Maternal Health Projects

Tuesday, October 4, 2022

This website is intended to provide background and relevant documents related to the DC Department of Health Care Finance’s 2022 projects to expand coverage and benefits related to maternal health, with a focus on doula enrollment and billing. If you are a District resident who is pregnant and currently receives health coverage through DHCF, please consult this page. If you are a District resident who is pregnant or may be pregnant and may be interested in DHCF health coverage, please consult this page.

The maternal health projects were in the following three areas: 1) Coverage of doula services; 2) Expansion of postpartum coverage to one year; and 3) Extension of non-emergency medical transportation benefits to pregnant and postpartum Alliance beneficiaries.

As of September 30, 2022, doulas can enroll as DHCF providers and bill DHCF for doula services. To enroll as a DHCF provider, doulas should create an account at www.dcpdms.com and submit an online enrollment application. When creating the account, doulas should begin the enrollment process by selecting the application type: Standard Application and then selecting provider type: Doula. Each doula must enroll as an “individual/solo” doula. For more information on enrollment standards, please see Transmittal 22-34 on the Doula Benefit.

DHCF and its contractor Maximus will be holding 8 online trainings for doulas on provider enrollment in October 2022. The training will be held on Thursdays October 6/13/20/27 at 10:30 am and 2:30 pm each of the dates. Doulas and doula groups interested in the training should contact [email protected] via email with the date and time of the training they would like to attend to receive the link to join the meeting.

Doula services are provided throughout the perinatal and postpartum periods. Doulas provide support to the birthing parent throughout the pregnancy and postpartum periods to improve maternal health outcomes. Doula services are provided as preventive services and must be recommended by a physician or other licensed practitioner of the healing arts within their scope of practice under state law to prevent perinatal complications and/or promote the physical and mental health of the beneficiary. Doula services are limited to a total of twelve (12) visits across the perinatal and the postpartum period.

During the perinatal period (before, during, and up to six (6) weeks after delivery), services shall include: and postpartum periods, services include:

Perinatal counseling and education, including infant care, to prevent adverse outcomes.
Labor support and attendance at delivery, including the development of a birth plan.
Coordination with community-based services, to improve beneficiary outcomes.

During the postpartum period (beginning on the last day of pregnancy and extending through the end of the calendar month in which one hundred eighty (180) days after the end of the pregnancy falls), services shall include:

Visits with the beneficiary to provide basic infant care.
Accompanying the beneficiary to a clinician visit.
Lactation support.
Emotional and physical support.

Qualified Provider Specifications:

Qualified doula providers must be at least 18 years of age, possess a high school diploma or equivalent, and possess a current certification by a doula training program or organization, approved by DHCF. Once the District develops a certification standard, doulas must be certified in accordance with standards established by DC Health.

Doula Services must meet the following standards:

Doula services may be reimbursed from the date of confirmed pregnancy through one hundred and eighty (180) days (six months) after the end of a pregnancy, if services are medically necessary.
The District will reimburse up to twelve (12) perinatal and postpartum visits, including attendance at delivery. The twelve (12) visits include a maximum of one (1) doula consultation and can be allocated across the perinatal and postpartum periods.
Each perinatal service visit (before, during, and up to six (6) weeks after delivery) shall be billed and reimbursed per visit, regardless of the length of time.
Postpartum service visits shall be billed and reimbursed separately as a unit of service and shall be billed in fifteen (15) minute increments and reimbursed at a per-unit rate. A postpartum service visit shall not exceed twenty-four (24) units or six (6) hours per visit.
During the postpartum period, there will be an additional value-based incentive payment made to the doula if the doula performs at least one (1) postpartum service visit and the client is seen by an obstetric clinician for one (1) postpartum visit between seven (7) and eighty-four (84) days after delivery after a labor and delivery claim.

In FY22, DHCF formed a Maternal Health Advisory Group to get input from providers, beneficiaries or beneficiary advocates, doulas, and managed care organizations. The Maternal Health Advisory Group is convened the Postpartum and Mental Health Subgroup and the Doula Enrollment and Billing to provide input on specific items. For more information on the Maternal Health Advisory Group and its Subgroups, please see this letter, its roster or email [email protected].

The agency held a Kickoff Meeting on December 14, 2021 to introduce stakeholders to upcoming agency action and provide notice of upcoming public meetings. The first meeting of the Maternal Health Advisory Group was held at 6 pm on January 31, 2022, the second meeting was held at 10:00 am on March 7, 2022, the third meeting was held at 1 pm on March 21, 2022, the fourth meeting was held at 11 am on April 25, 2022 and the fifth meeting was held at 11 am on June 13, 2022. Meetings of the Postpartum and Mental Health Subgroup were held on April 18, 2022 and July 18, 2022. For more information on those meetings and recordings of those meetings, please see the documents below.

Interested parties may send written questions or comments on maternal health projects to Melisa Byrd, Senior Deputy Director/State Medicaid Director, Department of Health Care Finance, 441 4th Street, NW, Suite 900S, Washington, DC 20001, or via email at [email protected] or [email protected].

For further information or to be contacted about agency action or future meetings related to maternal health, please contact [email protected].

Doula Services Benefit Documents

Documents