Policy changes from Texas Medicaid and from Medicaid managed care plans in Texas, with the Medicaid prior authorization lists and payer contacts we track for the state. Each item links to its public source.
The Texas Medicaid & Healthcare Partnership (TMHP) rescheduled its monthly system maintenance outage from December 6, 2026 to a window beginning 6 a.m. Central time on Saturday, December 5, 2026, and ending 4 a.m. Central time on Monday, December 7, 2026. During this outage all web-based applications and functions are unavailable, so the billing team should plan submissions, eligibility checks and portal work around it.
TMHP will delay electronic funds transfer (EFT) payments by one business day because Wednesday, November 11, 2026 (Veterans Day) is a bank holiday. Providers receiving EFT payments can expect funds by Monday, November 16, 2026.
Texas Medicaid's Critical Incident Management System (CIMS) provider team will host a monthly provider demonstration webinar on November 18, 2026, from 1:00 to 2:00 pm, offered to providers who have CIMS access. The Texas Health and Human Services Commission encourages participation, and the session applies to CLASS, DBMD, HCS, TxHmL providers and LIDDAs.
TMHP published the recording, a PDF transcript, and a webinar document for the October 27 quarterly Home and Community-based Services (HCS) and Texas Home Living (TxHmL) webinar, which covers program updates. Billing teams serving HCS and TxHmL providers can use these materials to review the presented updates.
TMHP announced its 2026 LTCR provider webinar training schedule for November and December 2026, covering joint sessions for nursing facilities, assisted living facilities, HCSSAs, HCS/TxHmL providers, ICFs, and DAHS/PPECC providers. The notice is educational only and states no new billing, coverage, or documentation requirements; a billing team may share the schedule with clinical or administrative staff who support long-term care programs.
Beginning November 13 (the source gives the year context as 2026 from the issue date), the SEMARC Refresh function will be available every three hours instead of every 24 hours, so searches that do not require manual DFPS review can be checked more often. Searches requiring manual review continue on standard DFPS timelines. The billing team should update how staff check search status and ensure search submissions include full subject information, especially the SSN.
TMHP announced the 10th annual free, one-day virtual PASRR (Preadmission Screening and Resident Review) Conference on Thursday, November 5, 2026, for nursing facility staff, IDD providers, local authority staff, hospital social workers, and PASRR recipients and families. The event is educational only, with no coverage, billing, or claims-processing rule changes stated; continuing education units are offered.
Texas HHSC is accepting applications for members of the State Preventive Health Advisory Committee, which advises on the state plan for the Preventive Health and Health Services Block Grant. Applications are due by 11:59 p.m. on November 30, 2026, and appointed members would serve terms expiring December 31, 2034 unless otherwise noted. This is an administrative notice with no billing, coverage, or claims requirements for the practice.
Texas Medicaid (TMHP) will update the TMPPM Children's Services Handbook section 3.2.8 effective December 1, 2026 to clarify dental informed consent and treatment plan documentation for services under deep sedation or general anesthesia. When a full dental exam or diagnostic imaging cannot reasonably be done beforehand, the provider must document the clinical circumstances, still obtain written informed consent describing the anticipated evaluation and possible treatment scope, and identify and document tooth and surface IDs as soon as they can be determined.
TMHP announced registration for the free, one-day virtual Cross Agency Employment Conference on Tuesday, November 17, 2026, which covers employment supports for people with disabilities. This is an educational event with no billing, coverage, or claims requirements for the practice.
HHSC is offering a mandatory online quarterly webinar on Nov. 18, 2026 at 1 p.m. for financial management services agencies (FMSAs) that are contracted with HHSC or a managed care organization. Registration closes at 3 p.m. on Nov. 17, 2026, and the source recommends running a computer connectivity test before the session.
TMHP scheduled system maintenance on Saturday, November 7, 2026 from 7:00 a.m. to 10:00 a.m. may cause TEA search results in SEMARC to return an error. Providers who receive an error should rerun the search after the maintenance window ends, and SEMARC is expected to return to normal afterward.
