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Massachusetts Senate Bill S789

Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S789 Compare Versions

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22 SENATE DOCKET, NO. 998 FILED ON: 1/15/2025
33 SENATE . . . . . . . . . . . . . . No. 789
44 The Commonwealth of Massachusetts
55 _________________
66 PRESENTED BY:
77 Liz Miranda
88 _________________
99 To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
1010 Court assembled:
1111 The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
1212 An Act relative to insurance coverage for doula services.
1313 _______________
1414 PETITION OF:
1515 NAME:DISTRICT/ADDRESS :Liz MirandaSecond Suffolk 1 of 10
1616 SENATE DOCKET, NO. 998 FILED ON: 1/15/2025
1717 SENATE . . . . . . . . . . . . . . No. 789
1818 By Ms. Miranda, a petition (accompanied by bill, Senate, No. 789) of Liz Miranda for legislation
1919 relative to insurance coverage for doula services. Financial Services.
2020 [SIMILAR MATTER FILED IN PREVIOUS SESSION
2121 SEE SENATE, NO. 680 OF 2023-2024.]
2222 The Commonwealth of Massachusetts
2323 _______________
2424 In the One Hundred and Ninety-Fourth General Court
2525 (2025-2026)
2626 _______________
2727 An Act relative to insurance coverage for doula services.
2828 Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
2929 of the same, as follows:
3030 1 SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after
3131 2section 33 the following section:- Section 34. (a) For the purpose of this section, the term “doula
3232 3services” shall have the following meaning:
3333 4 “Doula Services” are physical, emotional, and informational support, but not medical
3434 5care, provided by trained doulas to individuals and families from conception until twelve months
3535 6after pregnancy, labor, childbirth, adoption, miscarriage, stillbirth or abortion. Doula services
3636 7include but are not limited to: (1) continuous labor and delivery support, inclusive of all
3737 8outcomes; (2) support for pregnancy loss or infant loss, including bereavement home or in-
3838 9person visits; (3) accompanying individuals to health care and social services appointments; (4)
3939 10connecting individuals to community-based and state- and federally-funded resources, including 2 of 10
4040 11those which address social determinants of health; (5) being on-call around the time of birth,
4141 12adoption, loss or abortion, as well as providing on-call support in-person or via telehealth for
4242 13individuals’ questions or concerns; (6) support for other individuals providing care for a birthing
4343 14or adoptive parent, including spouses, partners, and other family members. (7) educational and
4444 15informational support including but not limited to childbirth preparation, newborn care, perinatal
4545 16mental health, and postpartum recovery. (8) empowering individuals to advocate for their
4646 17preferences, needs and rights during pregnancy, labor and delivery, and postpartum.
4747 18 (b) Any coverage offered by the commission to an active or retired employee of the
4848 19commonwealth and their dependents insured under the group insurance commission (hereinafter
4949 20“policy”) shall provide coverage for all doula services. Coverage provided for doula services
5050 21shall not be subject to any deductible, coinsurance, copayment or any other cost-sharing
5151 22requirement. (c) No policy shall require a referral for doula services by any other health care
5252 23provider as a condition of reimbursement. (d) Doulas shall be reimbursed for their services at a
5353 24rate at least equivalent to MassHealth’s reimbursement rate for doula services. (e) A policy shall
5454 25cover, without prior authorization, a minimum of twenty hours of prenatal and postpartum doula
5555 26services per pregnancy, and continuous support throughout labor and delivery, inclusive of all
5656 27pregnancy outcomes. Within the authorized number of doula hours, policies shall not impose
5757 28limitations on the amount of time a doula can bill per patient per day. (f) Policies must establish
5858 29a process to approve coverage of additional hours of doula services in cases where the patient has
5959 30heightened risk or need. (g) Policies shall follow the doula credentialing requirements developed
6060 31by the Massachusetts Department of Public Health, and may not impose any additional
6161 32credentialing requirements. Additionally, any doula approved as a MassHealth Doula Provider
6262 33shall be deemed as meeting all credentialing requirements. 3 of 10
6363 34 SECTION 2. Chapter 175 of the General Laws, as so appearing, is hereby amended by
6464 35inserting after section 47UU the following section:- SECTION 47VV. (a) For the purpose of this
6565 36section, the term “doula services” shall have the following meaning: “Doula Services” are
6666 37physical, emotional, and informational support, but not medical care, provided by trained doulas
6767 38to individuals and families from conception until twelve months after pregnancy, labor,
6868 39childbirth, adoption, miscarriage, stillbirth or abortion. Doula services include but are not limited
6969 40to: (1) continuous labor and delivery support, inclusive of all outcomes; (2) support for
7070 41pregnancy loss or infant loss, including bereavement home or in-person visits; (3) accompanying
7171 42individuals to health care and social services appointments; (4) connecting individuals to
7272 43community-based and state- and federally-funded resources, including those which address
7373 44social determinants of health; (5) being on-call around the time of birth, adoption, loss or
7474 45abortion, as well as providing on-call support in-person or via telehealth for individuals’
7575 46questions or concerns; (6) support for other individuals providing care for a birthing or adoptive
7676 47parent, including spouses, partners, and other family members.
