Or. Admin. Code § 410-130-0015 - Doula Services
(1) The
primary purpose of providing birth doula services as a member of the birthing
team is to optimize birth outcomes, including prevention of preterm births,
fewer neonatal intensive care admissions, reduced Caesarean sections, reduced
epidural use, and improved member experience of birthing care. These services
are provided during the prenatal, labor and delivery, and postpartum phases of
the member's pregnancy. Pregnant women or pregnant persons experiencing health
disparities are expected to benefit most from birth doula services, including
the following:
(a) A pregnant woman or
pregnant person with a racially or ethnically diverse background including,
Black/African American, Asian, Native Hawaiian/Pacific Islander, Native
American, Latino/Latina/Latinx, multicultural or multiracial;
(b) A pregnant woman or pregnant person
experiencing houselessness;
(c) A
pregnant woman or pregnant person who speaks limited to no English;
(d) A pregnant woman or pregnant person who
has limited to no family or partner support;
(e) A pregnant woman or pregnant person who
is under the age of 21.
(2) Birth doula providers shall meet the
following requirements at the time services are provided:
(a) Shall be enrolled with the Authority as a
Traditional Health Worker (THW) pursuant to OAR
950-060-0000.
(b) Shall be certified as a birth doula
pursuant to OAR 950-060-0040.
(3) Birth doula providers shall
document services provided for each encounter. The birth doula's record shall
include the dates of service, a brief description of education or services
provided, assessment of any client or member needs beyond routine care, and any
referrals made. The goal of documentation is to verify services were provided
and facilitate communication with other members of the birthing team.
(4) The Authority shall pay for birth doula
services for any woman or pregnant person whose benefit package covers labor
and delivery.
(5) Payment for birth
doula services:
(a) No pre-authorization is
required;
(b) For a member enrolled
in Fee for Service (FFS) medical programs:
(c) To be considered for payment, birth doula
services shall be billed on a professional claim and shall include the unique
Medicaid modifier of HD or 22 appended to the appropriate obstetrical
code;
(d) Birth doula care shall be
billed as a global birth doula package. A global package shall include at a
minimum two (2) prenatal face-to-face visits, care during the labor and
delivery phase, and two (2) postpartum face-to-face visits;
(e) Up to four (4) additional support visits
to be billed separately beyond the global birth doula package. The additional
support visits may occur anytime, in any combination of prenatal and postpartum
visits, continuing for twelve (12) months following the end of the
pregnancy.
(f) Itemized billing,
i.e., billing the day-of-delivery as a standalone and billing separate prenatal
and postpartum visits, is allowed in extenuating circumstances. Extenuating
circumstances include but are not limited to when the primary birth doula is
not able to attend the delivery and a backup birth doula provides services or
when a mother is late to care making scheduling two (2) prenatal face-to-face
visits impossible:
(A) When appropriate due to
extenuating circumstances, services rendered by multiple birth doulas for the
same pregnancy may be itemized for billing;
(B) Reimbursement of itemized services,
regardless of the number of birth doulas serving the member, may not exceed the
global package total and up to four (4) additional support visits.
(g) Billing for birth doula
services shall include:
(A) Using HCPCS T1033
with HD modifier one time for a global birth doula package (delivery with two
(2) prenatal and two (2) postpartum visits);
(B) Using HCPCS T1033 with 22 modifier for
doula service day of delivery only. T1033 with no modifier for support visit
(two (2) prenatal and two (2) postpartum visits);
(C) Using HCPCS T1033 with no modifier for
each additional support visits not exceeding four (4) in total;
(D) Claim only one global birth doula package
per pregnancy. A global birth doula package may not be billed together with any
of the itemized birth doula services codes for the same pregnancy.
(h) Birth doula services may only
be billed once per pregnancy. Multiples (i.e., twins, triplets) are not
eligible for additional payment;
(i) Only an enrolled birth doula, provider
type designation 13/600, may be the rendering provider for birth doula
services.
(j) For a member enrolled
in CCO medical programs, payment shall be per OARs governing CCO provider
payment.
Notes
Statutory/Other Authority: ORS 413.042 & ORS 414.065
Statutes/Other Implemented: ORS 414.065
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