On November 1, 2026, the state-provided Electronic Visit Verification (EVV) system HHAeXchange and proprietary EVV systems automatically adjusted for Daylight Saving Time. This adjustment means billable time for EVV visits recorded during the time change will increase by one hour in the EVV system. The system automatically accounts for the change; manual visits should be recorded based on actual service start and end times.
Effective October 30, 2026, Texas HHSC now requires exact unit matching between Electronic Visit Verification (EVV) records and claims for in-home respite services under CLASS and DBMD programs. Claims with mismatched units will be denied with an EVV06 rejection code. Billing teams must verify EVV units match claim units before submission.
This is a reminder notification about the Texas ICF UPL Program's fourth-quarter FFY 2026 Intergovernmental Transfer (IGT) payment. The notice provides deadlines and instructions for Texas ICF providers to schedule and transfer IGT funds through TexNet by November 4, 2026, with settlement on November 5 and expected payment release on November 27, 2026.
This is a recruitment notice for the Texas Health and Human Services Commission's Preparedness Coordinating Council, seeking members to serve on an advisory body focused on emergency preparedness and public health response. This is an administrative announcement with no impact on healthcare billing, claims, coverage, or reimbursement.
The Texas Health and Human Services Commission is seeking members to serve on the Statewide Medicaid Drug Utilization Review Board. This is a recruitment notice for board membership with an application deadline of November 29, 2026. This is not a billing, coverage, coding, or claims processing policy change and does not affect how the practice bills or submits claims to the payer.
HHSC is holding a public rate hearing on November 20, 2026, to gather testimony on proposed Medicaid payment rates for Non-Medical Transportation (NMT) services effective July 1, 2026, and Employment Services rates effective January 1, 2027, for the YES and HCBS-AMH Waiver Programs in Texas. Rate packets are now available for review, and written comments may be submitted until 5 p.m. CDT on the hearing date.
UnitedHealthcare Community Plan of Texas now conducts structured medical record review of acute care readmissions occurring within 31 days of discharge at the same facility or tax ID group. The practice must submit complete medical records for both the initial and readmission stays within 60 calendar days of the payer's written request, or the readmission claim may be denied. The payer reviews whether readmissions were clinically related to premature discharge, preventable, and correctly billed per CMS guidelines.
The Intellectual Disability/Related Condition (ID/RC) Assessment Form 8578-CFC will transition from the CARE system to the Long-Term Care Online Portal (LTCOP) effective February 1, 2027. After this date, HHSC and TMHP will accept Form 8578-CFC submissions only through LTCOP. Local intellectual and developmental disability authorities must submit all outstanding assessments in CARE before January 22, 2027, or they will require re-entry in LTCOP.
Texas Medicaid corrected reimbursement rate information for the Allergy Testing spreadsheet that was originally published March 9, 2026. The corrected fee schedule applies to services dated on or after March 1, 2026, covering 27 procedure categories reviewed at a November 10, 2025 public rate hearing. Billing teams should obtain and verify the updated spreadsheet to ensure accurate claim submission going forward.
The Long-Term Care Online Portal (LTCOP) experienced an outage from October 24–26, 2026, which may have resulted in missing forms. Billing staff should verify that all forms processed during this outage period are present in the portal, and contact the TMHP Help Desk if any forms cannot be located.
SEMARC system will be unavailable on October 29, 2026 from 7:00 p.m. to 9:00 p.m. CST due to scheduled DFPS system updates. Providers and billing staff should avoid submitting time-sensitive information during this maintenance window.
The LTCR TULIP platform will undergo two scheduled maintenance windows to transition the Expedited Life Safety Code (ELSC) Inspection request process for Nursing Facilities to a new LPI format. The first transition occurs October 31, 2026, and the second occurs November 7, 2026. System downtime will occur on October 30 and November 6 at 7:00pm, with restoration at 7:30pm the following day.
Blue Cross and Blue Shield of Texas is clarifying that all prior authorization requests for applied behavioral analysis (ABA) services must include complete supporting documentation per the Texas Medicaid Provider Procedures Manual, Children's Services Handbook, Section 2.3.7. Incomplete or insufficient documentation may delay review and result in adverse determinations.
