Eligibility Criteria for MassHealth Doula Providers
Note: These 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 before applying (see Enrolling as a MassHealth Doula Provider for more information).
- Demonstrate competency in the following areas, through either the Formal Training Pathway or the Experience Pathway as defined in 130 CMR 463.404.
- Basic understanding of the following topics at a minimum, since they 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.
- Basic newborn care, including the fundamentals of breastfeeding/chestfeeding.
- Basic understanding of the following topics at a minimum, since they 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:
Enrolling as a MassHealth Doula Provider
To become MassHealth doula providers, 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 or 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 number (NPI)
The National Provider Identifier number (NPI) is a unique identification number for covered health care providers across the U.S. Doulas are required to have an NPI before applying to be a MassHealth doula provider. If you don’t have one already, apply for an 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
You must complete the MassHealth Doula Provider Training before applying to be a MassHealth doula provider. The training is free and covers several topics, including MassHealth covered doula services and rates, eligibility criteria, application materials, the 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 divided into several parts. You must complete all the parts to receive credit for the training. The entire training can take about two hours to complete. When you finish it, you’ll receive a certificate you can save and print. You must submit the certificate with your MassHealth Doula Provider Application.
Please note: Any doula who attended an entire live training session has already fulfilled the training requirement. These doulas do not need the training certificate to continue the enrollment process.
You can find instructions on how to register for the MassHealth Doula Provider Training here:
MassHealth Doula Provider Training Instructions (PDF) | (DOCX)
Step 3: Complete and submit the application materials
All prospective doula providers MUST complete Steps 1 and 2 before applying to be MassHealth providers. If an applicant has not completed Step 1 or Step 2, they will have 60 days to complete those steps to prevent the denial of their application.
After completing Steps 1 and 2, doulas can apply to enroll as individual doula providers practicing independently and/or as part of a doula-only group practice. If you are submitting an application for a doula group practice, please review Section 1.2 of the application to confirm that the business meets the 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 ask us to mail you the application materials, contact the provider support team at (800) 841-2900, TTD/TTY: 711 or provider@masshealthquestions.com.
- a completed Doula Provider Application (PDF) | (DOCX)
- a signed MassHealth Provider Contract for Individuals (PDF) | (DOCX)
- a completed Data Collection Form (PDF) | (DOCX)
- a completed Federally Required Disclosure Form for Individual Practitioners (PDF) | (DOCX)
- an Attestation of Health Equity Resources for MassHealth Doula Providers (PDF) | (DOCX)
- Download and review Health Equity Resources for MassHealth Doula Providers (PDF) | (DOCX)
Doulas applying through the Formal Training Pathway must provide the following.
- a certificate of completion or other proof of doula training(s) attended, and/or proof of doula certification by a doula-certifying organization
- a completed Formal Training Pathway Training Information and Attestation Form (PDF) | (DOCX)
Doulas applying through the Experience Pathway must provide the following recommendations using forms provided by EOHHS:
- recommendations from at least three different former clients for whom the prospective MassHealth doula provided doula services (either paid or volunteer) in the last five years, using the Experience Pathway Client Recommendation Supplemental Form
- 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 in the last five years, using the Experience Pathway Health Care Provider Recommendation Supplemental Form
All doula providers, except for those who will practice ONLY as part of a doula group practice, must also submit the following.
- a Massachusetts Substitute W-9 Form (PDF) | (DOCX)
- an Electronic Funds Transfer Enrollment/Modification Form (PDF) | (DOCX)
- an Electronic Remittance Advice Enrollment/Modification Form (PDF) | (DOCX)
- a signed Trading Partner Agreement (PDF) | (DOCX)
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
Mail your completed application documents to the address listed on the application. Once you have completed the required MassHealth Doula Provider Training and submitted all your application materials, MassHealth will review your application and contact you with any questions. You must respond on time to MassHealth communications, or your application may be denied.
Step 5: Notification of approval or denial
MassHealth usually processes provider applications within 60 days after we receive them. Once we process your application, we will tell you whether we’ve approved or denied it.
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.
We will add your name and phone number 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.
Please refer to the MassHealth Doula Provider Billing Reference Guide for more information on submitting claims. This guide outlines the process for submitting professional claims electronically through the Provider Online Service Center (POSC).
Download and review the Doula Provider Billing Reference Guide (PDF) | (Word)
MassHealth pays for the following services by MassHealth doula providers per MassHealth member per perinatal period. (The perinatal period is the period encompassing pregnancy, labor, and delivery, as well as the 12 months after delivery, regardless of the outcome of the pregnancy.)
