New York State Medicaid Doula Pilot

Frequently Asked Questions

  • FAQs are also availaboe in Portable Document Format (PDF)

October 22, 2019                                                 www.Health.ny.gov/doulapilot


Program Background

The Department of Health will launch a pilot expanding the State´s Medicaid program to cover doula services for Medicaid fee–for–service and Medicaid Managed Care members residing in Erie County and parts of Kings County. The Medicaid pilot program will be implemented through a phased–in approach in order to ensure access to this new benefit. Phase 1 of the pilot launches Erie County on March 1, 2019. The Department continues to work with doulas in Kings County to enroll as Medicaid providers and Phase 2 of the pilot will launch in Kings County when provider capacity is reached.

A doula is a non–medical birth coach who assists a woman during the prenatal period, labor, delivery, and post childbirth.

Research suggests the use of a Doula may have a positive effect on health outcomes. The pilot will focus on Erie and Kings Counties which have among the highest maternal and infant mortality rates and largest number of Medicaid births in New York State.

The New York State Medicaid Program will reimburse participating doulas for up to four prenatal visits, support during labor and delivery, and up to four postpartum visits.

Information on the pilot design can be found here.

A1: How does a doula become a NYS Medicaid Provider?

To enroll as a NYS Medicaid provider, a doula will be asked to:

  1. Apply for a National Provider Identification Number (NPI#) at the National Plan and Provider Enumeration System website.
  2. Provide a signed and dated attestation of receiving doula training in the doula core competencies. The doula training attestation form can be found here.
  3. Provide a copy of the doula"s training certificate – or – an original signed and dated letter from the doula training organization stating the doula has attended and completed a doula training course (this letter must be on the organization´s letterhead).
  4. Complete and return all required NYS Medicaid Provider Enrollment forms:
    1. NYS Medicaid Enrollment Form (eMedNY form #436801)
    2. Electronic Funds Transfer (EFT) Authorization (eMedNY form #701101)
    3. Electronic Transmitter Identification Number (ETIN) Certification Statement for New Enrollment (eMedNY form #490602)

Doulas will be required to return the signed and dated doula training attestation form, proof of doula training and all completed NYS Medicaid Provider Enrollment forms to the following address:

Bureau of Provider Enrollment – Doula Pilot
431 Broadway – Room A129
Albany, New York 12204

A2: Is there an application fee for doulas to enroll in the NYS Medicaid program?

No, there is no application fee for doulas to enroll as a NYS Medicaid providers.

A3: Is the Doula Training Attestation Form available on the DOH website?

Yes, the Doula Training Attestation form can be found here.

A4: Will the NYS Department of Health provide training on the Health Insurance Portability and Accountability Act (HIPAA)?

There are a number of no–cost or low–cost HIPAA trainings available, including the following training provided by the U.S. Department of Health and Human Services.

A5: How can doulas learn about how they can enroll into the Medicaid program, and how they can bill for services?

The Department will provide doulas with training on how to enroll and how to bill/claim for services as providers in the Medicaid Program. PowerPoint presentations with audio recordings can be found at here. In–person trainings can be requested by contacting the regional CSRA representative at the eMedNY call center at 1–800–343–9000. Information on seminar and webinar offerings can be found on the Training page.

A6: How can doulas demonstrate their particular cultural competencies to prospective clients?

The New York State Department of Health is creating a doula provider directory which will be located here. Doulas will be able to provide information such as their contact information, languages spoken, and cultural competencies.

A7: What is and who administers the doula proficiency exam referenced in the doula training attestation form?

Most doula training organizations have a proficiency exam that is taken by the training doulas as a part of their coursework.

A8: Is there a minimum amount of doula experience required to be eligible to enroll as a Medicaid doula provider?

No, the enrolling doula need only provide an attestation of their doula training and proof of training in the form of a training certificate – or – a letter on the doula training organization´s letterhead stating the doula has attended and completed their training.

More information regarding enrollment requirements can be found here.

A9: Is a background check part of the enrollment process for doulas?

Yes. Upon receipt of an application for enrollment or re–enrollment, the NYS Department of Health (the Department) will conduct an investigation to verify information contained in the application. As part of the NYS Medicaid provider enrollment process, all providers undergo a monthly background review. Since doulas are enrolling as NYS Medicaid providers, they will also be subject to this enrollment requirement.

A10: What are the core competencies a doula must meet in order to enroll in the Medicaid program?