A recording and materials from the October 15 ICF/IID Quarterly Webinar with HHSC Long-term Care Regulation are now available for review. This is an educational resource publication, not a policy change affecting billing or claims processing.
Texas Medicaid providers must submit GA-46 reports by December 1, 2026, for Reporting Period 4 (opened September 1, 2026). Before submitting, providers must review and update their enrollment records in the Provider Enrollment and Management System (PEMS) to ensure access and successful report submission; delays in PEMS updates may occur depending on the type of change made.
SEMARC system maintenance occurred on October 25, 2026 from 8:00 a.m. to 6:00 p.m. CST, causing temporary unavailability or slowness. This maintenance window has already passed as of the analysis date (October 27, 2026), and the system has returned to normal operations.
This is an educational announcement of in-person training opportunities for Long-Term Care providers and regulatory staff across multiple facility types (nursing facilities, assisted living, intermediate care facilities, home and community support services, and emergency preparedness). Training sessions are scheduled October through December 2026 at various Texas locations; registration is open and cancellation is requested if attendance is not possible. This is informational only and does not establish billing, coverage, or operational policy changes.
The Long-Term Care Online Portal (LTCOP) operated by TMHP is currently unavailable due to a server outage. TMHP is actively working to restore service, but no estimated resolution timeframe has been provided. Billing teams should anticipate potential delays in submitting, accessing, or verifying long-term care claims and authorizations through this system.
Texas Medicaid (TMHP) is implementing a CMS-mandated provider revalidation initiative requiring certain Texas Medicaid providers to revalidate their enrollment by June 5, 2028. TMHP will notify affected providers by October 31, 2026, and providers must complete revalidation with no extensions available or face disenrollment from Texas Medicaid and associated state health care programs.
Effective November 1, 2026, Texas Medicaid introduces new prior authorization requirements for eplontersen (Wainua) treatment of hereditary transthyretin-mediated amyloidosis (hATTR) polyneuropathy, including mandatory vitamin A supplementation and therapy non-duplication rules. Existing prior authorization criteria for patisiran (Onpattro) and vutrisiran (Amvuttra) are updated to include eplontersen in non-duplication exclusions.
Texas Medicaid (HHSC Vendor Drug Program) is removing Foundayo from the formulary effective October 30, 2026, due to erroneous addition on September 20, 2026. All NDCs for Foundayo tablets (0.8 mg through 17.2 mg) will lose provisional coverage status, making the drug non-covered for Texas Medicaid beneficiaries.
CMS is offering optional virtual training webinars in November 2026 for nurses and therapists who collect OASIS data. The trainings cover OASIS resources, data collection conventions, and assessment procedures. These are informational sessions with no billing or clinical workflow implications for the medical billing team.
This guidance document provides procedural instructions for HHSC partners, providers, and staff on how to handle 'Potential Match' results when searching the SEMARC (Search Engine for Multi-Agency Reportable Conduct) database. It outlines verification steps to confirm whether a hiring candidate or employee actually appears on DFPS, TJJD, TEA, or HHSC registries, and directs employers to contact relevant agencies for clarification when uncertain.
SEMARC system will be unavailable on October 21, 2026, from 7:00 p.m. to 9:00 p.m. CST due to scheduled DFPS system updates. Billing and clinical staff should avoid submitting time-sensitive information during this window.
Texas Medicaid & Healthcare Partnership (TMHP) has rescheduled their monthly system maintenance outage from October 24, 2026, to October 25–26, 2026 (2 p.m. Sunday to 4 a.m. Monday, Central time). During this outage, all web-based applications and functions will be unavailable, affecting claims submission and eligibility verification.
Texas is implementing Phase II of the Integrated Dual Special Needs Plans (D-SNP) model effective January 1, 2027, requiring additional STAR+PLUS managed care organizations to begin operating Integrated D-SNPs in five counties (Bexar, Dallas, El Paso, Harris, and Hidalgo). Billing teams must update EVV system plan codes and create new authorizations for dual-eligible members who transition to different MCOs, and submit claims to the new payers for dates of service on or after January 1, 2027.
