Thank you for being a Jefferson Health Plans participating provider and for your continued efforts to manage our members’ health.

We are writing to inform you that the updated Medical Assistance (MA) Program Sterilization Consent Form (MA 31) is available for use.

Effective immediately, all Medicaid enrolled providers must utilize the updated MA 31 form. Providers may refer to their *Promise Provider Handbook for sterilization consent form instructions, which remain unchanged, before completing the MA 31. Providers can download the MA 31 form by visiting this link: www.dhs.pa.gov/docs/Publications/Pages/Form-Search.aspx.

If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday - Friday, 9:00 a.m. – 5:30 p.m.).