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The Oregon Doula Association (ODA) is excited to share with you current information on the status of the state doula care program and services will be provided for Oregon Health Plan families.

 

It has been a long road from House Bill 3311, which gave recommendations on doula care for Medicaid (OHP) clients, to where we are today. HB 3311 got folded under HB 3650, the Traditional Health Workers bill, and we are now one of the five worker types. 

 
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During this time the rules of the law had to be worked out and implementation plans put in place. Several committees and commissions later, we now have the particulars figured out to be able to get clients served.  

 
 

We have learned that these processes take more time than anyone thought they would, which is why OHP clients are just beginning to be served. Patience is still needed as we inform the health care system and doulas on each of their parts. ODA is working on two fronts to make this happen. On one hand, we are collaborating with health care systems in establishing the program and determining which reimbursement pathways they will use.  On the other hand, we are educating and recruiting the doula workforce needed to provide doula care. We will provide ongoing support to our state’s legislative and government bodies in streamlining doula services.  The following describes how the state program will work.

 

Overview of the Doula Care Program

 
 

Oregon’s Birth Doula Care Model

 

Oregon is endorsing a community-based model of doula care, which means two things.  One is that there is an expanded version of birth doula services that includes more prenatal contact, continuous birth attendance, and postpartum home visits.  In some cases with higher risk clients, additional prenatal visits may be provided.

The second is that a priority of the state doula care program is to provide doula services for clients identified as having disparities in health care, including those from the various populations that are listed below. Ideally, doulas are able to speak the language of their clients, and/or are doulas who have experience working with these client bases.

 
 

Until such time as the workforce is adequate to serve all OHP clients, priorities for services will be for these persons.  We need a diverse pool of state certified doulas available to serve these clients.  Please contact our Diverse Communities Chair, Kimberly Porter, Kimberly.porter@thebpi.com  if you are from or have contacts with doulas from the prioritized groups listed above.  Kimberly is doing outreach to all of these communities within our state.

 
 

The ODA is assisting Oregon in building a diverse and sustainable workforce.  There are only a few doulas on the state registry so far, so we will need a lot more to meet the demand.  For more information on the State Registry requirements and process, click here.  Presentations are also available to educate groups of doulas on how the program works, address questions on meeting the state registry requirements, and work as a team with the doulas serving your area. To schedule a presentation in your area, contact Debra Catlin, at debcatlin@aol.com

 

Serving Oregon Health Plan (OHP) Clients

 

The Oregon Health Plan is administered by the Medical Assistance Program (MAP) and the Oregon Health Authority.  These entities receive Federal funds from the Center for Medicare and Medicaid Services (CMS) and disperse these funds to OHP for “covered services.”  OHP serves two groups of clients with Medicaid Funds. The majority (89%) are members of a Coordinated Care Organization (CCO) who contracts with the state.  

 
 

Clients receive integrated care through “Care Homes” that then contract with the CCO or sometimes with an insurance company under the CCO, known as a Payer. There are 16 CCO’s in our state.

 
 

The concept of CCO care is that clients have a primary care team that includes medical and dental care, mental health services, and an array of social support services.  Doulas will be part of the primary care team, and thus work closely with the other members.  In fact, doulas are considered as “treatment” for the “condition of pregnancy!”

 

The balance (11%) are known as Fee for Service(FFS) clients and their health care is directly through the care providers, who in turn bill the state for the covered services.  This group includes undocumented workers, Native Americans, and clients served by direct entry midwives. Each of the two groups handle maternity care services differently when it comes to doula care.

 
 

Doula Care Process for CCO OHP Clients

 
 

There are different ways that doulas can be utilized to serve the OHP clients.  In some cases the CCO’s may contract directly with independent practicing doulas. In that case, payment will go directly to the doula.  Another model is for the CCO’s to contract with a community based organization that employs doulas and that organization will reimburse the doula.  We already have contracts for this model being negotiated now. Here is how the process works:

 

 

1)      Doula services must be requested by the M.D. or CNM, who then refers the client to a group of local doulas on the State Registry or to a community based organization that provides services by state registered doulas. A simple referral method is being developed for this by ODA. 

