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New Doula and CHW Provider Types for CPW Case Management Services Available December 1, 2024

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective December 1, 2024, Texas Medicaid will now offer two new separate provider types, doula and community health worker (CHW), for providers of Case Management for Children and Pregnant Women (CPW) services.

Doulas and CHWs who successfully enroll in the Provider Enrollment and Management System (PEMS) will be authorized to provide CPW case management services. The Texas Health and Human Services Commission (HHSC) will manage all certifications, attestations, and documents required for enrollment through the Texas Medicaid & Healthcare Partnership (TMHP) using PEMS.

Billing of Services

Providers that have enrolled with Texas Medicaid as doulas or CHWs may submit claims to Texas Medicaid for the billing of CPW case management services.

PEMS Updates

The Licenses/Certification/Accreditation page in PEMS will be updated to capture all the required documentation for enrollment as a doula or CHW.

Doulas Enrolling With the Experience Pathway

Doulas who are enrolling with the experience pathway must:

  • Attest to having five years of experience as a doula within the last seven years.
  • Attest to attendance in three births in the last seven years.
  • Submit an approval letter from HHSC.
  • Attest to having completed Health Insurance Portability and Accountability Act (HIPAA) training.
  • Upload their HIPAA certification.
  • Submit three professional letters of recommendation dated in the last seven years.

Doulas Enrolling With the Training Pathway

Doulas who are enrolling with additional training in core competencies must:

  • Attest to attendance in three births.
  • Submit an approval letter from HHSC.
  • Attest to having completed HIPAA training.
  • Upload their HIPAA certification.
  • Submit three professional letters of recommendation dated in the last seven years.
  • Attest to having completed all training that is necessary to meet the core competency requirements.

Community Health Workers (CHWs)

CHWs must:

  • Submit an approval letter from HHSC.
  • Submit their CHW certification number and state the expiration date, which should be no more than two years from the date of enrollment as CHW.
  • Attest to having completed HIPAA training.
  • Upload their HIPAA certification.

Note: After a provider has submitted the required documentation, including certifications and attestations, they must associate their certificate and attestation with the corresponding practice location.

Providers can refer to the PEMS Instructional Site for additional guidance on completing their enrollment.

For more information, call the TMHP Contact Center at 800-925-9126.