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