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SENATE DOCKET, NO. 998 FILED ON: 1/15/2025
SENATE . . . . . . . . . . . . . . No. 789
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
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 :Liz MirandaSecond Suffolk 1 of 10
SENATE DOCKET, NO. 998 FILED ON: 1/15/2025
SENATE . . . . . . . . . . . . . . No. 789
By Ms. Miranda, a petition (accompanied by bill, Senate, No. 789) of Liz Miranda for legislation
relative to insurance coverage for doula services. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 680 OF 2023-2024.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
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 32A of the General Laws is hereby amended by inserting after
2section 33 the following section:- Section 34. (a) For the purpose of this section, the term “doula
3services” shall have the following meaning:
4 “Doula Services” are physical, emotional, and informational support, but not medical
5care, provided by trained doulas to individuals and families from conception until twelve months
6after pregnancy, labor, childbirth, adoption, miscarriage, stillbirth or abortion. Doula services
7include but are not limited to: (1) continuous labor and delivery support, inclusive of all
8outcomes; (2) support for pregnancy loss or infant loss, including bereavement home or in-
9person visits; (3) accompanying individuals to health care and social services appointments; (4)
10connecting individuals to community-based and state- and federally-funded resources, including 2 of 10
11those which address social determinants of health; (5) being on-call around the time of birth,
12adoption, loss or abortion, as well as providing on-call support in-person or via telehealth for
13individuals’ questions or concerns; (6) support for other individuals providing care for a birthing
14or adoptive parent, including spouses, partners, and other family members. (7) educational and
15informational support including but not limited to childbirth preparation, newborn care, perinatal
16mental health, and postpartum recovery. (8) empowering individuals to advocate for their
17preferences, needs and rights during pregnancy, labor and delivery, and postpartum.
18 (b) Any coverage offered by the commission to an active or retired employee of the
19commonwealth and their dependents insured under the group insurance commission (hereinafter
20“policy”) shall provide coverage for all doula services. Coverage provided for doula services
21shall not be subject to any deductible, coinsurance, copayment or any other cost-sharing
22requirement. (c) No policy shall require a referral for doula services by any other health care
23provider as a condition of reimbursement. (d) Doulas shall be reimbursed for their services at a
24rate at least equivalent to MassHealth’s reimbursement rate for doula services. (e) A policy shall
25cover, without prior authorization, a minimum of twenty hours of prenatal and postpartum doula
26services per pregnancy, and continuous support throughout labor and delivery, inclusive of all
27pregnancy outcomes. Within the authorized number of doula hours, policies shall not impose
28limitations on the amount of time a doula can bill per patient per day. (f) Policies must establish
29a process to approve coverage of additional hours of doula services in cases where the patient has
30heightened risk or need. (g) Policies shall follow the doula credentialing requirements developed
31by the Massachusetts Department of Public Health, and may not impose any additional
32credentialing requirements. Additionally, any doula approved as a MassHealth Doula Provider
33shall be deemed as meeting all credentialing requirements. 3 of 10
34 SECTION 2. Chapter 175 of the General Laws, as so appearing, is hereby amended by
35inserting after section 47UU the following section:- SECTION 47VV. (a) For the purpose of this
36section, the term “doula services” shall have the following meaning: “Doula Services” are
37physical, emotional, and informational support, but not medical care, provided by trained doulas
38to individuals and families from conception until twelve months after pregnancy, labor,
39childbirth, adoption, miscarriage, stillbirth or abortion. Doula services include but are not limited
40to: (1) continuous labor and delivery support, inclusive of all outcomes; (2) support for
41pregnancy loss or infant loss, including bereavement home or in-person visits; (3) accompanying
42individuals to health care and social services appointments; (4) connecting individuals to
43community-based and state- and federally-funded resources, including those which address
44social determinants of health; (5) being on-call around the time of birth, adoption, loss or
45abortion, as well as providing on-call support in-person or via telehealth for individuals’
46questions or concerns; (6) support for other individuals providing care for a birthing or adoptive
47parent, including spouses, partners, and other family members.
48 (7) educational and informational support including but not limited to childbirth
49preparation, newborn care, perinatal mental health, and postpartum recovery. (8) empowering
50individuals to advocate for their preferences, needs and rights during pregnancy, labor and
51delivery, and postpartum. (b) A policy, contract, agreement, plan or certificate of insurance
52issued, delivered or renewed within the commonwealth (hereinafter “policy”) shall provide
53coverage for all doula services. Coverage provided under this section for doula services shall not
54be subject to any deductible, coinsurance, copayment or any other cost-sharing requirement. (c)
55No policy shall require a referral for doula services by any other health care provider as a
56condition of reimbursement. (d) Doulas shall be reimbursed for their services at a rate at least 4 of 10
57equivalent to MassHealth’s reimbursement rate for doula services. (e) A policy shall cover,
58without prior authorization, a minimum of twenty hours of prenatal and postpartum doula
59services per pregnancy, and continuous support throughout labor and delivery, inclusive of all
60pregnancy outcomes. Within the authorized number of doula hours, policies shall not impose
61limitations on the amount of time a doula can bill per patient per day. (f) Policies must establish
62a process to approve coverage of additional hours of doula services in cases where the patient has
63heightened risk or need.
