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MassHealth Doula Services Program: Information for Doulas

As of December 8, 2023, MassHealth now covers doula services, subject to MassHealth coverage limitations, for MassHealth members while they are pregnant, during delivery, and up to 12 months after delivery.

MassHealth covers doula services provided by individual doulas practicing independently and doula group practices. Individual doulas and doula group practices need to enroll with MassHealth to provide services to MassHealth members and receive payment. Doula group practices cannot be part of a hospital, other group practice, or other healthcare facility. See MassHealth regulation 130 CMR 463.000: Doula Services for more information.

Pursuant to 130 CMR 463.407(B), doula services must be recommended by a physician or other licensed practitioner of the healing arts acting within the scope of their practice under state law. MassHealth notes that the MassHealth Chief Medical Officer has issued a standing recommendation which recommends doula services, subject to the limitations and conditions described in 130 CMR 463.000 and the MassHealth Doula Guidelines for Medical Necessity Determination For Doula Perinatal Visits, for all pregnant and postpartum MassHealth members. The standing recommendation is located in Section I of the Guidelines, which can be found at the following link: MassHealth Guidelines for Medical Necessity Determination. Due to the standing recommendation, MassHealth does not require pregnant and postpartum MassHealth members to obtain an additional recommendation for the purposes of 130 CMR 463.407(B).

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Eligibility Criteria for MassHealth Doula Providers

Note: The below eligibility criteria are described in more detail in 130 CMR 463.000: Doula Services.

Doulas must meet the following criteria to be eligible to enroll as a MassHealth doula provider:

  • Be at least 18 years old; 
  • Complete the free online MassHealth Doula Provider Training prior to submitting an application (see the Enrolling as a MassHealth Doula Provider section below for more information)
  • Demonstrate competency in the following areas, either through the Formal Training Pathway or Experience Pathway as defined in 130 CMR 463.404, subject to Executive Office of Health and Human Services (EOHHS) review and approval: 
    • 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: 
      • maternal anatomy and physiology during the perinatal period, including basic fetal growth and development in each trimester of pregnancy; 
      • common medical interventions during pregnancy, childbirth, and the postpartum period; 
      • common potential complications associated with pregnancy, childbirth, and the postpartum period, including but not limited to 
        • pregnancy and infant loss; 
        • mental health conditions including perinatal mood and anxiety disorders (PMADs); 
        • substance use disorder (SUD); and 
        • high blood pressure;  
      • labor and delivery comfort measures; 
      • best practices for supporting members in advocating for their needs and making informed decisions using a trauma-informed approach; and  
      • basic newborn care, including the fundamentals of breastfeeding/chestfeeding.

Enrolling as a MassHealth Doula Provider

In order to become a MassHealth doula provider, doulas need to meet the eligibility criteria outlined in 130 CMR 463.000 and submit a complete application package to MassHealth. Below is a step-by-step guide to enrolling as an individual MassHealth doula provider.

If you have questions of need any support throughout this process, please contact the Customer Service Center at (800) 841-2900, TDD/TTY: 711 or email the Provider Support Team at provider@masshealthquestions.com.


Step 1: Obtain a National Provider Identifier (NPI) number

The National Provider Identifier (NPI) is a unique identification number for covered health care providers across the U.S. Doulas are required to have an NPI prior to applying to enroll as a MassHealth doula provider. If you don’t have one already, apply for a NPI at https://nppes.cms.hhs.gov/. You’ll need to create an account, but the process is free.


Step 2: Complete MassHealth Doula Provider Training

Completion of the MassHealth Doula Provider Training is required prior to applying to enroll as a MassHealth doula provider. The training is free and covers several topics including MassHealth covered doula services and rates, eligibility criteria, application materials and enrollment process, how to submit claims for getting paid, information about protecting member privacy, where to get help with questions, and more.

The MassHealth Doula Provider Training is available on the Provider Learning Management System. The training is segmented into several parts. All parts must be completed to receive credit for the training. The entire training can take about 2 hours to complete. Upon completion, a certificate will be issued, which can be saved and printed. This certificate must be submitted with the MassHealth Doula Provider Application.

Please note: Any doula who attended one of the live training sessions in its entirety has already completed the MassHealth Doula Provider Training requirement. For these doulas, the training certificate is not required to continue the enrollment process.