7777 48 (7) educational and informational support including but not limited to childbirth
7878 49preparation, newborn care, perinatal mental health, and postpartum recovery. (8) empowering
7979 50individuals to advocate for their preferences, needs and rights during pregnancy, labor and
8080 51delivery, and postpartum. (b) A policy, contract, agreement, plan or certificate of insurance
8181 52issued, delivered or renewed within the commonwealth (hereinafter “policy”) shall provide
8282 53coverage for all doula services. Coverage provided under this section for doula services shall not
8383 54be subject to any deductible, coinsurance, copayment or any other cost-sharing requirement. (c)
8484 55No policy shall require a referral for doula services by any other health care provider as a
8585 56condition of reimbursement. (d) Doulas shall be reimbursed for their services at a rate at least 4 of 10
8686 57equivalent to MassHealth’s reimbursement rate for doula services. (e) A policy shall cover,
8787 58without prior authorization, a minimum of twenty hours of prenatal and postpartum doula
8888 59services per pregnancy, and continuous support throughout labor and delivery, inclusive of all
8989 60pregnancy outcomes. Within the authorized number of doula hours, policies shall not impose
9090 61limitations on the amount of time a doula can bill per patient per day. (f) Policies must establish
9191 62a process to approve coverage of additional hours of doula services in cases where the patient has
9292 63heightened risk or need.
9393 64 (g) Policies shall follow the doula credentialing requirements developed by the
9494 65Massachusetts Department of Public Health, and may not impose any additional credentialing
9595 66requirements. Additionally, any doula approved as a MassHealth Doula Provider shall be
9696 67deemed as meeting all credentialing requirements.
9797 68 SECTION 3. Chapter 176A of the General Laws, is hereby amended by inserting after
9898 69section 8VV the following section:- SECTION 8WW. (a) For the purpose of this section, the
9999 70term “doula services” shall have the following meaning: “Doula Services” are physical,
100100 71emotional, and informational support, but not medical care, provided by trained doulas to
101101 72individuals and families from conception until twelve months after pregnancy, labor, childbirth,
102102 73adoption, miscarriage, stillbirth or abortion. Doula services include but are not limited to: (1)
103103 74continuous labor and delivery support, inclusive of all outcomes; (2) support for pregnancy loss
104104 75or infant loss, including bereavement home or in-person visits; (3) accompanying individuals to
105105 76health care and social services appointments; (4) connecting individuals to community-based and
106106 77state- and federally-funded resources, including those which address social determinants of
107107 78health; 5 of 10
108108 79 (5) being on-call around the time of birth, adoption, loss or abortion, as well as providing
109109 80on-call support in-person or via telehealth for individuals’ questions or concerns; (6) support for
110110 81other individuals providing care for a birthing or adoptive parent, including spouses, partners,
111111 82and other family members. (7) educational and informational support including but not limited to
112112 83childbirth preparation, newborn care, perinatal mental health, and postpartum recovery. (8)
113113 84empowering individuals to advocate for their preferences, needs and rights during pregnancy,
114114 85labor and delivery, and postpartum. (b) Any contract between a subscriber and a corporation
115115 86subject to this chapter, pursuant to an individual or group hospital service plan that is delivered,
116116 87issued or renewed within the commonwealth (hereinafter “policy”) shall provide coverage for all
117117 88doula services. Coverage provided under this section for doula services shall not be subject to
118118 89any deductible, coinsurance, copayment or any other cost-sharing requirement. (c) No policy
119119 90shall require a referral for doula services by any other health care provider as a condition of
120120 91reimbursement. (d) Doulas shall be reimbursed for their services at a rate at least equivalent to
121121 92MassHealth’s reimbursement rate for doula services.
122122 93 (e) A policy shall cover, without prior authorization, a minimum of twenty hours of
123123 94prenatal and postpartum doula services per pregnancy, and continuous support throughout labor
124124 95and delivery, inclusive of all pregnancy outcomes. Within the authorized number of doula hours,
125125 96policies shall not impose limitations on the amount of time a doula can bill per patient per day.
