NOTICES
DEPARTMENT OF HUMAN SERVICES
Addition of Doula Services to the Medicaid State Plan and Medical Assistance Program Fee Schedule
[54 Pa.B. 8204]
[Saturday, December 14, 2024]The Department of Human Services (Department) announces the addition of doula services to the Medical Assistance (MA) Program Fee Schedule and submits a State Plan Amendment to the Centers for Medicare & Medicaid Services to add doula services to the Commonwealth's Medicaid State Plan.
Doulas are nonmedical, trained professionals who provide emotional, physical and informational support and guidance during the perinatal period with the goal of improving health outcomes for pregnant and postpartum individuals and their infants. Certification from the Pennsylvania Certification Board as a Certified Perinatal Doula is required for Doulas to enroll in the MA Program.
In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department announces the addition of the following procedure codes to the MA Program Fee Schedule. The table also identifies the accompanying modifiers, MA fees, MA Fee Schedule limits and effective dates for the procedure codes.
Procedure Code Modifier Service Description MA Fee Effective Date Limits T1032 U7 Doula Services
(Prenatal visit)$100 01/01/25 Combined limit of
12 visits per calendar yearT1032 U8 Doula Services
(Postpartum visit)$100 01/01/25 T1032 U9 Doula Services (Other services—fertility and preconception counseling, pregnancy loss, infant loss or termination of pregnancy) $175 01/01/25 2 total ''other services'' per calendar year T1033 Labor and Delivery $1,000 01/01/25 Limit one per pregnancy The Department will issue an MA Bulletin to inform providers enrolled in the MA Program of the addition of doula services to the MA Program and how to bill for the provision of doula services.
Fiscal Impact
The estimated fiscal impact of the addition of doula services for Fiscal Year (FY) 2025-2026 is $1.400 million in total funds ($0.461 million in State funds). The estimated fiscal impact of the addition of doula services for FY 2026-2027 is $8.500 million in total funds ($2.579 million in State funds).
Public Comment
Interested persons are invited to submit written comments regarding the addition of doula services and the procedure codes being added to the MA Program Fee Schedule to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or to RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revision to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1664. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2024-25 is $461,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are $2,579,000; (4) 2023-24 Program—$3,594,000,000; 2022-23 Program—$3,418,000,000; 2021-22 Program—$4,557,000,000; (7) MA—Capitation; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 24-1790. Filed for public inspection December 13, 2024, 9:00 a.m.]
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