A doula must attest to being trained in the doula core competencies outlined below:

  • At least 24 contact hours of education that includes any combination of childbirth education, birth doula training, antepartum doula training, and postpartum doula training.
  • Attendance at a minimum of one (1) breastfeeding class.
  • Attendance at a minimum of two (2) childbirth classes.
  • Attendance at a minimum of two (2) births.
  • Submission of one (1) position paper/essay surrounding the role of doulas in the birthing process.
  • Completion of cultural competency training.
  • Completion of a doula proficiency exam.
  • Completion of HIPAA / client confidentiality training.

A11: If a doula has a question regarding their enrollment form, what resources are available?

Information on the provider enrollment process can be found here. Specific questions regarding the enrollment form can be directed to the Medicaid program at doulapilot@health.ny.gov.

A12: Is there a limit or restriction on the number of Managed Care Organizations (MCOs) a doula can contract with?

A doula may contract with as many MCOs as they deem necessary in order to provide services to their clients.

A13: Who should you contact if you are willing to host an in–person training regarding doula enrollment and/or billing?

In–person trainings can be scheduled by contacting a CSRA Regional Representative at the eMedNY Call Center at 1–800–343–9000.

B1: Why is doula enrollment limited to Erie and Kings county only?

Erie and Kings counties were selected for the pilot after reviewing data on the highest prevalence of maternal and infant mortality rates by county and number of Medicaid births. Also considered were the percentage of babies with low birth weight, infant deaths per 1000 births, and the percentage of cases where late or no prenatal care was given.

B2: What areas of New York State (NYS) does the Doula Pilot Program target?

The pilot is designed to target Erie and Kings counties except for zip codes 11207, 11212, 11233 in Kings county. The pilot will exclude these three zip codes already funded through New York City Department of Health and Mental Hygiene´s (NYC DOHMH) By My Side program. The Medicaid pilot program will be implemented through a phased–in approach in order to ensure access to this new benefit. Phase 1 of the pilot launches Erie County on March 1, 2019. The Department continues to work with doulas in Kings County to enroll as Medicaid providers and Phase 2 of the pilot will launch in Kings County when provider capacity is reached.

B3: Are doulas who serve these two counties the only doulas that can enroll as providers for this pilot program?

Yes, only NYS Medicaid enrolled doulas serving Medicaid eligible members residing in Erie County and Kings County (except for zip codes 11207, 11212, 11233 in Kings County) are eligible to enroll and bill for services for this pilot. Doulas enrolled in Erie County will be able to provide services on March 1, 2019, and doulas enrolled in Kings County will be able to provide services at date in the near future.

B4: When will this be available for counties other than the ones listed?

The NYS Medicaid program will consider expanding the pilot to other counties after the launch of the pilot in Erie County on March 1, 2019 and the subsequent launch in Kings County.

B5: If a member moves out of Erie county or the eligible zip codes in Kings County, can the member still access Doula Services?

No, if a member moves out of Erie county or the eligible zip codes in Kings county, then the member can no longer receive doula services.

C1: What CPT codes should be billed by the doula for services rendered?

Medicaid enrolled doulas will be able to bill using the following CPT codes:

Visit Type Procedure Code Max Number of
Billable Visits
Before Childbirth (Prenatal) Visit(s) 99600 4
Labor and Delivery 99499 1
After Childbirth (Postpartum) Visit(s) 99600 +
UA Modifier
4

C2: What diagnosis codes should be included on the Medicaid claim?

Providers must use the following diagnosis codes for billing:

Visit Type Procedure Code Diagnosis Code Max Number of
Billable Visits
Before Childbirth (Prenatal) Visit(s) 99600 Z32.2 4
Labor and Delivery 99499 Z32.2 1
After Childbirth (Postpartum) Visit(s) 99600 +
UA Modifier
Z32.3 4

C3: What is the reimbursement rate for a doula?

A doula will be reimbursed $30 for each prenatal and postpartum visit provided and will be reimbursed $360 for assistance at labor and delivery that results in an actual birth. For additional information, please view the Doula Provider Manual or Fee Schedule for fee–for–service reimbursement rates which can be found here.

C4: Are doulas required to work in a clinic or facility setting?

No, doulas are not required to work in a clinic or facility setting. Doulas can work as independent providers usually from the Medicaid participant´s place of residency. Doulas can accompany their clients to any clinic or facility setting for emotional/educational support regardless of the zip code location of the clinic or facility. Guidance for doulas that are employed in clinics or facilities is under development.

C5: Is there a maximum or minimum number of clients that can be served?

No, there is no restriction on how many patients a doula can serve. However, a doula is expected to maintain the same quality of care for each of his/her clients regardless of the number of clients the doula serves.

C6: Can multiple doulas deliver services to a single Medicaid member? For example, if the doula who has been working with the mother is unable to attend the birth, can a “backup” doula attend and be reimbursed by NYS Medicaid?

