Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1139 Compare Versions

Only one version of the bill is available at this time.

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 2467 FILED ON: 1/19/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 1139
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Lindsay N. Sabadosa and Liz Miranda
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to insurance coverage for doula services.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Lindsay N. Sabadosa1st Hampshire1/19/2023Liz MirandaSecond Suffolk1/19/2023Mindy Domb3rd Hampshire1/20/2023Bud L. Williams11th Hampden1/20/2023Christine P. Barber34th Middlesex1/27/2023Andres X. Vargas3rd Essex2/2/2023Michelle M. DuBois10th Plymouth2/7/2023Jason M. LewisFifth Middlesex2/9/2023 1 of 11
16	16	HOUSE DOCKET, NO. 2467 FILED ON: 1/19/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 1139
18	18	By Representative Sabadosa of Northampton and Senator Miranda, a joint petition (accompanied
19	19	by bill, House, No. 1139) of Lindsay N. Sabadosa, Liz Miranda and others relative to insurance
20	20	coverage for doula services. Financial Services.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Third General Court
24	24	(2023-2024)
25	25	_______________
26	26	An Act relative to insurance coverage for doula services.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1: Chapter 118E of the General Laws is hereby amended by inserting after
30	30	2section 10N the following section:-
31	31	3 Section 10-O: Medicaid Coverage for Doula Services.
32	32	4 (A) For purposes of this section, the term “doula services” shall have the following
33	33	5meaning:
34	34	6 “Doula Services” are physical, emotional, and informational support, but not medical
35	35	7care, provided by trained doulas to individuals and families during and after pregnancy, labor,
36	36	8childbirth, miscarriage, stillbirth or pregnancy loss. Doula services include but are not limited to:
37	37	9 (1) continuous labor support;
38	38	10 (2) prenatal, postpartum, and bereavement home or in-person visits throughout the
39	39	11perinatal period, lasting until 1 year after birth, pregnancy loss, stillbirth, or miscarriage; 2 of 11
40	40	12 (3) accompanying pregnant individuals to health care and social services appointments;
41	41	13 (4) providing support to individuals for loss of pregnancy or infant from conception
42	42	14through one year postpartum;
43	43	15 (5) connecting individuals to community-based and state- and federally-funded
44	44	16resources, including those which address social determinants of health;
45	45	17 (6) making oneself available (being on-call) around the time of birth or loss as well as
46	46	18providing support for any concerns of pregnant individuals throughout pregnancy and until one
47	47	19year after birth, pregnancy loss, stillbirth, or miscarriage.
48	48	20 (7) providing support for other individuals providing care for a birthing parent,
49	49	21including a birthing parent’s partner and family members.
50	50	22 (B) Coverage of Doula Services:
51	51	23 (1) The Division shall provide coverage of doula services to pregnant individuals and
52	52	24postpartum individuals up to 12 months following the end of the pregnancy who are eligible for
53	53	25medical assistance under this chapter and/or through Title XIX or Title XXI of the Social
54	54	26Security Act. The Division shall provide the same coverage of doula services to pregnant and
55	55	27postpartum individuals who are not otherwise eligible for medical assistance under this chapter
56	56	28or Titles XIX or XXI of the Social Security Act solely because of their immigration status.
57	57	29 (2) The Division must cover continuous support through labor and childbirth, and at least
58	58	30up to six doula visits across the prenatal and one year postpartum period, including at least two
59	59	31postpartum visits, without the need for prior authorization. The Division must also establish a
60	60	32procedure to cover additional doula visits as needed. 3 of 11
61	61	33 (C) Creation of Doula Advisory Committee: There is hereby created a Doula Advisory
62	62	34Committee.
63	63	35 (1) The committee shall consist of 10-12 members to be appointed by the commissioner
64	64	36of public health, or designee.
65	65	37 (a) All but 2 of the members must be practicing doulas from the community; the
66	66	38remaining 2 members must be individuals from the community who have experienced pregnancy
67	67	39as a MassHealth member and are not practicing doulas.