2)      The Client interviews and selects the primary doula then notifies the provider, who documents the doulas names and contact information in client records. Once a back-up doula is chosen, that information is added to the chart.

3)      The doula(s) documents and provides the services either as an independent contractor or may be contracted with a Community Based Organization who will reimburse the doula.

4)      CCOs/Payers will use a designated claim form with specialized codes that is submitted to the CCO or Payer by either the Care Provider or by the doula directly. Each CCO will create its own process for this. The doula does not “bill” the CCO, Dr., or CNM.

5)      The CCO/Payer or Care Provider will issue the payment to the Doula or to an organization that the doula contracts with.

 

Reimbursement Rates

 
*This is an approximation of the rates of payment when providing services for CCO clients.  

*This is an approximation of the rates of payment when providing services for CCO clients.

 

 

So far, this amount has been well received by CCO’s.  Doulas should understand that traditionally, Medicaid reimbursement is lower than for private pay clients, and this is true for all care providers.  They make up the difference with the private pay market, and this would be the same for doulas. By supporting the state’s doula program, not only are we meeting a need and making a difference, we are building our professional presence as a respected and valued member of the maternity care team.  Private insurance companies are already taking note and it won’t be long before they want a piece of the doula action!

 

Doula Care for Fee For Service (FFS) OHP Clients

 
 

1)      Doula services must be requested by the M.D. or CNM, who then refers the client to local doulas on the State Registry. A simple referral method is being developed for this. 

2)      The Client interviews and selects the primary doula then notifies the provider, who documents the doulas names and contact information in client records. Once a back-up doula is chosen, that information is added to the chart.

3)      The primary doula does the prenatal home visits.

4)      When the doula attends the birth, the doula’s name and time of arrival & departure are documented in the client’s chart. The M.D. or CNM adds a line to the bill they submit to MAP that includes the code for delivering the baby plus a modifier, U9, which triggers the doula payment.

5)      The doula who attended the birth does the postpartum visits.

6)      The doula invoices the Care Provider. Payment for doula services flow from MAP to the M.D. or CNM that delivered the baby and then to the doula as an independent contractor.  

 
 

Combining the pre and post visit payments and birth care will be approximately $330 for the doula care package when serving FFS clients.  There is currently discussion of a rule change that the doula home visits and the birth care will be combined into a package fee, at a higher reimbursement amount. As soon as we hear the change on that, we will make an announcement.

 

ODA Assisting Oregon State in Launching Doula Care

 
 

ODA representatives are already setting up meetings with key personnel from the Coordinated Care Organizations (CCOs) around the state.  As each CCO/Payer is engaging with us, we are providing education and support about the state doula care program.  They are working out which funding source they want to use, contracting details, a claims process for doulas to utilize after they have completed services, and a reimbursement procedure.

It is taking time to connect with some CCO personnel.  It would help to let us know if any of you have established relationships with the ones that serve your area, or with the providers that work with them, as they can expedite this contact.  Contact Deb Catlin at debcatlin@aol.com if you know anyone who can help.

After arrangements have been worked out with each CCO, the care providers need to be educated on the program, their responsibilities, supervision, etc.  ODA has developed presentations and documents to do this.

When agreements with CCO’s are made, we will notify the area’s state certified doulas and post the CCOs on our web site, and doulas can begin serving clients for those CCOs and their care providers.

 

Regional Service Areas and Service Teams

 
 

In order to coordinate and streamline state doula care, have good communication with area doulas, and provide support to doulas giving care to OHP clients, ODA has established 12 service regions, based upon the counties served by the CCOs and geographic considerations.   For each region there will be a Regional Representative (RR) and a State Certified Doula Team who can communicate with each other and the ODA via a Googlegroup list serve. Advertising materials and a web site page will be created as well, to make it easy for Care Providers to refer clients to the doula team for services.

Please join us in our efforts to be the first state in the nation to be supported with Medicaid funds in serving these mothers and babies who will benefit the most from doula care and who can least afford it.