Oregon State Medicaid Reimbursement

A little history (House Bill 3311): 

"During the 2011 session, the Oregon Legislature passed House Bill 3311, which directed the Oregon Health Authority to explore options for providing or utilizing doulas in the state medical assistance program to improve birth outcomes for women who face a disproportionately greater risk of poor birth outcomes. To complete this work, the Oregon Health Authority's Office of Equity and Inclusion (formerly the Office of Multicultural Health and Services) convened a committee representing stakeholders from health systems, community groups, and doula organizations. The committee was convened in September 2011 and met monthly for four-months to develop the attached report and recommendations. The process included reviewing state birth outcomes data, published research, and programs currently utilizing doulas. The committee also disseminated a survey to practicing doulas in Oregon to assist the committee in identifying a scope of practice and the core competencies necessary to effectively fulfill that scope." Tillman MPH, Latricia. (2/22/2012). Re: HB 3311 (2011) - Doula Report. Retrieved from: http://www.oregon.gov/oha/legactivity/2012/hb3311report-doulas.pdf. 

How to get on the registry and receive the Medicaid reimbursement for your intrapartum doula services: 

Getting on the Registry: 

In order to receive Medicaid Reimbursement a trained doula must meet all of the state's requirements, fill out and submit the application. http://www.oregon.gov/oha/oei/Pages/thw-certification.aspx

Requirements to apply for the Oregon State Registry: 

Doulas must be trained (not certified) in order to be able to get on the registry and receive Medicaid reimbursement. Your training must have included at least 38 contact hours (see detailed hours taken from OAR-410-180-375). Most doula training organizations currently meet the minimum hours of labor support/breastfeeding.and childbirth education hours. However, many doula trainings have not required the 6 hours of Cultural Competency training that the state does. Any additional training hours must be completed and you will submit proof of completion of the requirement with your application. 

Summary/Checklist:

Go to: http://arcweb.sos.state.or.us/pages/rules/oars_400/oar_410/410_180.html and scroll down to OAR-180-410-375 for official rules and requirements. 

  • Proof of 38 contact hours (16 hours of Labor Support training, 4 breastfeeding training, 12 Childbirth Education, 6 Cultural Competency training) 
  • Your training must have incorporated the following: read 5 books off of an approved list, written a 500 - 1000 word essay on the value of labor support, created a community resource list, attended at least 3 births and postpartum visits and have proof of documentation from a provider)
  • Oregon Food Handlers card
  • CPR Certified for children and adults
  • A background check (which will be completed by the State once you have applied for the registry. There is no fee for the background check). 
  • Get a National Provider Number (NPI) online: Each Oregon state registered doula will need their own NPI number. This will need to be submitted to the provider in order to get your reimbursement. Note: When asked on the online application, you should use the Taxonomy code for Doula (374J00000X) which can be found under "37 Nursing Service Related Providers"
  • Fill out Non-Payable Provider Form 3113, and fax it in with a EDMS cover sheet

Application process: 

Once you have completed all of the requirements you must apply to the registry.

The application can be found here: http://www.oregon.gov/oha/oei/Documents/THW_FullCertification_Application.pdf. There is only one application for all Traditional Healthcare Workers and you must check off "Birth Doula" and submit the appropriate documentation for this category. The Traditional Health Care Online Registry is currently being enhanced and  you must submit your application and supporting documents via email to: thw.program@state.or.us

Due to limited staffing and the initiation of an innovative process, the application might take up to 3 months to process. Once your application has been submitted the State will conduct a background check. There is no fee for this service. It is conducted by an outside source and you will be contacted via email. Make sure you check you email regularly as you will need to respond withing a certain time period or else the process will have to be restarted.