68	68	40 (b) Among the members described in (a) above:
69	69	41 (i) at least 1 member must be a person who identifies as belonging to the LGBTQIA+
70	70	42community;
71	71	43 (iii) at least 1 member must be a person who has experienced a severe maternal
72	72	44morbidity, a perinatal mental health or mood disorder, or a near-death experience while pregnant
73	73	45or in maternity care;
74	74	46 (iv) at least 1 member must be a person who identifies as a person with disabilities or
75	75	47disabled person;
76	76	48 (c) The members of the committee shall represent a diverse range of experience levels-
77	77	49from doulas new to the practice to more experienced doulas.
78	78	50 (d) The members of the committee shall be from areas within the Commonwealth where
79	79	51maternal and infant outcomes are worse than the state average, as evidenced by the MA
80	80	52Department of Public Health’s most current perinatal data available at the time the member is
81	81	53appointed. 4 of 11
82	82	54 (e) The members of the committee shall represent an equitable geographic distribution
83	83	55from across the Commonwealth.
84	84	56 (2) The committee must be convened within six months of passage of this law.
85	85	57 (3) Of the initial appointments to the Doula Advisory Committee, half shall be appointed
86	86	58to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter, all terms shall
87	87	59be 2 years. The commissioner of public health, or designee, shall fill vacancies as soon as
88	88	60practicable.
89	89	61 (4) At least once every 8 weeks, the Division must meet with the Doula Advisory
90	90	62Committee to consult about at least the following:
91	91	63 (a) the scope of doula services covered by MassHealth;
92	92	64 (b) doula competencies required for reimbursement by MassHealth, and standards of
93	93	65proof or demonstration of those competencies;
94	94	66 (c) the recruitment of a diverse workforce of doulas to provide services to MassHealth
95	95	67members;
96	96	68 (d) the development of comprehensive and high quality continuing education and
97	97	69training that is free or low-cost to doulas committed to providing services to MassHealth
98	98	70members, as well as the development of mentorship and career growth opportunities for doulas
99	99	71providing services to MassHealth members;
100	100	72 (e) the performance of any third party administrators of MassHealth’s doula coverage
101	101	73program, and standards and processes around billing for and prompt reimbursement of doula
102	102	74services; 5 of 11
103	103	75 (f) establishing grievance procedures for doulas, MassHealth members, and health care
104	104	76providers about MassHealth’s coverage of doula services and/or the provision of doula services
105	105	77to MassHealth members;
106	106	78 (g) outreach to the public and stakeholders about how to access doula care for
107	107	79MassHealth members, and about the availability of and advantages of doula care;
108	108	80 (h) the evaluation and collection of data on the provision of, outcomes of, access to, and
109	109	81satisfaction with doula care services provided to MassHealth members;
110	110	82 (i) maintaining a reimbursement rate for doula services that incentivizes and supports a
111	111	83diverse workforce representative of the communities served, and establishing a recurring
112	112	84timeframe to review that rate in light of inflation and changing costs of living in the
113	113	85commonwealth;
114	114	86 (j) how to ensure that MassHealth’s doula reimbursement program is directed towards
115	115	87the goal of reducing inequities in maternal and birth outcomes among racial, ethnic, and cultural
116	116	88populations who reside in all areas within the commonwealth, as evidenced by the most current
117	117	89perinatal data supplied by the department of public health.
118	118	90 (5) Each year, the Doula Advisory Committee must, by a majority vote of a quorum of its
119	119	91members, select an individual to serve as its chairperson for a one year term. The Doula
120	120	92Advisory Committee may replace the chairperson in the same manner mid-term.
121	121	93 (6) The Doula Advisory Committee may, by a majority vote of a quorum of its members,
122	122	94reduce the frequency of meetings with MassHealth to less than once every 8 weeks. 6 of 11
123	123	95 (7) The division and the Department of Public Health shall seek resources to offer
124	124	96reasonable compensation to members of the Doula Advisory Committee for fulfilling their
125	125	97duties, and must reimburse members for actual and necessary expenses incurred while fulfilling
126	126	98their duties.
