DSS opens family‑medicine opt‑in and expands case‑rate start windows for maternity bundle

Fatmata Williams, deputy Medicaid director at the Department of Social Services, opened a provider forum and said the agency will continue regular engagement as the maternity bundle program matures.

DSS announced a policy change allowing participating practices to request that family medicine providers who deliver exclusively maternity care be added to the bundle. Tiffany, a DSS presenter, said requests will be reviewed case‑by‑case during the first program year and will move to annual case‑by‑case reviews in subsequent years. "This opt in option will allow practices to request for their family medicine providers to be added into the program," Tiffany said.

The agency also expanded when practices may initiate case‑rate payments. Tiffany said that beginning April 2025 practices can initiate case‑rate payments for patients in the second and third trimesters as well as the postpartum period. Previously, for the first three months of the program, case‑rate initiation had been limited to the second trimester. "This has now been expanded so that this can be done in the third and postpartum period as well," Tiffany said.

DSS staff emphasized that family‑medicine opt‑ins will affect year‑end reconciliation because family‑medicine maternity costs will be included in the reconciliation calculation when providers receive the case‑rate payment rather than fee‑for‑service. Providers wanting to opt in were instructed to contact their practice's provider engagement services representative or the general PES email; Tiffany said DSS will approve and review requests on a case‑by‑case basis in year one.

The agency urged providers to expect annual reviews for opt‑in requests in later years and to follow guidance posted with meeting materials.