New Doula and CHW Provider Types for CPW Case Management Services Available

12/17/2024

What’s New

On December 1, 2024, Texas Medicaid introduced two new provider types to enhance case management services: Doulas Providers and Community Health Workers. These additions aim to streamline services, improve accessibility, and ensure comprehensive care for clients.

Key Details

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

Billing of Services

When you enroll with Texas Medicaid as doulas or CHWs, you 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.
Attest to having completed Health Insurance Portability and Accountability Act training.
Submit an approval letter from HHSC.
Submit three professional letters of recommendation dated in the last seven years.
Upload their HIPAA certification.

Doulas Enrolling with the Training Pathway

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

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

Community Health Workers (CHWs)

CHWs must:

Attest to having completed HIPAA training.
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.
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.

If you have questions or would like additional information, please contact our Medicaid Provider Network team at 1-855-212-1615 or email questions to Texas Medicaid Network Department.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.