Section 463.404 - Provider EligibilityPayment for services described in 130 CMR 463.000 will only be made to doulas or group practices who are participating in MassHealth on the date of service. Doulas must meet the following eligibility requirements.
(A)In-state Providers. To be eligible to participate in MassHealth, an in-state doula must meet the following qualifications: (1) be at least 18 years old;(2) complete trainings provided by the Executive Office of Health and Human Services (EOHHS) on topics including, but not limited to:(a) overview of the MassHealth Doula Services Program, including best practices for meeting the needs of diverse MassHealth members and their families;(b) federal and state laws and regulations established for the protection of the privacy and security of the member information doulas create, use, collect, store, and/or transmit; (c) navigating MassHealth-covered services and community resources for MassHealth members; and(3) demonstrate competency in the following areas, either through the Formal Training Pathway or Experience Pathway as defined in 130 CMR 463.404, subject to EOHHS review and approval: (a) 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: 1. maternal anatomy and physiology during the perinatal period, including basic fetal growth and development in each trimester of pregnancy;2. common medical interventions during pregnancy, childbirth, and the postpartum period;3. common potential complications associated with pregnancy, childbirth, and the postpartum period including, but not limited to a. pregnancy and infant loss; b. mental health conditions including Perinatal Mood and Anxiety Disorders (PMADs);c. substance use disorder (SUD); and d. high blood pressure;4. labor and delivery comfort measures;5. best practices for supporting members in advocating for their needs and making informed decisions using a trauma-informed approach; and f. basic newborn care, including the fundamentals of breastfeeding/chestfeeding.(b)Formal Training Pathway. Provide a certificate of completion or other proof of doula training(s) attended, and/or proof of doula certification by a doula-certifying organization and a completed attestation form, using the template provided by EOHHS, stating that the completed formal training(s) covered the required competencies listed above.(c)Experience Pathway. Provide the following recommendations using templates provided by EOHHS:1. recommendations from at least three different former clients for whom the prospective MassHealth doula provided doula services (either paid or volunteer) within the last five years; and2. 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 within the last five years.(B)Out-of-state Providers. To participate in MassHealth, an out-of-state doula must obtain a MassHealth provider number and meet the following criteria: (1) be legally authorized to perform the services of a doula in their own state;(2) participate in their state's Medicaid program (or the equivalent); and(3) meet the conditions set forth in 130 CMR 450.109: Out-of-state Services.Adopted by Mass Register Issue 1510, eff. 12/8/2023.Amended by Mass Register Issue 1535, eff. 11/8/2024 (EMERGENCY).