New Pennsylvania Medicaid Provider Types in 2024 Released

In 2024, the Pennsylvania Office of Medical Assistance Programs (OMAP) will begin enrolling new provider types in the MA program to prepare for upcoming service expansion. Pharmacists will be enrolled as individual practitioners in early 2024. Pharmacies are currently enrolled, but now individual pharmacists will be enrolled too. Enrolled pharmacists will be able to provide services to MA beneficiaries within the scope of their licensure. MCOs will be able to submit encounters to the Department of Human Services for claims paid to pharmacists. Also beginning in early 2024, doulas will be enrolled in the MA Program for the purposes of managed care only. In 2024, doulas are required to be a part of maternity care teams, which MCOs must use to provide perinatal services for at least 25% of their covered births. The doulas may be employed or contracted by the birthing hospital or a physician group, or they may be independent. Like pharmacists, this enrollment will allow MCOs to submit encounters to DHS for any claims paid to doulas. To be enrolled in the MA Program, doulas will need to possess the PA Certification Board’s Certified Perinatal Doula credential. By establishing doula services in the managed care delivery system throughout 2024, OMAP is paving the way for doula services to be added to the State Plan once capacity has been established, hopefully in 2025. Community Health Workers (CHWs) are also going to be enrolled in the MA Program soon and are on track to be added to the State Plan in 2025. MCOs must work with CHWs as part of their Community Based Care Management programs. PACHC is seeking clarification from DHS on if and when each of these providers become eligible to generate an FQHC encounter and will share additional information when available.