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Breanna Reeves |
The Division of Well being Care Services and products (DHCS) officially revealed the long-awaited Medi-Cal Supplier Handbook for the doula products and services get advantages simply prior to the ease takes impact on Jan. 1, 2023.
After months of deliberation, revision and statement a number of the DHCS stakeholder workgroup, an meeting of greater than a dozen maternal well being advocates, doulas, start staff and community-based organizations, and the DHCS advantages department, the supplier guide officially defines the scope of doula products and services, categorizes coated products and services beneath each the fee-for-service and controlled care supply methods. It additionally outlines doula enrollment eligibility standards.
“The Supplier Handbook had in reality impactful stakeholder engagement this is the most important to making sure the ease is as equitable and sustainable as conceivable. Nationwide Well being Regulation Program (NHeLP) may be very thankful to paintings with an exquisite crew of community-based doulas and stakeholders who’ve shared their time, insights and experience,” NHeLP Well being Coverage Analyst Alexis Robles-Fadet stated by the use of e-mail.
On November 7, DHCS submitted the State Plan Modification (SPA 22-0002) for doula products and services to the Facilities for Medicare and Medicaid Services and products. The SPA covers a vast description of coated products and services beneath the doula get advantages. On every occasion the state plans to make a metamorphosis to its program, an SPA will have to be submitted to CMS for federal approval. CMS has till February 5 (90 days) to study the SPA.
In contrast to the State Plan Modification, the supplier guide gives better information about doula products and services, full-spectrum doula care, non-covered products and services, billing codes and contains extra details about documentation necessities for doulas who search to sign up with Medi-Cal.
In step with the supplier guide, coated products and services come with as much as a complete of eleven visits, together with postpartum visits and strengthen at stillbirths or abortions, for a complete fee of $1,154 in line with start.
Doula software and enrollment
With the supplier guide revealed, the state is one step nearer to increasing get entry to to doula products and services around the state. DHCS first of all deliberate for the ease to take impact on July 1, 2022, however driven again the date to January 1, 2023 after receiving comments from stakeholders and refining facets of the doula get advantages.
“This variation is had to permit DHCS to proceed operating with stakeholders to additional outline and broaden the ease, put in force wanted adjustments to the Supplier Utility and Verification for Enrollment (PAVE) on-line device to permit doulas to sign up as Medi-Cal suppliers, search and procure federal approval and provides Medi-Cal controlled care plans time beyond regulation to devise for and put in force the ease. The brand new efficient date can even permit for a extra powerful stakeholder engagement procedure to lend a hand DHCS with implementation,” consistent with the DHCS web site.
DHCS may be offering an indication sequence for doula suppliers to learn to post enrollment programs at the PAVE portal. Doulas or doula teams will have to sign up the use of the PAVE portal to post fee-for-service claims. The primary demonstration, “Creation to PAVE for Doula Suppliers,” is to be had on-line. The second one demonstration will probably be held just about as a are living consultation on Jan. 10, 2023 the place doulas will be capable of ask questions are living and obtain real-time responses.
Because the release of the doula products and services get advantages attracts nearer, doulas and community-based organizations will be capable of post their programs to sign up as Medi-Cal suppliers, permitting them to officially invoice for his or her products and services and strengthen households with Medi-Cal. The vast majority of coated populations in California are served thru Medi-Cal controlled care plans, famous René Mollow, Deputy Director of Well being Care Advantages & Eligibility, in an interview again in September.
Doulas will want required paperwork and/or attestations and must download a Nationwide Supplier Identifier (NPI).
{Qualifications} for enrollment
{Qualifications} for enrollment for all doulas come with: a duplicate of state-issued id that demonstrates that doula is a minimum of 18 years previous; Grownup CPR certification of entirety via American Purple Pass or American Center Affiliation; Toddler CPR certification of entirety via American Purple Pass or American Center Affiliation; and certificates of entirety or attestation of Well being Insurance coverage Portability and Responsibility Act (HIPAA) Coaching.
Moreover, doulas will probably be required to post explicit {qualifications} relying on which coaching pathway they sign up in (Coaching Pathway or Enjoy Pathway). Doula products and services additionally require a written advice via a health care provider or different authorized practitioner “of the therapeutic arts performing inside their scope of observe beneath state legislation.” On the other hand, the authorized supplier who submits a advice does no longer want to be enrolled in Medi-Cal or be a community supplier inside the beneficiary’s controlled care plan.
Medi-Cal coaching for brand new doula get advantages
Forward of the brand new yr, native organizations are getting ready doulas, birthworkers and network organizations via webhosting Medi-Cal coaching for the brand new doula get advantages. Inland Empire Well being Plan (IEHP) and Riverside Neighborhood Well being Basis (RCHF) hosted a Doula Medi-Cal Supplier Transition Coaching previous this month to speak about the supplier procedure with contributors of DHCS, IEHP, Molina Well being and Well being Internet.
“General, I discovered the educational/knowledge to be very useful. Most of the necessities I’ve met (and lots of different birthworkers have as neatly), however there was once one part I needed to download and any other I’m completing now,” Karen Sykes, doula and founding father of CaliSis Doulas, stated by the use of e-mail. Sykes attended the RCHF coaching to be informed extra concerning the Medi-Cal doula get advantages. “RCHF has been nice in offering well timed and significant knowledge on how one can contract with the suppliers inside the California Medi-Cal device for doula products and services.”
Sykes has been supporting households all over start for roughly 12 years in an unofficial capability, however has been operating as a doula in an authentic capability for the closing 3 years. Sykes may be a part of the Sankofa Birthworker’s Collective of Inland Empire, a community-based group created from start staff who supply strengthen and training to Black birthing folks right through Riverside and San Bernardino Counties. Sykes stated she is lately serving 3 households thru this system.
“Within the new yr, we await paintings at the enrollment of doulas as Medi-Cal Suppliers, making sure that Medi-Cal enrollees know concerning the new get advantages and are in a position to get entry to it and ascertaining how lengthy the ramp as much as the availability of advantages and compensation will take,” Robles-Fadet stated.
California is one step nearer to formalizing doula products and services as a coated get advantages inside the well being care device and spotting doula products and services as really helpful, important and impactful to Black households and households of colour who regularly have worse start results inside the clinic surroundings.
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