<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.39.05" title_num="10" subtitle_num="09" chapter_num="39" heading="Limitations.">
  <text>Doula services covered under this chapter are subject to the following limitations:</text>
  <paragraph num="A.">
    <text>One of the following providers shall be present while doula services are provided during the delivery:</text>
    <paragraph num="(1)">
      <text>An obstetrician-gynecologist;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A family medicine practitioner; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A certified nurse midwife.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Doula services furnished during labor and delivery may not be rendered via telehealth.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Payment for doula services shall be limited to direct services provided. Expenses may not be reimbursed for items related to:</text>
    <paragraph num="(a)">
      <text>Travel;</text>
    </paragraph>
    <paragraph num="(b)">
      <text>Administrative overhead; or</text>
    </paragraph>
    <paragraph num="(c)">
      <text>Ongoing certification, training, or consultation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Multiple visits are not allowed in the same day except in the following instances:</text>
    <paragraph num="(a)">
      <text>A prenatal visit occurs earlier in the day, and a labor and delivery visit later in the day; or</text>
    </paragraph>
    <paragraph num="(b)">
      <text>A labor and delivery visit occurs earlier in the day, and a postpartum doula later in the day.</text>
    </paragraph>
  </paragraph>
</regulation>