- Up to eight hours of perinatal visits without prior authorization.
- MassHealth may pay for visits above these limits, with prior authorization.
- Doulas may bill for any combination of perinatal visits up to 60 minutes and/or perinatal visits between 61 and 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 of the Doula Services Manual.
For more information on submitting prior authorization requests, please review the Guidelines for Medical Necessity Determination for Doula Perinatal Visits.
Frequently Asked Questions
If you have any questions regarding the MassHealth Doula Services Program, please refer to the Frequently Asked Questions (FAQ) below. The FAQ includes questions about National Provider Identifier numbers (NPIs), the application and enrollment process, covered services, billing, and member eligibility.
Download and review the FAQ: Frequently Asked Questions (PDF) | (Word)
Resources
Application Materials and Forms
Individual Doula Provider Application Forms:
- Individual doula provider application checklist (PDF) | (DOCX)
- Doula Provider Application (PDF) | (DOCX)
- MassHealth Provider Contract for Individuals (PDF) | (DOCX)
- Data Collection Form (PDF) | (DOCX)
- Federally Required Disclosure Form for Individual Practitioners (PDF) | (DOCX)
- Attestation of Health Equity Resources for MassHealth Doula Providers (PDF) | (DOCX)
- Download and review Health Equity Resources for MassHealth Doula Providers (PDF) | (DOCX)
- Formal Training Pathway Training Information and Attestation Form (PDF) | (DOCX)
- Experience Pathway Client Recommendation Supplemental Form (PDF) | (DOCX)
- Experience Pathway Health Care Provider Recommendation Supplemental Form (PDF) | (DOCX)
- Massachusetts Substitute W-9 Form (PDF) | (DOCX)
- Electronic Funds Transfer Enrollment/Modification Form (PDF) | (DOCX)
- Electronic Remittance Advice Enrollment/Modification Form (PDF) | (DOCX)
- Trading Partner Agreement (PDF) | (DOCX)
Doula Group Practice Application Forms:
- Doula group practice application checklist (PDF) | (DOCX)
- Doula group Practice Organization Application (PDF) | (DOCX)
- MassHealth Provider Contract for Entities (PDF) | (DOCX)
- Federally Required Disclosure Form for Group Practices (PDF) | (DOCX)
- Massachusetts Substitute W-9 Form (PDF) | (DOCX)
- Electronic Funds Transfer Enrollment/Modification Form (PDF) | (DOCX)
- Electronic Remittance Advice Enrollment/Modification Form (PDF) | (DOCX)
- Trading Partner Agreement (PDF) | (DOCX)
- Data Collection Form (PDF) | (DOCX)
MassHealth Doula Regulations
Doula Services Manuals
- Subchapter 1 through 3: Administration and Billing for all MassHealth Providers
- Subchapter 4: Doula Regulation
- Subchapter 5: Administrative and Billing Instructions for all MassHealth Providers
- Subchapter 6: Doula Service Codes
Helpful Resources:
- Information for Pregnant MassHealth Members
- POSC Eligibility Verification for Providers
- MassHealth Provider Library
- MassHealth Provider Directory
- Health Equity Resources for MassHealth Doula Providers
- Provider Training Portal (LMS)
- MassHealth Doula Provider Training Instructions (PDF) | (DOCX)
- MassHealth Doula Provider Billing Reference Guide (PDF) | (Word)
- Doula Services Program FAQ (PDF) | (Word)
- Resource Guide for Doula Providers (PDF) | (Word)
- Guidelines for Medical Necessity Determination for Doula Perinatal Visits (PDF) | (Word)
HIPAA and Patient Privacy Resources
- MassHealth Member Privacy Information | Mass.gov
- HIPAA Frequently Asked Questions for MassHealth Members | Mass.gov
- MassHealth HIPAA Companion Guides | Mass.gov
- Guide on the disclosure of confidential information: Health care information | Mass.gov
- HIPAA Basics for Providers: Privacy, Security, & Breach Notification Rules (cms.gov)
- HIPAA FAQs for Professionals | HHS.gov
- Special Topics in Health Information Privacy | HHS.gov
- Information Related to Mental and Behavioral Health | HHS.gov
- HIPAA and Telehealth | HHS.gov
- HIPAA and Reproductive Health | HHS.gov
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.
Flyers
See flyers in the Additional Resources Section here:
Additional Resources
Contact for MassHealth Doula Services Program: Information for Doulas
Phone
Open Monday–Friday 8 a.m.–5 p.m.
Fax
Address
| Date published: | December 8, 2023 |
|---|---|
| Last updated: | July 10, 2024 |