126126 97(f) Policies must establish a process to approve coverage of additional hours of doula services in
127127 98cases where the patient has heightened risk or need. (g) Policies shall follow the doula
128128 99credentialing requirements developed by the Massachusetts Department of Public Health, and
129129 100may not impose any additional credentialing requirements. Additionally, any doula approved as a
130130 101MassHealth Doula Provider shall be deemed as meeting all credentialing requirements. 6 of 10
131131 102 SECTION 4. Chapter 176B of the General Laws, is hereby amended by inserting after
132132 103section 4VV the following section:- Section 4WW. (a) For the purpose of this section, the term
133133 104“doula services” shall have the following meaning: “Doula Services” are physical, emotional,
134134 105and informational support, but not medical care, provided by trained doulas to individuals and
135135 106families from conception until twelve months after pregnancy, labor, childbirth, adoption,
136136 107miscarriage, stillbirth or abortion. Doula services include but are not limited to: (1) continuous
137137 108labor and delivery support, inclusive of all outcomes;
138138 109 (2) support for pregnancy loss or infant loss, including bereavement home or in-person
139139 110visits; (3) accompanying individuals to health care and social services appointments; (4)
140140 111connecting individuals to community-based and state- and federally-funded resources, including
141141 112those which address social determinants of health; (5) being on-call around the time of birth,
142142 113adoption, loss or abortion, as well as providing on-call support in-person or via telehealth for
143143 114individuals’ questions or concerns; (6) support for other individuals providing care for a birthing
144144 115or adoptive parent, including spouses, partners, and other family members. (7) educational and
145145 116informational support including but not limited to childbirth preparation, newborn care, perinatal
146146 117mental health, and postpartum recovery. (8) empowering individuals to advocate for their
147147 118preferences, needs and rights during pregnancy, labor and delivery, and postpartum. (b) Any
148148 119subscription certificate under an individual or group medical service agreement that is delivered,
149149 120issued or renewed within the commonwealth (hereinafter “policy”) shall provide coverage for all
150150 121doula services. Coverage provided under this section for doula services shall not be subject to
151151 122any deductible, coinsurance, copayment or any other cost-sharing requirement.
152152 123 (c) No policy shall require a referral for doula services by any other health care provider
153153 124as a condition of reimbursement. (d) Doulas shall be reimbursed for their services at a rate at 7 of 10
154154 125least equivalent to MassHealth’s reimbursement rate for doula services. (e) A policy shall cover,
155155 126without prior authorization, a minimum of twenty hours of prenatal and postpartum doula
156156 127services per pregnancy, and continuous support throughout labor and delivery, inclusive of all
157157 128pregnancy outcomes. Within the authorized number of doula hours, policies shall not impose
158158 129limitations on the amount of time a doula can bill per patient per day. (f) Policies must establish
159159 130a process to approve coverage of additional hours of doula services in cases where the patient has
160160 131heightened risk or need. (g) Policies shall follow the doula credentialing requirements developed
161161 132by the Massachusetts Department of Public Health, and may not impose any additional
162162 133credentialing requirements. Additionally, any doula approved as a MassHealth Doula Provider
163163 134shall be deemed as meeting all credentialing requirements.
164164 135 SECTION 5. Chapter 176G of the General Laws, is hereby amended by inserting after
165165 136section 4NN the following section:- Section 4OO. (a) For the purpose of this section, the term
166166 137“doula services” shall have the following meaning:
167167 138 “Doula Services” are physical, emotional, and informational support, but not medical
168168 139care, provided by trained doulas to individuals and families from conception until twelve months
169169 140after pregnancy, labor, childbirth, adoption, miscarriage, stillbirth or abortion. Doula services
170170 141include but are not limited to: (1) continuous labor and delivery support, inclusive of all
171171 142outcomes; (2) support for pregnancy loss or infant loss, including bereavement home or in-
172172 143person visits; (3) accompanying individuals to health care and social services appointments; (4)
173173 144connecting individuals to community-based and state- and federally-funded resources, including
174174 145those which address social determinants of health; (5) being on-call around the time of birth,
175175 146adoption, loss or abortion, as well as providing on-call support in-person or via telehealth for
176176 147individuals’ questions or concerns; (6) support for other individuals providing care for a birthing 8 of 10
177177 148or adoptive parent, including spouses, partners, and other family members. (7) educational and
178178 149informational support including but not limited to childbirth preparation, newborn care, perinatal
179179 150mental health, and postpartum recovery. (8) empowering individuals to advocate for their
180180 151preferences, needs and rights during pregnancy, labor and delivery, and postpartum.
