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Reminder: 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.

Reminder: 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.

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.

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.

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.

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.