Instructions on how to register for the MassHealth Doula Provider Training can be found here:

MassHealth Doula Provider Training Instructions (PDF) | (DOCX)


Step 3: Complete and submit the application materials

All prospective doula providers MUST complete Step 1 and Step 2 prior to applying to MassHealth. If an applicant submits an application and has not completed Step 1 or Step 2, the applicant will have 60 days to complete those steps to prevent the denial of their application.

After completing step 1 and step 2, doulas can apply to enroll as individual doula providers practicing independently and/or part of a doula-only group practice. If submitting an application for a potential doula group practice organization, please review Section 1.2 of the application to confirm if the business meets enrollment criteria to provide services to MassHealth members.

There are two options or pathways for applying to become a MassHealth doula provider: The Formal Training Pathway and the Experience Pathway. Every individual doula applicant must apply through one of these pathways. Please review this entire section before downloading application forms.

All applicants for both the Formal Training Pathway and the Experience Pathway must submit the following via mail. To request application materials by mail, contact the provider support team at (800) 841-2900, TTD/TTY: 711 or provider@masshealthquestions.com.

Doulas applying through the Formal Training Pathway must provide:

Doulas applying through the Experience Pathway must provide the following recommendations using templates provided by EOHHS:

All doula providers, except for those who will practice ONLY as part of a doula group practice, must also submit:

These forms, as well as the individual doula and doula group practice application checklists, are available to download and print in the Resources section below.


Step 4: MassHealth reviews your application

Once you have completed the required MassHealth Doula Provider Training and submitted all of your application materials, MassHealth will review your application and contact you with any questions. You must respond timely to MassHealth communications or your application may be denied. Completed application documents must be mailed to the address listed on the application.


Step 5: Notification of approval or denial

MassHealth provider applications are typically processed within 60 days of receipt. MassHealth will contact you once the application is processed to notify you if your application to enroll as a MassHealth doula provider was approved or denied.


Step 6: Begin providing services to MassHealth members

Once you are approved as a MassHealth doula provider, you can begin providing MassHealth covered doula services to eligible MassHealth members. You can also begin submitting claims to receive payment from MassHealth. See the Payment for Doulas section below for more information.

Your name and phone number will be added to the public MassHealth Provider Directory. MassHealth members may use this directory to contact you for doula services.

All MassHealth providers need to revalidate their information at least every 5 years. Click here for more information about provider revalidation.

Payment for Doulas

The required MassHealth Doula Provider Training covers how to submit claims for payment and the prior authorization process for MassHealth doula providers.

MassHealth pays for the following services provided by MassHealth doula providers per MassHealth member per perinatal period (the perinatal period is defined as the period encompassing pregnancy and labor and delivery, through 12 months following delivery, inclusive of all pregnancy outcomes):

  • Up to eight hours of perinatal visits without prior authorization.
    • Visits above these limits require prior authorization. 
    • Doulas may bill for any combination of perinatal visits up to 60 minutes and/or perinatal visits between 61-90 minutes.
  • Labor and delivery support

For information about rates for these services, see 101 CMR 319.00: Rates for Doula Services.

MassHealth covered doula services can be provided in-person and via telehealth in accordance with Subchapter 6: Doula Services Codes.

Resources

Application Materials and Forms

Individual Doula Provider Application Forms:
 
Doula Group Practice Application Forms:
 

MassHealth Doula Regulations

Doula Services Manuals

Helpful Resources:

 

HIPAA and Patient Privacy Resources:

 

To join MassHealth’s listserv and receive updates about the MassHealth doula services program:

  • Send a blank email to: join-masshealth-doula-program@listserv.state.ma.us
  • IMPORTANT: The subject line and email body must be completely empty – make sure to remove any email signatures
    After sending the email, you should get an automatic response indicating that you’ve successfully joined the listserv

Contact   for MassHealth Doula Services Program: Information for Doulas

Online

Email Email MassHealth Customer Service for Providers at provider@masshealthquestions.com

Phone

Main: Call MassHealth Customer Service for Providers, Main: at (800) 841-2900

Open Monday–Friday 8 a.m.–5 p.m.

TTY/TDD: Call MassHealth Customer Service for Providers, TTY/TDD: at 711

Fax

(617) 988-8974

Address

P.O. Box 278, Quincy, MA 02171
Directions 
Date published: December 8, 2023
Last updated: February 23, 2024

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