127	127	99 (8) The division, in partnership with the Doula Advisory Committee, shall conduct at
128	128	100least 1 public hearing or forum each year until three years after passage of this law. The purposes
129	129	101of these hearings or forums shall be to gather feedback from the public and to inform the public
130	130	102about MassHealth’s coverage of doula care.
131	131	103 SECTION 2. Chapter 32A of the General Laws, as appearing in the 2014 Official
132	132	104Edition, is hereby amended by inserting after section 27 the following section:
133	133	105 Section 28. (a) Any coverage offered by the commission to any active or retired
134	134	106employee of the commonwealth insured under the group insurance commission shall provide
135	135	107coverage for all doula services as defined in Section XX.
136	136	108 (b) Nothing in this section shall be construed to deny or restrict in any way the group
137	137	109insurance commission’s authority to ensure plan compliance with this chapter.
138	138	110 SECTION 3. Chapter 118E of the General Laws, as so appearing, is hereby amended by
139	139	111inserting after section 10I the following section:
140	140	112 10J (a) The division and its contracted health insurers, health plans, health maintenance
141	141	113organizations, behavioral health management firms and third-party administrators under contract
142	142	114to a Medicaid managed care organization or primary care clinician plan shall provide coverage
143	143	115for all doula services as defined in Section XX. 7 of 11
144	144	116 (b) Nothing in this section shall be construed to deny or restrict in any way the group
145	145	117insurance commission’s authority to ensure plan compliance with this chapter.
146	146	118 SECTION 4. Chapter 175 of the General Laws, as so appearing, is hereby amended by
147	147	119inserting after section 47W(c) the following:
148	148	120 (d) An individual policy of accident and sickness insurance issued pursuant to section
149	149	121108 that provides hospital expense and surgical expense and any group blanket policy of accident
150	150	122and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical
151	151	123expense insurance, delivered, issued or renewed by agreement between the insurer and the
152	152	124policyholder, within or without the Commonwealth, (hereinafter “policy”) shall provide benefits
153	153	125for residents of the Commonwealth and all group members having a principal place of
154	154	126employment within the Commonwealth coverage for all doula services as defined in Section XX.
155	155	127 (e) Nothing in this section shall be construed to deny or restrict in any way the division of
156	156	128insurance’s authority to ensure compliance with this chapter.
157	157	129 SECTION 5. Chapter 176A of the General Laws, as so appearing, is hereby amended by
158	158	130inserting after section 8W(c) the following:
159	159	131 (d) Any contract between a subscriber and the corporation under an individual or group
160	160	132hospital service plan that is delivered, issued or renewed within or without the Commonwealth
161	161	133and that provides benefits for outpatient services shall provide to all individual subscribers and
162	162	134members within the Commonwealth and to all group members having a principal place of
163	163	135employment within the Commonwealth coverage for all doula services as defined in Section XX. 8 of 11
164	164	136 (e) Nothing in this section shall be construed to deny or restrict in any way the division of
165	165	137insurance’s authority to ensure compliance with this chapter.
166	166	138 SECTION 6. Chapter 176B of the General Laws, as so appearing, is hereby amended by
167	167	139inserting after section 4W(c) the following:
168	168	140 (d) Any subscription certificate under an individual or group medical service agreement
169	169	141that is delivered, issued or renewed within or without the Commonwealth and that provides
170	170	142benefits for outpatient services shall provide to all individual subscribers and members within the
171	171	143Commonwealth and to all group members having a principal place of employment within the
172	172	144Commonwealth coverage for all doula services as defined in Section XX.
173	173	145 (e) Nothing in this subsection shall be construed to deny or restrict in any way the
174	174	146division of insurance’s authority to ensure medical service agreement compliance with this
175	175	147chapter.
