Key policy shifts affect IDD providers in 2026

As the new year approaches, recent policy changes in Texas, South Dakota, and Oregon will directly influence operations for intellectual and developmental disabilities (IDD) providers. These developments involve electronic visit verification (EVV) adjustments, reimbursement rate revisions, and licensing updates. Providers should take note to ensure compliance and optimize service delivery as these changes take effect in 2026.

EVV requirements update in Texas 

Effective January 1, 2026, the Texas Health and Human Services Commission (HHSC) will end the Dual Demonstration Program that integrates Medicare-Medicaid Plans (MMPs) in select counties, including Bexar, Dallas, El Paso, Harris, and Hidalgo. With this sunset, providers, financial management service agencies (FMSAs), and third-party operators must transition to new payer plan codes and authorizations for services delivered on or after this date. Existing authorizations linked to MMPs should be reviewed and manually entered into EVV systems before the deadline to avoid interruptions in billing or EVV claims processing. Providers that fail to update their EVV records risk delays in payment and compliance challenges.

South Dakota increases Health Home rates 

South Dakota’s Department of Social Services approved State Plan Amendment SD-25-0010 on December 1, 2025, which revises reimbursement mechanisms for the Health Home program. These adjustments, effective retroactively from July 1, 2025, raise per-member-per-month payments and modify quality-incentive structures. Providers are advised to reconcile previously submitted claims with the updated rate framework and prepare for potential true-up payments as the new rates are fully implemented. Timely claim reviews ensure accurate reimbursement and financial planning aligned with the revised payment structure.

Oregon lifts provider moratorium

After a temporary pause, the Oregon Office of Developmental Disabilities Services (ODDS) has resumed accepting applications for new IDD agencies, 24-hour residential providers, and Standard Model Agency (SMA) endorsements as of early December 2025. This reopening provides an opportunity for agencies to expand capacity amid ongoing demand for IDD services. Agencies planning to enter or grow within Oregon should act promptly to secure approvals and begin service delivery under the renewed licensing framework.

Operational considerations for Q1 2026 

These three significant policy movements mark an operational inflection point heading into the first quarter of 2026. Providers operating across these states should prioritize:

• Auditing and updating EVV authorizations in Texas to align with MMP sunsets 
• Reviewing South Dakota Health Home claims to optimize reimbursements 
• Submitting timely licensure applications in Oregon to benefit from capacity expansion 
• Adjusting internal compliance and billing workflows to accommodate all new state requirements

Addressing these items proactively will mitigate administrative disruptions, safeguard revenue streams, and position providers for sustained service delivery success in the evolving IDD policy landscape.