181181 152 (b) Any individual or group health maintenance contract that is issued or renewed within
182182 153or without the commonwealth (hereinafter “policy”) shall provide coverage for all doula
183183 154services. Coverage provided under this section for doula services shall not be subject to any
184184 155deductible, coinsurance, copayment or any other cost-sharing requirement. (c) No policy shall
185185 156require a referral for doula services by any other health care provider as a condition of
186186 157reimbursement. (d) Doulas shall be reimbursed for their services at a rate at least equivalent to
187187 158MassHealth’s reimbursement rate for doula services. (e) A policy shall cover, without prior
188188 159authorization, a minimum of twenty hours of prenatal and postpartum doula services per
189189 160pregnancy, and continuous support throughout labor and delivery, inclusive of all pregnancy
190190 161outcomes. Within the authorized number of doula hours, policies shall not impose limitations on
191191 162the amount of time a doula can bill per patient per day. (f) Policies must establish a process to
192192 163approve coverage of additional hours of doula services in cases where the patient has heightened
193193 164risk or need. (g) Policies shall follow the doula credentialing requirements developed by the
194194 165Massachusetts Department of Public Health, and may not impose any additional credentialing
195195 166requirements. Additionally, any doula approved as a MassHealth Doula Provider shall be
196196 167deemed as meeting all credentialing requirements.
197197 168 SECTION 6. Sections 2 through 6 of this act shall apply to all policies, contracts and
198198 169certificates of health insurance subject to chapters 32A, chapter 175, chapter 176A, chapter
199199 170176B, and chapter 176G which are delivered, issued or renewed on or after September 1, 2026. 9 of 10
200200 171SECTION 7. Doula Advisory Committee: There is hereby created a Doula Advisory Committee.
201201 172(1) The committee shall consist of 10-12 members to be appointed by the Governor, or designee.
202202 173(a) All but 2 of the members shall be practicing doulas from the community representing a range
203203 174of experience levels and a diversity of lived experience; the remaining 2 members shall be
204204 175individuals from the community who have experienced pregnancy as a MassHealth member and
205205 176are not practicing doulas. (b) The members of the committee shall represent an equitable
206206 177geographic distribution from across the Commonwealth, including representation from areas
207207 178within the Commonwealth where maternal and infant outcomes are worse than the state average,
208208 179as evidenced by the MA Department of Public Health’s most current perinatal data available at
209209 180the time the member is appointed. (2) The committee shall be convened within six months of
210210 181passage of this law. (3) Of the initial appointments to the Doula Advisory Committee, half shall
211211 182be appointed to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter,
212212 183all terms shall be 2 years. The Governor, or designee, shall fill vacancies as soon as practicable.
213213 184 (4) At least once every 8 weeks, the Division of Medical Assistance shall meet with the
214214 185Doula Advisory Committee to consult about MassHealth’s coverage of doula services, including
215215 186but not limited to the following: (a) the standards and processes around billing for and prompt
216216 187reimbursement of doula services; (b) establishing grievance procedures for doulas, MassHealth
217217 188members, and health care providers about MassHealth’s coverage of doula services, the
218218 189provision of doula services to MassHealth members, and bias that doulas face as they try to
219219 190integrate into birth teams; (c) maintaining a reimbursement rate for doula services that
220220 191incentivizes and supports a diverse workforce representative of the communities served, and
221221 192establishing a recurring timeframe to review that rate in light of inflation and changing costs of
222222 193living in the commonwealth; (5) Each year, the Doula Advisory Committee must, by a majority 10 of 10
223223 194vote of a quorum of its members, select an individual to serve as its chairperson for a one year
224224 195term. The Doula Advisory Committee may replace the chairperson in the same manner mid-
225225 196term. (6) The Doula Advisory Committee may, by a majority vote of a quorum of its members,
226226 197reduce the frequency of meetings with MassHealth to less than once every 8 weeks. (7) The
227227 198Division of Medical Assistance shall seek resources to offer reasonable compensation to
228228 199members of the Doula Advisory Committee for fulfilling their duties, and shall reimburse
229229 200members for actual and necessary expenses incurred while fulfilling their duties.
230230 201 SECTION 8. Chapter 111 of the General Laws is hereby amended by inserting in section
231231 20270E after “Every patient or resident of a facility shall have the right:”: (i) to have their birth
232232 203doula’s continuous presence during labor and delivery. Facilities shall not place an undue burden
233233 204on access of a patient’s doula to clinical labor and delivery settings, and shall not arbitrarily
234234 205exclude a patient’s doula from such settings. A doula shall not be counted as a patient's guest or
235235 206support person.