Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 114 - DOULA SERVICES
Section 317:30-5-1217 - General coverage
Universal Citation: OK Admin Code 317:30-5-1217
Current through Vol. 42, No. 1, September 16, 2024
(a) Covered benefits.
(1)
Prenatal/postpartum
visits. There is a total of eight (8) visits allowed for the member. The
doula must work with the member to determine how best to utilize the benefit to
meet the needs of the member.
(2)
Labor and delivery. There is one (1) visit allowed, regardless of
the duration.
(b) Visit requirements.
(1) The
minimum visit length is sixty (60) minutes.
(2) Visits must be face-to-face.
(A) Prenatal and postpartum visits may be
conducted via telehealth.
(B) Labor
and delivery services may not be conducted via telehealth.
(c) Service locations.
(1)
Prenatal and postpartum.
(A) Doulas must coordinate directly with the
member and their family to determine the most appropriate service location for
prenatal and postpartum visits.
(B)
Service locations may include the following:
(i) Member's place of residence;
(ii) Doula's office;
(iii) Physician's office;
(iv) Hospital; or
(v) In the community.
(2)
Labor and delivery
services. There is no coverage for home birth(s).
(d) Referral requirements. Doula services must be recommended by a physician or other licensed practitioner of the healing arts who is operating within the scope of their practice under State law.
(1) The following providers may
recommend doula services:
(A)
Obstetricians;
(B) Certified Nurse
Midwifes;
(C) Physicians;
(D) Physician Assistants; or
(E) Certified Nurse Practitioners.
(2) The SoonerCare Referral Form
must be completed and submitted, noting the recommendation for doula
services.
(e) Prior authorization (PA) requirements.
(1) A PA is not required to access the
standard doula benefit package.
(2)
A PA may be submitted, for members with extenuating medical circumstances, if
there is need for additional visits beyond the eight (8) prenatal/postpartum
visits.
(f) Medical records requirements. The medical record must include, but is not limited to, the following:
(1) Date of
service;
(2) Person(s) to whom
services were rendered;
(3) Start
and stop time for the service(s);
(4) Specific services performed by the doula
on behalf of the member;
(5)
Member/family response to the service;
(6) Any new needs identified during the
service; and
(7) Original signature
of the doula, including the credentials of the doula.
(g) Auditing review. All doula services are subject to post-payment reviews and audits by the OHCA.
(h) Reimbursement.
(1) All doula services, that are outlined in
Part 114 of this Chapter, are reimbursed per the methodology established in the
Oklahoma Medicaid State Plan.
(2)
There are no allotted incentive payments.
Disclaimer: These regulations may not be the most recent version. Oklahoma 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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