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<section article="ghg" article_name="Health - General" number="15-141.4" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Birthing parent” means the individual giving birth and who is receiving doula services throughout the parent’s pregnancy, including the prenatal, labor, and postpartum periods.</text>
    </level>
    <level label="3">
      <text>“Certified doula” means a trained nonmedical professional who provides continuous physical, emotional, and informational support to the birthing parent throughout the prenatal, labor, and postpartum periods who has received a certification to perform doula services approved by the Program.</text>
    </level>
    <level label="4">
      <text>“Doula services” means continuous and nonclinical physical, emotional, and informational support, based on evidence–based practices and with respect for individual care needs, culture, and family traditions, to a birthing parent provided by a certified doula, including:</text>
      <level label="i">
        <text>Education and guidance, supplementing the services of health care providers, on childbirth, coping skills for new parents, breastfeeding, infant feeding, infant soothing, and making informed decisions about childbirth and postpartum care;</text>
      </level>
      <level label="ii">
        <text>Prenatal coaching;</text>
      </level>
      <level label="iii">
        <text>Support for other individuals providing care for a birthing parent, including a birthing parent’s partner and family members; and</text>
      </level>
      <level label="iv">
        <text>Facilitation of access to resources that can improve birth–related outcomes, including ongoing home visiting services, transportation, housing, the Special Supplemental Nutrition Program for Women, Infants and Children, the Supplemental Nutrition Assistance Program WIC, intimate partner violence resources, and alcohol, tobacco, and drug cessation.</text>
      </level>
    </level>
    <level label="5">
      <text>“Home” means the residence of the birthing parent.</text>
    </level>
    <level label="6">
      <text>“Labor and delivery” means the period during which the fetus, membranes, umbilical cord, and placenta are expelled from the uterus through vaginal birth or through surgical delivery by a cesarean section.</text>
    </level>
    <level label="7">
      <text>“Medically indicated” means that a service or benefit meets the coverage requirements set by the Department.</text>
    </level>
    <level label="8">
      <text>“Participating doula” means an individual who:</text>
      <level label="i">
        <text>Meets the certification requirements as provided in subsection (d) of this section; and</text>
      </level>
      <level label="ii">
        <text>Is authorized by the Department to provide health care services to a Program recipient.</text>
      </level>
    </level>
    <level label="9">
      <text>“Provider” means an individual, an association, a partnership, or an incorporated or unincorporated group of doulas certified to provide doula services and who, through an appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.</text>
    </level>
  </level>
  <level label="b">
    <text>This section may not be construed to limit the authority of the Health Services Cost Review Commission to set the appropriate rates for hospital services.</text>
  </level>
  <level label="c">
    <text>The Department shall:</text>
    <level label="1">
      <text>Ensure that doulas providing care under the Program are participating doulas;</text>
    </level>
    <level label="2">
      <text>Review participation in the Program of participating doulas and Program recipients; and</text>
    </level>
    <level label="3">
      <text>Evaluate the effectiveness of doula services covered by the Program.</text>
    </level>
  </level>
  <level label="d">
    <text>A provider shall:</text>
    <level label="1">
      <text>Be certified by an organization approved by the Department; and</text>
    </level>
    <level label="2">
      <text>Present proof to the Department of completion of the associated certification from at least one organization before providing doula services through the Program.</text>
    </level>
  </level>
  <level label="e">
    <text>To participate in the Program, a provider shall:</text>
    <level label="1">
      <text>Meet the requirements of COMAR 10.09.36.03 to participate in the Program;</text>
    </level>
    <level label="2">
      <text>Maintain up–to–date certification as required by the Program; and</text>
    </level>
    <level label="3">
      <text>Hold adequate liability insurance.</text>
    </level>
  </level>
  <level label="f">
    <level label="1">
      <text>The Program shall cover doula services that:</text>
      <level label="i">
        <text>Are medically indicated;</text>
      </level>
      <level label="ii">
        <text>Are provided during the prenatal, labor and delivery, or postpartum period of a birthing parent; and</text>
      </level>
      <level label="iii">
        <text>If provided remotely, comply with the telehealth requirements in COMAR 10.09.49 and other relevant State and federal law.</text>
      </level>
    </level>
    <level label="2">
      <text>Doula services covered by the Program are subject to any limitations adopted by the Department.</text>
    </level>
  </level>
  <level label="g">
    <level label="1">
      <text>A provider shall submit a request for payment in the format designated by the Program.</text>
    </level>
    <level label="2">
      <text>The Program may return to the provider, before payment, any invoices that are not properly:</text>
      <level label="i">
        <text>Signed;</text>
      </level>
      <level label="ii">
        <text>Completed; or</text>
      </level>
      <level label="iii">
        <text>Accompanied by properly completed forms required by the Program.</text>
      </level>
    </level>
    <level label="3">
      <level label="i">
        <text>A provider may charge the Program and the Program shall reimburse a provider.</text>
      </level>
      <level label="ii">
        <text>A charge by a provider may be different from a customary charge by the provider for the same service.</text>
      </level>
      <level label="iii">
        <text>The Program shall pay for covered services at a rate equal to the lesser of:</text>
        <level label="1">
          <text>The customary charge the provider charges to the general public, unless the services are free to individuals not covered by the Program; or</text>
        </level>
        <level label="2">
          <text>The Program’s fee schedule.</text>
        </level>
      </level>
    </level>
  </level>
  <level label="h">
    <text>A managed care organization that participates in the Program shall provide medically indicated doula services to pregnant and postpartum enrollees.</text>
  </level>
</section>
