Molinalogo

Members meet the criteria for a recommendation for doula services if they are pregnant or were pregnant within the past year and would either benefit from doula services or have requested doula services.

The member must be active and enrolled with MHC. Providers are encouraged to utilize the Availity Essentials Provider Portal as the primary method to verify member enrollment for the month of service. Alternatively, providers can contact the MHC Interactive Voice Response (IVR) system at (800) 357-0172 to verify member status.

During this step, members should also be checked for whether they qualify for Enhanced Care Management (ECM) or Community Supports (CS) services. Follow the instructions on the Case Management Referral Form to initiate member referrals for these services.

The member must have an initial recommendation on file from a physician or other licensed practitioner of the healing arts. Doulas must retain a record of the licensed provider’s recommendation prior to initiation of a member’s care, storing the record in a manner consistent with HIPAA requirements. The forms below are acceptable:

• • Written recommendations
• • Standing orders for doula services, such as the Department of Health Care Services (DHCS) Standing Recommendation
• • Standard forms, such as the DHCS Medi-Cal Doula Services Recommendation form

Initial recommendations authorize:

• • One initial prenatal visit;
• • Eight visits during the perinatal period, including up to one year after pregnancy;
• o Support during labor and delivery, miscarriage, or abortion;
• • Two extended postpartum visits.

Doulas will contact members to schedule an appointment.

Doulas services are available either virtually or in person and can be delivered in various settings, such as homes, office visits, hospitals, or alternative birth centers.

Doulas must document the dates, times, and duration of services provided to members.

Documentation must be accessible to MHC and integrated into the member's medical record. Be prepared to provide documentation to DHCS upon request. Documentation should meet the guidelines set in APL 23-024 - Doula Services.

A second recommendation is required for additional visits during the postpartum period. A doula may facilitate the obtainment of a recommendation from any licensed practitioner on behalf of a member.

A secondary recommendation authorizes up to nine additional postpartum visits. The forms below are acceptable:

• • Written recommendations
• • Standard forms, such as the DHCS Medi-Cal Doula Services Recommendation form

Fee-for-service claims for doula services can be submitted by:

• • A doula,
• • An enrolled doula group,
• • An enrolled licensed provider who employs or contracts with a qualified doula.

Claims may be submitted through the Availity Essentials Provider Portal and must use the allowable current procedural terminology codes outlined in the Medi-Cal Provider Manual.

Billing training

To learn more about how to bill for doula services, refer to the Billing for Doula Services Webinar.