MedicaidDocumentationMedium impact
MAB2023122801
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Dec 28, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires providers to complete a specific CMS attestation form (MA 584) when billing for routine patient care costs associated with qualifying clinical trials. The form must be signed by both the principal investigator and health care provider and retained in medical records.
Action Required
Immediately: Billing team must obtain and use the new Medicaid Attestation Form on the Appropriateness of the Qualified Clinical Trial (MA 584) for all Pennsylvania Medicaid patients participating in qualifying clinical trials. Submit this form with prior authorization requests for clinical trial services in fee-for-service, and contact managed care organizations for managed care patients. Retain completed forms in patient medical records per state/federal requirements.