Breanna Reeves |
The Department of Health Care Services (DHCS) formally published the long-awaited Medi-Cal Provider Manual for the doula services benefit just before the benefit takes effect on Jan. 1, 2023.
After months of deliberation, revision and commentary among the DHCS stakeholder workgroup, an assembly of more than a dozen maternal health advocates, doulas, birth workers and community-based organizations, and the DHCS benefits division, the provider manual formally defines the scope of doula services, categorizes covered services under both the fee-for-service and managed care delivery systems. It also outlines doula enrollment eligibility criteria.
“The Provider Manual had really impactful stakeholder engagement that is crucial to ensuring the benefit is as equitable and sustainable as possible. National Health Law Program (NHeLP) is very grateful to work with a wonderful group of community-based doulas and stakeholders who have shared their time, insights and expertise,” NHeLP Health Policy Analyst Alexis Robles-Fadet said via email.
On November 7, DHCS submitted the State Plan Amendment (SPA 22-0002) for doula services to the Centers for Medicare and Medicaid Services. The SPA covers a broad description of covered services under the doula benefit. Whenever the state plans to make a change to its program, an SPA must be submitted to CMS for federal approval. CMS has until February 5 (90 days) to review the SPA.
Unlike the State Plan Amendment, the provider manual offers greater details about doula services, full-spectrum doula care, non-covered services, billing codes and includes more information about documentation requirements for doulas who seek to enroll with Medi-Cal.
According to the provider manual, covered services include up to a total of 11 visits, including postpartum visits and support at stillbirths or abortions, for a total rate of $1,154 per birth.
Doula application and enrollment
With the provider manual published, the state is one step closer to expanding access to doula services across the state. DHCS initially planned for the benefit to take effect on July 1, 2022, but pushed back the date to January 1, 2023 after receiving feedback from stakeholders and refining aspects of the doula benefit.
“This change is needed to allow DHCS to continue working with stakeholders to further define and develop the benefit, implement needed changes to the Provider Application and Verification for Enrollment (PAVE) online system to allow doulas to enroll as Medi-Cal providers, seek and obtain federal approval and give Medi-Cal managed care plans additional time to plan for and implement the benefit. The new effective date will also allow for a more robust stakeholder engagement process to assist DHCS with implementation,” according to the DHCS website.
DHCS is also providing a demonstration series for doula providers to learn how to submit enrollment applications on the PAVE portal. Doulas or doula groups must enroll using the PAVE portal to submit fee-for-service claims. The first demonstration, “Introduction to PAVE for Doula Providers,” is available online. The second demonstration will be held virtually as a live session on Jan. 10, 2023 where doulas will be able to ask questions live and receive real-time responses.
As the launch of the doula services benefit draws closer, doulas and community-based organizations will be able to submit their applications to enroll as Medi-Cal providers, allowing them to formally bill for their services and support families with Medi-Cal. The majority of covered populations in California are served through Medi-Cal managed care plans, noted René Mollow, Deputy Director of Health Care Benefits & Eligibility, in an interview back in September.
Doulas will need required documents and/or attestations and will have to obtain a National Provider Identifier (NPI).
Qualifications for enrollment
Qualifications for enrollment for all doulas include: a copy of state-issued identification that demonstrates that doula is at least 18 years old; Adult CPR certification of completion by American Red Cross or American Heart Association; Infant CPR certification of completion by American Red Cross or American Heart Association; and certificate of completion or attestation of Health Insurance Portability and Accountability Act (HIPAA) Training.
Additionally, doulas will be required to submit specific qualifications depending on which training pathway they enroll in (Training Pathway or Experience Pathway). Doula services also require a written recommendation by a physician or other licensed practitioner “of the healing arts acting within their scope of practice under state law.” However, the licensed provider who submits a recommendation does not need to be enrolled in Medi-Cal or be a network provider within the beneficiary’s managed care plan.
Medi-Cal training for new doula benefit
Ahead of the new year, local organizations are preparing doulas, birthworkers and community organizations by hosting Medi-Cal training for the new doula benefit. Inland Empire Health Plan (IEHP) and Riverside Community Health Foundation (RCHF) hosted a Doula Medi-Cal Provider Transition Training earlier this month to discuss the provider process with members of DHCS, IEHP, Molina Health and Health Net.
“Overall, I found the training/information to be very helpful. Many of the requirements I’ve met (and many other birthworkers have as well), but there was one component I had to obtain and another I’m finishing now,” Karen Sykes, doula and founder of CaliSis Doulas, said via email. Sykes attended the RCHF training to learn more about the Medi-Cal doula benefit. “RCHF has been great in providing timely and meaningful information on how to contract with the providers within the California Medi-Cal system for doula services.”
Sykes has been supporting families during birth for about 12 years in an unofficial capacity, but has been working as a doula in an official capacity for the last three years. Sykes is also part of the Sankofa Birthworker’s Collective of Inland Empire, a community-based organization comprised of birth workers who provide support and education to Black birthing people throughout Riverside and San Bernardino Counties. Sykes said she is currently serving three families through the program.
“In the new year, we anticipate work on the enrollment of doulas as Medi-Cal Providers, ensuring that Medi-Cal enrollees know about the new benefit and are able to access it and ascertaining how long the ramp up to the provision of benefits and reimbursement will take,” Robles-Fadet said.
California is one step closer to formalizing doula services as a covered benefit within the health care system and recognizing doula services as beneficial, necessary and impactful to Black families and families of color who often have worse birth outcomes within the hospital setting.