This is a task force membership recruitment notice with an application deadline of October 26, 2026. It is not a billing policy change and does not affect medical billing, coding, coverage, reimbursement, or clinical workflows at the healthcare practice.
This is an educational announcement for a 2027 conference on quality in long-term care, not a policy change affecting billing, coding, or reimbursement. Registration opens June 2027; no billing team action is required.
TEA system maintenance will cause temporary unavailability of TEA search results in SEMARC during two scheduled downtime windows in October 2026. Billing and administrative staff should anticipate errors when conducting TEA searches on October 18 (6:00–10:00 a.m.) and October 25 (6:00–8:00 a.m.) and retry searches after maintenance ends.
HHSC is notifying ICF providers of upcoming Intergovernmental Transfer (IGT) deadlines for FFY 2026 fourth-quarter UPL supplemental payments. Providers must schedule IGT transfers in TexNet by November 4, 2026, with settlement on November 5, 2026, and expected payment release by November 27, 2026. This is an administrative notification for facilities receiving ICF/IID UPL payments in Texas.
Texas HHSC is reinforcing provider enrollment requirements to ensure accurate and consistent disclosure of ownership, creditor, principal, subcontractor, and related information across both Medicare and Texas Medicaid records. Dual providers must reconcile discrepancies in owner/creditor/principal names, dates of birth, SSNs, legal entity names, and EINs between the two programs to prevent enrollment processing delays. Providers should review and resolve inconsistencies before their next revalidation, and allow up to 30 business days for PEMS maintenance changes to take effect before submitting revalidation applications.
Texas Medicaid is expanding peer specialist services (H0038) eligibility from age 21+ to age 14+, effective December 1, 2026. Providers may now bill telehealth peer specialist services using modifier 95 (synchronous audiovisual) or modifier FQ (synchronous telephone), replacing the prior in-person-only requirement.
Texas HHSC has published the October 2026 NDC-to-HCPCS Crosswalk for clinician-administered drugs (CAD), identifying relationships between National Drug Codes and Medicaid-reimbursable HCPCS codes. Prescribers and billing teams should review this quarterly update to ensure accurate claim submission for CAD processing in Texas Medicaid.
Blue Cross and Blue Shield of Texas launched the Medicaid Authorizations application in Availity Essentials in April 2026 to streamline prior authorization and notification requests for Texas Medicaid members. This guidance document published on October 15, 2026 provides reminders and tips for providers on how to access and navigate the application, including real-time prior authorization checks, concurrent review submission, and medical documentation uploads.
SEMARC system will be unavailable on October 15, 2026 from 7:00 p.m. to 9:00 p.m. CST due to scheduled DFPS system updates. Providers and billing staff should avoid submitting time-sensitive information during this window to prevent access delays or submission failures.
Texas Medicaid is conducting a retroactive utilization review of inpatient claims from September 26, 2024, through August 22, 2026, to identify overpayments related to the 30-day spell-of-illness limitation. Any excess payments identified will be recouped through deductions on future Remittance and Status (R&S) Reports. The billing team should monitor R&S Reports for recoupment activity and verify claim compliance with spell-of-illness rules.
The LTCR TULIP application system is transitioning to a new Licensing, Permit, and Inspection (LPI) platform for Nursing Facilities, Medication Aides, and Expedited Life Safety Code Inspection requests. The transition occurs in two phases: Medication Aides on October 24, 2026, and Nursing Facilities on October 31, 2026. TULIP will experience scheduled downtime during each transition, with the new platform resuming service the following day.
The LTCR TULIP application process for Nurse Aides will transition to a new Licensing, Permit, and Inspection (LPI) system tentatively on January 16, 2027. Beginning with this transition, all nurse aide certification and renewal applications submitted through LPI will require fingerprints as a new mandatory requirement. The application requirements remain similar, but the interface and submission format will change.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.