176	176	148 SECTION 7. Chapter 176G of the General Laws, as so appearing, is hereby amended by
177	177	149inserting after section 4O(c) the following:
178	178	150 (d) Any individual or group health maintenance contract that is issued, renewed or
179	179	151delivered within or without the Commonwealth and that provides benefits for outpatient
180	180	152prescription drugs or devices shall provide to residents of the Commonwealth and to persons
181	181	153having a principal place of employment within the Commonwealth coverage for all doula
182	182	154services as defined in Section XX. 9 of 11
183	183	155 (e) Nothing in this subsection shall be construed to deny or restrict in any way the
184	184	156division of insurance’s authority to ensure health maintenance contract compliance with this
185	185	157chapter.
186	186	158 SECTION 8. Sections 1 through 6 of this act shall apply to all policies, contracts and
187	187	159certificates of health insurance subject to chapters 32A, chapter 118E, chapter 175, chapter
188	188	160176A, chapter 176B, and chapter 176G which are delivered, issued or renewed on or after
189	189	161September 1, 2024.
190	190	162 SECTION 9. Chapter 29 of the Massachusetts General Laws is hereby amended by
191	191	163inserting after section 2QQQQQ the following section:-
192	192	164 Section 2RRRRR. (a) There shall be established and set up on the books of the
193	193	165commonwealth a separate fund known as the Doula Workforce Development Trust Fund,
194	194	166hereinafter called the fund. The fund shall be administered by the department of career services
195	195	167which shall contract with the Commonwealth Corporation to administer the fund. The fund shall
196	196	168be credited with: (i) revenue from appropriations or other money authorized by the general court
197	197	169and specifically designated to be credited to the fund; (ii) interest earned on such revenues; and
198	198	170(iii) funds from public and private sources; and other gifts, grants and donations for the growth,
199	199	171training and continuous support of the doula workforce. Amounts credited to the fund shall not
200	200	172be subject to further appropriation and any money remaining in the fund at the end of a fiscal
201	201	173year shall not revert to the General Fund.
202	202	174 (b) The Commonwealth Corporation shall make expenditures from the fund for the
203	203	175purposes of: 10 of 11
204	204	176 (i) the development and expansion of comprehensive doula training available across the
205	205	177commonwealth. including the development of doula training focused on meeting the needs of
206	206	178MassHealth members;
207	207	179 (ii) ensuring that doulas committed to serving MassHealth members have access to high
208	208	180quality doula training at no- or low-cost to them;
209	209	181 (iii) the recruitment and retention of doulas from communities with high concentrations
210	210	182of MassHealth members, as well as areas within the commonwealth where maternal and infant
211	211	183outcomes are worse than the state average, as evidenced by the MA Department of Public
212	212	184Health’s perinatal data.
213	213	185 (iv) expanding doula mentoring opportunities across the state, which provide new doulas
214	214	186the opportunity to attend births and incentivize experienced practicing doulas to take on mentees.
215	215	187 (v) leveraging funds to secure future federal funding to support doula workforce
216	216	188development in the commonwealth.
217	217	189 (c) The director of career services shall annually, not later than December 31, report to
218	218	190the secretary of administration and finance, the house and senate committees on ways and means
219	219	191and the joint committee on labor and workforce development on the efforts undertaken in
220	220	192support of section (b) above; the number of doulas recruited and trained as a result of activities
221	221	193taken in support of (b) above, including but not limited to sex, gender identity, race, and ethnicity
222	222	194of such doulas; the amount of grants and identities of grantees awarded in support of section (b)
223	223	195above; and the availability of doula training at no- or low-cost to doulas committed to serving
224	224	196MassHealth members. 11 of 11
225	225	197 SECTION 10: Chapter 111 of the General Laws is hereby amended by inserting in
226	226	198section 70E after “Every patient or resident of a facility shall have the right:”:
227	227	199 (p) to have their birth doula’s continuous presence during labor and delivery.
228	228	200Facilities shall not place an undue burden on a patient’s doula’s access to clinical labor and
229	229	201delivery settings, and shall not arbitrarily exclude a patient’s doula from such settings.