation are:

• Bexar County: Molina Healthcare of Texas
• Dallas County: Molina Healthcare of Texas and Superior Health Plan
• El Paso County: Molina Healthcare of Texas
• Harris County: Molina Healthcare of Texas and United Healthcare
• Hidalgo County: Molina Healthcare of Texas and Superior Health Plan

MMP members chose a STAR+PLUS managed care organization (MCO) with an Integrated D-SNP in their demonstration county to continue their services.

The table below lists the Integrated D-SNPs implemented on Jan. 1, 2026, the corresponding county and the plan code.

The model is now in Phase II of implementation, which requires the remaining STAR+PLUS MCOs in Bexar, Dallas, El Paso, Harris and Hidalgo counties to begin operating Integrated D-SNPs on Jan. 1, 2027.

The table below lists the current Integrated D-SNPs and the additional STAR+PLUS MCOs (in bold) that will begin operating Integrated D-SNPs on Jan. 1, 2027, the corresponding county and the plan code.

STAR+PLUS MCOs are listed in the table and in the HHSC Appendix XXIX, STAR+PLUS Plan Codes and Contract Numbers of the STAR+PLUS Program Support Unit Operational Procedures Handbook.

Payment of Services as of Jan. 1, 2027

Beginning Jan. 1, 2027, dual eligible members may transition to a different MCO operating an Integrated D-SNP.

If dual eligible members transition to a different MCO, program providers, financial management services agencies (FMSAs) and Proprietary System Operators (PSOs) must update the MCO payer plan code in the EVV system for the dual eligible members. In addition, program providers, FMSAs and PSOs must bill the new payer with dates of service on or after Jan. 1, 2027.

Program providers, FMSAs and PSOs using a third-party vendor for billing need to notify the third-party vendor about the changes.

Responsibilities of Program Providers, FMSAs and PSOs: Members Select a Different MCO Operating an Integrated D-SNP

Program providers, FMSAs and PSOs should continue to use the current authorization in the EVV system for their members through Dec. 31, 2026.

For dates of service beginning Jan. 1, 2027, and after, program providers, FMSAs and PSOs should:

• Identify the STAR+PLUS MCO operating an Integrated D-SNP and the plan code that dual eligible members transitioned to.
• Create a new authorization for dual eligible members, using the new STAR+PLUS MCO operating an Integrated D-SNP’s plan code and applicable information from the authorization that ends on Dec. 31, 2026.
• Manually enter the dual eligible members new STAR+PLUS authorization into their EVV system.

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 with EVV required services directly to TMHP for EVV claims matching.

HHSC Policy Webinars

STAR+PLUS Policy is hosting the Texas Integrated Dual Eligible Special Needs Plans (D-SNPs) Phase 2 (2027) webinars for members enrolled in Medicare and Medicaid and healthcare providers to learn more about the 2027 expansion.

Member Information Session Webinar

Oct. 19, 2–3 p.m. Central time

Register for the webinar.

Provider Information Session Webinar

Oct. 21, noon to 1 p.m. Central time

Register for the webinar.

Resources

Review the HHSC Options for Medicare and Medicaid Dual Coverage webpage.

For more information about the Dual Demonstration Transition, email HHSC Managed Care Initiatives.