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MassHealth Doula Services Program: Information for Doulas

As of December 8, 2023, MassHealth 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’s regulations under 130 CMR 463.000: Doula Services for more information.

The MassHealth Chief Medical Officer recommends doula services for all pregnant and postpartum MassHealth members, under the rules in 130 CMR 463.000 and Section I of the MassHealth “Guidelines for Medical Necessity Determination For Doula Perinatal Visits.” Therefore, MassHealth does not require pregnant and postpartum MassHealth members to obtain an additional recommendation. See 130 CMR 463.407(B) for more details.

Table of Contents

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.

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.

Doulas applying through the Formal Training Pathway must provide the following.

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

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

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:
 
Doula Group Practice Application Forms:
 

MassHealth Doula Regulations

Doula Services Manuals

Helpful Resources:

Additional Resources

HIPAA and Patient Privacy Resources

Contact   for MassHealth Doula Services Program: Information for Doulas

Date published: December 8, 2023
Last updated: July 10, 2024

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