Chapter 39. Doula Services
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Birthing parent” means the participant giving birth, who is receiving doula services throughout their pregnancy, including the prenatal, labor, and postpartum periods.
(2)
“Certified doula” means a trained nonmedical professional who provides continuous physical, emotional, and informational support to the birthing parent throughout the prenatal and postpartum periods and who has received a certification as approved by the Program to perform doula services.
(3)
“Department” means the Maryland Department of Health, the single State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.
(4)
“Doula services” means continuous physical, emotional, and informational support to the birthing parent throughout the prenatal and postpartum periods, provided by a certified doula, including:
(a)
Information about the childbirth process;
(b)
Emotional and physical support provided at perinatal visits and during labor and delivery, which may include:
(i)
Prenatal coaching;
(ii)
Providing person-centered care that honors cultural and family traditions; and
(iii)
Teaching and advocating on behalf of the birthing parent during appointment visits, hospitalization, and delivery;
(c)
Provision of evidence-based information on general health practices pertaining to pregnancy, childbirth, postpartum care, newborn health, and family dynamics;
(d)
Provision of emotional support, physical comfort measures, and information to the birthing parent to enable the birthing parent to make informed decisions pertaining to childbirth and postpartum care, and other issues throughout the perinatal period;
(e)
Provision of support for the whole birth team including a birthing parent’s partner, family members, and other support persons;
(f)
Provision of evidence-based information on infant feeding;
(g)
Provision of general breastfeeding guidance and resources to supplement, but not in lieu of, the services of a lactation consultant;
(h)
Provision of infant soothing and coping skills for the new parents; and
(i)
Facilitation of access to resources that can improve birth-related outcomes, including ongoing home visiting services, transportation, housing, alcohol, tobacco and drug cessation, WIC, SNAP, and intimate partner violence resources.
(5)
“Home” means the birthing parent’s place of residence in a community setting.
(6)
“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 the surgical delivery by a cesarean section.
(7)
“Medically necessary” means that the service or benefit is:
(a)
Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;
(b)
Consistent with current accepted standards of good medical practice;
(c)
The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and
(d)
Not primarily for the convenience of the consumer, family, or provider.
(8)
“Perinatal period” means the period that encompasses both the prenatal and postpartum periods.
(9)
“Postpartum period” means the period that begins immediately after childbirth up to 180 days following childbirth.
(10)
“Prenatal period” means the developmental period between conception and birth.
(11)
“Program” means the Maryland Medical Assistance Program.
(12)
“Provider” means an individual doula or an association, partnership, or incorporated or unincorporated group of doulas certified to provide doula services that, through an appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.
Regulation .02 Certification Requirements.LinkCopy Citation
A provider shall be certified as described in the Professional Services Provider Manual and Fee Schedule under COMAR 10.09.02.07D.
Regulation .03 Conditions for Participation.LinkCopy Citation
A.
General requirements for participation in the Program are that a provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.
B.
Specific requirements for participation in the Program as a certified doula provider require that the provider:
(1)
Maintain up-to-date certification through a doula certification program as specified in Regulation .02 of this chapter; and
(2)
Shall have adequate liability insurance.
Regulation .04 Covered Services.LinkCopy Citation
A.
Effective January 1, 2022, the Program covers doula services as defined in Regulation .01 of this chapter when the services:
(1)
Are medically necessary;
(2)
Are rendered during a birthing parent’s prenatal period, labor and delivery, and postpartum period; and
(3)
If rendered via telehealth, comply with the requirements established in COMAR 10.09.49 and any other subregulatory guidance.
B.
The Program shall cover up to:
(1)
Eight prenatal or postpartum visits; and
(2)
One labor and delivery service.
Regulation .05 Limitations.LinkCopy Citation
Doula services covered under this chapter are subject to the following limitations:
A.
One of the following providers shall be present while doula services are provided during the delivery:
(1)
An obstetrician-gynecologist;
(2)
A family medicine practitioner; or
(3)
A certified nurse midwife.
B.
Doula services furnished during labor and delivery may not be rendered via telehealth.
C.
Payment for doula services shall be limited to direct services provided. Expenses may not be reimbursed for items related to:
(a)
Travel;
(b)
Administrative overhead; or
(c)
Ongoing certification, training, or consultation.
D.
Multiple visits are not allowed in the same day except in the following instances:
(a)
A prenatal visit occurs earlier in the day, and a labor and delivery visit later in the day; or
(b)
A labor and delivery visit occurs earlier in the day, and a postpartum doula later in the day.
Regulation .06 Payment Procedures.LinkCopy Citation
A.
The provider shall submit the request for payment in the format designated by the Program.
B.
The Program reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Program.
C.
The provider shall charge the Program the provider's customary charge to the general public. If the service is free to individuals not covered by Medicaid:
(1)
The provider:
(a)
May charge the Program; and
(b)
Shall be reimbursed in accordance with §H of this regulation; and
(2)
The provider's reimbursement is not limited to the provider's customary charge.
D.
The Program will pay for covered services, the lesser of:
(1)
The provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or
(2)
The Program's fee schedule.
E.
The provider may not bill the Program or the participant for:
(1)
Completion of forms and reports;
(2)
Broken or missed appointments;
(3)
Professional services rendered by mail;
(4)
Professional services rendered via telehealth when services are indicated as an exclusion; or
(5)
Providing a copy of a participant's medical record when requested by another provider on behalf of the participant.
F.
Payments for services rendered to a birthing parent shall be made directly to a qualified provider.
G.
Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.
H.
Reimbursement.
(1)
Unless otherwise specified, payments shall be made in 15-minute units of service.
(2)
The provider shall be reimbursed in accordance with COMAR 10.09.02.07D.
Regulation .07 Recovery and Reimbursement.LinkCopy Citation
Recovery and reimbursement regulations are set forth in COMAR 10.09.36.07.
Regulation .08 Cause for Suspension or Removal and Imposition of Sanctions.LinkCopy Citation
Cause for suspension or removal and imposition of sanctions are set forth in COMAR 10.09.36.08.
Regulation .09 Appeal Procedures.LinkCopy Citation
Providers filing appeals from administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09.
Regulation .10 Interpretive Regulation.LinkCopy Citation
Interpretive regulatory requirements shall be as set forth in COMAR 10.09.36.10.
Regulation .11 Implementation Date.LinkCopy Citation
This chapter shall be implemented on January 1, 2022.
Chapter annotations
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
History: Effective date: February 21, 2022 (49:4 Md. R. 300)
History: Regulation .02 amended effective June 24, 2024 (51:12 Md. R. 618)
History: Regulation .06H amended effective June 24, 2024 (51:12 Md. R. 618)