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.
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 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 support 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.email@example.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 firstname.lastname@example.org.
Serving Oregon Health Plan 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 (92%) 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 (8%) 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
Establishing THW Doula Services for OHP Clients in Your Area
Founding THW Doula Workgroups:
The first step in being able to provide doula services to OHP clients is for THW Doulas to form workgroups for their region or by counties in large urban areas. Some are already in existence in parts of Oregon. There are several reasons for this. THW Doulas will need to contract with a Billing Provider in their area because CCOs prefer to work with just a few billing providers rather than individual doulas. More information is detailed below on this.
Other reasons include the need for THW Doulas to know each other and work together for matching clients, providing back-up, discussing work challenges, gaining continuing education, and giving and receiving support for each other. To this end, ODA has designated 15 service regions with regional representatives who can communicate with us for assistance. Our Member-at-Large, Rebekah Orton, at email@example.com, coordinates these representatives and works to establish groups in areas who do not have them yet.
Serving CCO Members:
THW Doulas can serve the CCO OHP members in two ways. Currently, THW Doulas may provide care as a non-contracted provider, however, this would be only at the Fee for Service rate and care package described below. To be able to provide the expanded care package and be reimbursed at higher rates, a contract would need to be negotiated with THW doulas, doula businesses or community based organizations that serve their coverage area. Oregon Doula Association has a team to help negotiate these initial contracts and fees for services with the CCO’s. Please contact Debra Catlin at firstname.lastname@example.org for more information on this.
Either way, THW Doulas who contract with doula businesses or community based organizations will need to have an individual NPI# and also be enrolled with the state as a non-payable provider. They will be listed on the claim form as the Performing Provider. For instructions on how to do this, see Enrolling as a Non-payable Provider.
Doula businesses or community based organizations may become Billing Providers who will bill on behalf of the THW Doulas. They will need to have a group NPI# and be enrolled as a Type 09 Billing Provider with DMAP. See Enrolling as a Billing Provider. Each CCO will need to enroll the billing providers with their organization as well.
Doula Care Process for CCO OHP Clients:
1. Doula services must be requested by the M.D. or CNM, who then refers the client to a group of local THW doulas or to a community based organization (CBO) that provides services by THW Doulas. The local group or CBO will match the client with suitable doulas.
2. The Client interviews and selects a primary doula then notifies the care provider, who documents the doula’s name and contact information in patient records. Once a back-up doula is chosen, that information is added to the chart.
3. The doula(s) documents and provides the services as per agreement. When the doula attends the birth, the provider should enter the name of the doula into the patient’s chart, along with the the date of service and the time she/he arrived and left.
4. The Billing Provider will complete a 1500 claim form with specific codes to submit to the CCO or Payer. The doula will be listed as the Performing Provider. If one doula completed all of the services, a global code will be used, and if two doulas provided care, such as when a back-up doula attends the birth, services will be itemized.
5. The CCO/Payer will issue the payment to the Billing Provider, who will then issue payment to the doula. If more than one doula provided care for a client, each doula will be paid accordingly.
*In contract negotiation with CCOs, reimbursement rates may vary according to region and the type of population served. Here 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
When serving any Fee for Service Clients, the process is the same as above except for the following:
- The service package is two prenatal visits, attendance at the birth, and two postpartum visits
- When the doula attends the birth, the doula’s name and time of arrival & departure are documented in the client’s chart. The doula will be listed as the Performing Provider.
- The Billing Provider sends a claim form bill directly to MAP for payment then pays the doula.
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 email@example.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 THW Doulas can begin serving clients for those CCOs and their care providers.
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.