Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 463.000 - Doula Services
Section 463.404 - Provider Eligibility
Universal Citation: 130 MA Code of Regs 130.463
Current through Register 1531, September 27, 2024
Payment for services described in 130 CMR 463.000 will only be made to doulas or doula group practices who are participating in MassHealth on the date of service. Doulas must meet the following eligibility requirements.
(A) In-state Providers. To be eligible to participate in MassHealth, an in-state doula must meet the following qualifications:
(1) be at least 18 years old;
(2) complete trainings provided by the
Executive Office of Health and Human Services (EOHHS) on topics including, but
not limited to:
(a) overview of the MassHealth
Doula Services Program, including best practices for meeting the needs of
diverse MassHealth members and their families;
(b) federal and state laws and regulations
established for the protection of the privacy and security of the member
information doulas create, use, collect, store, and/or transmit;
(c) navigating MassHealth-covered services
and community resources for MassHealth members; and
(3) demonstrate competency in the following
areas, either through the Formal Training Pathway or Experience Pathway as
defined in
130
CMR 463.404, subject to EOHHS review and
approval:
(a) basic understanding of the
following topics at a minimum, as those topics relate to the ability to provide
emotional, informational, and physical support to individuals and families
during the perinatal period, regardless of the outcome of the pregnancy:
1. maternal anatomy and physiology during the
perinatal period, including basic fetal growth and development in each
trimester of pregnancy;
2. common
medical interventions during pregnancy, childbirth, and the postpartum
period;
3. common potential
complications associated with pregnancy, childbirth, and the postpartum period
including, but not limited to
a. pregnancy and
infant loss;
b. mental health
conditions including Perinatal Mood and Anxiety Disorders (PMADs);
c. substance use disorder (SUD);
and
d. high blood
pressure;
4. labor and
delivery comfort measures;
5. best
practices for supporting members in advocating for their needs and making
informed decisions using a trauma-informed approach; and
f. basic newborn care, including the
fundamentals of breastfeeding/chestfeeding.
(b)
Formal Training
Pathway. Provide a certificate of completion or other proof of
doula training(s) attended, and/or proof of doula certification by a
doula-certifying organization and a completed attestation form, using the
template provided by EOHHS, stating that the completed formal training(s)
covered the required competencies listed above.
(c)
Experience
Pathway. Provide the following recommendations using templates
provided by EOHHS:
1. recommendations from at
least three different former clients for whom the prospective MassHealth doula
provided doula services (either paid or volunteer) within the last five years;
and
2. recommendations from at
least two different licensed health care providers such as physicians,
midwives, social workers, or nurses who observed the applicant providing doula
services within the last five years.
(B) Out-of-state Providers. To participate in MassHealth, an out-of-state doula must obtain a MassHealth provider number and meet the following criteria:
(1) be legally authorized to perform the
services of a doula in their own state;
(2) participate in their state's Medicaid
program (or the equivalent); and
(3) meet the conditions set forth in
130
CMR 450.109: Out-of-state
Services.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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