The Texas Health and Human Services Commission published proposed Electronic Visit Verification rule updates in the Texas Register on April 3, 2026. The public comment period has closed. These rules are moving toward finalization — and if your home health agency has not taken a hard look at what they mean operationally, now is the time.
Most of the coverage of these rule changes has focused on the compliance mechanics. What has received almost no attention is the real-world access to care impact on two specific patient populations that are already among the most underserved in the Texas home health system.
As a Houston-based home health billing specialist who works with agencies across Texas every day, I want to lay out exactly what is changing, what it means in practice, and what your agency should be doing right now.
What the Proposed EVV Rules Actually Change
The proposed amendments to Texas Administrative Code clarify several things that were previously ambiguous in EVV policy. The most significant change for most home health agencies is this: EVV is now explicitly required any time Medicaid pays any portion of a claim — even when a third-party payer such as private insurance is the primary payer and Medicaid is only covering a secondary portion of the cost.
This closes a loophole that some agencies were using — intentionally or not — to avoid EVV compliance on dual-coverage visits. Going forward there is no ambiguity. If Medicaid money touches the claim in any way, EVV applies.
The proposed rules also update definitions related to dual eligible members, reflect the end of the STAR+PLUS Medicare-Medicaid Plan demonstration program that concluded December 31, 2025, and remove Free Text Reviews from the list of compliance review types since HHSC and managed care organizations stopped conducting those reviews in 2023.
| THE ENFORCEMENT THRESHOLD YOUR AGENCY NEEDS TO KNOW Texas has resumed strict EVV compliance usage reviews. Agencies whose EVV compliance score falls below an 80% mobile app usage rate — meaning manual visit entries represent more than 20% of documented visits — now face formal corrective action plans. This is not a warning threshold. It is an enforcement trigger. |
The Access to Care Problem Nobody Is Discussing
Here is where the policy conversation has been incomplete — and where the real-world impact is being felt by agencies and patients right now.
Problem One — Contracted Therapy Providers Refusing EVV Compliance
A significant number of Texas home health agencies do not employ physical therapists, occupational therapists, or speech-language pathologists directly. They use contracted therapy providers to deliver these services to their patients under the home health benefit.
What is happening on the ground right now is that many of those contracted therapy providers are refusing to comply with EVV requirements. The reasons vary — some object to the technology requirements, some have concerns about patient privacy, some simply have not built EVV compliance into their operational model and are unwilling to do so.
This puts home health agencies in an impossible position with three bad options. They can drop the therapy contractor — which means finding a replacement, often in an area with limited provider availability. They can lose the patient’s therapy services entirely — which means a patient who was receiving medically necessary PT, OT, or SLP services simply stops receiving them. Or they can document those visits through manual entry — which counts against their mobile app usage rate and risks pushing the agency below the 80 percent compliance threshold that triggers formal corrective action.
None of those options serve the patient. And the patient population most affected — those who depend on Medicaid-funded contracted therapy services delivered in the home — is not a population with a lot of alternatives.
Problem Two — Non-Private Duty Home Health Patients
The second access to care concern involves patients who need home health services but do not qualify for or require private duty nursing. This is already an underserved segment within the Texas Medicaid home health system — agencies serving these patients operate with tighter margins, more documentation complexity, and less flexibility than those serving private duty populations.
Stricter EVV compliance enforcement without operational flexibility creates an additional burden for agencies serving this population. When every visit must be documented through a mobile app — and the realities of serving patients in their homes sometimes make that difficult or impossible — agencies face a compliance versus care delivery tension that should not exist if the policy was designed with operational reality in mind.
The result is that some agencies are becoming more selective about which patients they serve. That selectivity, driven by compliance risk rather than clinical need, is an access to care problem — even if it does not appear in any CMS data report as such.
The Legitimate Purpose Behind EVV — And Why Implementation Matters
It is important to be clear about something. The intent behind EVV is sound. Fraud in the Texas Medicaid home health system is real, it is documented, and it costs taxpayers, legitimate providers, and — most importantly — the patients those dollars are supposed to serve. The CMS moratorium on new home health and hospice Medicare enrollments announced this week is a direct response to documented fraud patterns. EVV exists to create a verifiable record that services were actually delivered.
The problem is not the goal. The problem is implementation that does not account for the realities of how home health actually operates in Texas — particularly the widespread use of contracted therapy providers and the operational complexity of serving non-private duty Medicaid patients.
A policy that inadvertently restricts access to care for the patients it was designed to protect is not achieving its goal. And the agencies caught in the middle — the legitimate providers who are not committing fraud and are simply trying to serve their patients — deserve a clearer implementation pathway than the current rules provide.
What Your Agency Should Be Doing Right Now
Whether these proposed rules are finalized as written or modified before adoption, the direction of EVV enforcement in Texas is clear. Stricter compliance reviews, harder enforcement thresholds, and less tolerance for manual entry are the direction of travel. Here is what your agency should be addressing immediately.
• Audit your current EVV mobile app usage rate. If you are below 80 percent you are already at risk under current enforcement standards — not just the proposed rules.
• Review every contracted therapy provider relationship. Have a direct conversation about EVV compliance. Document their position in writing. If they will not comply you need to know now and develop a plan before it creates a compliance problem for your agency.
• Identify which patient visits are generating manual entries and why. Some manual entries are legitimate — EVV reason codes exist for a reason. But if manual entries are systemic rather than exceptional you have an operational issue that needs to be addressed.
• Review your dual coverage visit documentation. The proposed rules explicitly close the third-party payer gap. If you have been relying on that gap for any visits make sure your EVV compliance covers those claims going forward.
• Consult with your billing specialist about how EVV compliance data affects your claims. Billing errors that stem from EVV documentation gaps are among the most common and most preventable sources of Texas Medicaid home health denials.
A Note on the Timing
These proposed rules were published April 3, 2026. The comment period closed May 4, 2026. If you had concerns about the access to care impact and wanted to submit formal comments you have missed that window for this rule cycle.
However, the access to care issues described above are not going to resolve themselves when the rules finalize. The Texas Association for Home Care and Hospice (TAHCH) and the Home Care Association of Florida (HCAF) are both appropriate channels for raising these concerns with HHSC through organized industry advocacy. If your agency is experiencing the contracted therapy provider refusal problem or the non-private duty patient access issue in a concrete and documented way, I would encourage you to bring that documentation to your state association.
Policy changes in response to real-world harm require real-world evidence. The agencies experiencing these issues are that evidence.