Multiple doulas can provide services to a single Medicaid member. A member can receive up to 4 prenatal visits and 4 postpartum visits. Those visits can be provided by more than one doula if the occasion arises. However, multiple doulas cannot bill for the same visit or bill for separate visits on the same day. A duplicate claim for services provided on the same day to the same member will be denied. If a doula that has been working with the mother is unable to attend the birth, a "backup" doula can attend the birth and be reimbursed by NYS Medicaid. If there is an extended labor/delivery and more than one doula attends, only one claim for the labor/delivery will be reimbursed by Medicaid. The doula who is present during the delivery will be reimbursed for the full extent of the labor/delivery.

C7: What services are included in the postpartum period for a Medicaid member?

Services such as lactation services are included in the postpartum visit rate. Additional information on services included in the postpartum rate can be found in the provider manual located here.

C8: Is there a minimum amount of time the doula is required to spend with a client to bill for a visit?

All reimbursable visits must be face–to–face and provided on an individual basis to the member. Visits can be any length of time but are typically a minimum of 20 minutes.

C9: If a bilingual doula is also interpreting, would the doula be able to bill for that service as well?

Reimbursement is available for language interpretation services when necessary, which are provided by a third party. The doula cannot bill for interpretation services provided by her/himself. The doula will bill on behalf of the interpreter and would be responsible for paying the interpreter for services rendered.

To qualify as an interpreter, the service must be provided by an independent third–party vendor (e.g., telephonic interpretation service) whose sole function is to provide interpretation services for individuals with limited English proficiency and communication services for people who are deaf and hard of hearing. It is recommended that such individuals be recognized by the National Board of Certification for Medical Interpreters (NBCMI). The need for this service must also be documented in the medical record.

C10: Will doulas be reimbursed for transportation or parking expenses?

Doulas will not be reimbursed for transportation expenses or parking expenses.

D1: How can providers receive updates on the Medicaid doula pilot?

Providers are encouraged to subscribe to the Medicaid doula pilot listserv which can be found here to receive regular updates. Direct questions can be submitted to doulapilot@health.ny.gov. The Medicaid Redesign Team´s Twitter (@NewYorkMRT) and Facebook (@New York Medicaid Redesign Team) will also be providing regular updates on the doula pilot.

D2: Will clients be referred to doulas by the pilot program or managed care plans, or will doulas have to find clients enrolled in Medicaid on their own?

The NYS Department of Health and Managed Care Organizations will be conducting outreach to eligible Medicaid members, as well as providing a listing of enrolled doulas on a Department webpage for members to access. Doulas are also encouraged to outreach to Medicaid eligible members.

D3: Will a registry of doulas enrolled in the NYS Medicaid Doula Pilot Program be provided?

The New York State Department of Health will be providing information on doulas that are enrolled in the Medicaid program through a directory that can be found here.

D4: Will the Managed Care Organizations (MCOs) maintain a list of participating doulas?

MCOs maintain a list of participating providers in their provider network.

D5: Will information on the pilot be made available in different languages?

Yes, brochure for the Doula Pilot Program will be made available in Spanish, Haitian–Creole, Italian, Korean, simplified Chinese, and Russian.

E1: Will there be an evaluation of the Medicaid doula pilot?

Yes, the New York State Department of Health will evaluate the doula pilot.

E2: What will the New York State Department of Health evaluate?

The Department of Health will evaluate:

  • how many members access doula services,
  • the doula pilot´s effectiveness, and
  • doula and member satisfaction with the doula pilot.

Effectiveness will include rates of breastfeeding and doctor´s visits. Satisfaction will include feedback from doulas and members on their experience. The evaluation will help the Department identify what is working well and what needs to be changed.

E3: How will the evaluation be performed?

Two surveys will be given to both the doulas and the members they serve.

E4: How and when will doulas receive the surveys for evaluation?

Doulas will receive two surveys in an email from the Department of Health. The first survey will be emailed after the first three claims have been reimbursed. The second survey will be at the end of the pilot. The surveys will take 10 to 15 minutes to complete. It is the Department´s expectation that doulas will complete the surveys to ensure the success of both the pilot and the evaluation.

E5: How and when will the members receive the surveys for evaluation?

Members who have received doula services will get two surveys in the mail. The first survey will arrive 4 to 6 weeks after childbirth. The second survey will arrive around 3 months after childbirth. The surveys will take 10 to 15 minutes to complete.

E6: Why is filling out the surveys important?

The Department of Health is using surveys to evaluate the doula pilot. These surveys are the best way for the Department to receive feedback from doulas and members. This feedback will help the Department identify what is working well and what needs to be changed.