64 (g) Policies shall follow the doula credentialing requirements developed by the
65Massachusetts Department of Public Health, and may not impose any additional credentialing
66requirements. Additionally, any doula approved as a MassHealth Doula Provider shall be
67deemed as meeting all credentialing requirements.
68 SECTION 3. Chapter 176A of the General Laws, is hereby amended by inserting after
69section 8VV the following section:- SECTION 8WW. (a) For the purpose of this section, the
70term “doula services” shall have the following meaning: “Doula Services” are physical,
71emotional, and informational support, but not medical care, provided by trained doulas to
72individuals and families from conception until twelve months after pregnancy, labor, childbirth,
73adoption, miscarriage, stillbirth or abortion. Doula services include but are not limited to: (1)
74continuous labor and delivery support, inclusive of all outcomes; (2) support for pregnancy loss
75or infant loss, including bereavement home or in-person visits; (3) accompanying individuals to
76health care and social services appointments; (4) connecting individuals to community-based and
77state- and federally-funded resources, including those which address social determinants of
78health; 5 of 10
79 (5) being on-call around the time of birth, adoption, loss or abortion, as well as providing
80on-call support in-person or via telehealth for individuals’ questions or concerns; (6) support for
81other individuals providing care for a birthing or adoptive parent, including spouses, partners,
82and other family members. (7) educational and informational support including but not limited to
83childbirth preparation, newborn care, perinatal mental health, and postpartum recovery. (8)
84empowering individuals to advocate for their preferences, needs and rights during pregnancy,
85labor and delivery, and postpartum. (b) Any contract between a subscriber and a corporation
86subject to this chapter, pursuant to an individual or group hospital service plan that is delivered,
87issued or renewed within the commonwealth (hereinafter “policy”) shall provide coverage for all
88doula services. Coverage provided under this section for doula services shall not be subject to
89any deductible, coinsurance, copayment or any other cost-sharing requirement. (c) No policy
90shall require a referral for doula services by any other health care provider as a condition of
91reimbursement. (d) Doulas shall be reimbursed for their services at a rate at least equivalent to
92MassHealth’s reimbursement rate for doula services.
93 (e) A policy shall cover, without prior authorization, a minimum of twenty hours of
94prenatal and postpartum doula services per pregnancy, and continuous support throughout labor
95and delivery, inclusive of all pregnancy outcomes. Within the authorized number of doula hours,
96policies shall not impose limitations on the amount of time a doula can bill per patient per day.
97(f) Policies must establish a process to approve coverage of additional hours of doula services in
98cases where the patient has heightened risk or need. (g) Policies shall follow the doula
99credentialing requirements developed by the Massachusetts Department of Public Health, and
100may not impose any additional credentialing requirements. Additionally, any doula approved as a
101MassHealth Doula Provider shall be deemed as meeting all credentialing requirements. 6 of 10
102 SECTION 4. Chapter 176B of the General Laws, is hereby amended by inserting after
103section 4VV the following section:- Section 4WW. (a) For the purpose of this section, the term
104“doula services” shall have the following meaning: “Doula Services” are physical, emotional,
105and informational support, but not medical care, provided by trained doulas to individuals and
106families from conception until twelve months after pregnancy, labor, childbirth, adoption,
107miscarriage, stillbirth or abortion. Doula services include but are not limited to: (1) continuous
108labor and delivery support, inclusive of all outcomes;
109 (2) support for pregnancy loss or infant loss, including bereavement home or in-person
110visits; (3) accompanying individuals to health care and social services appointments; (4)
111connecting individuals to community-based and state- and federally-funded resources, including
112those which address social determinants of health; (5) being on-call around the time of birth,
113adoption, loss or abortion, as well as providing on-call support in-person or via telehealth for
114individuals’ questions or concerns; (6) support for other individuals providing care for a birthing
115or adoptive parent, including spouses, partners, and other family members. (7) educational and
116informational support including but not limited to childbirth preparation, newborn care, perinatal
117mental health, and postpartum recovery. (8) empowering individuals to advocate for their
118preferences, needs and rights during pregnancy, labor and delivery, and postpartum. (b) Any
119subscription certificate under an individual or group medical service agreement that is delivered,
120issued or renewed within the commonwealth (hereinafter “policy”) shall provide coverage for all
121doula services. Coverage provided under this section for doula services shall not be subject to
122any deductible, coinsurance, copayment or any other cost-sharing requirement.
123 (c) No policy shall require a referral for doula services by any other health care provider
124as a condition of reimbursement. (d) Doulas shall be reimbursed for their services at a rate at 7 of 10
125least equivalent to MassHealth’s reimbursement rate for doula services. (e) A policy shall cover,
126without prior authorization, a minimum of twenty hours of prenatal and postpartum doula
127services per pregnancy, and continuous support throughout labor and delivery, inclusive of all
128pregnancy outcomes. Within the authorized number of doula hours, policies shall not impose
129limitations on the amount of time a doula can bill per patient per day. (f) Policies must establish
130a process to approve coverage of additional hours of doula services in cases where the patient has
131heightened risk or need. (g) Policies shall follow the doula credentialing requirements developed
132by the Massachusetts Department of Public Health, and may not impose any additional
133credentialing requirements. Additionally, any doula approved as a MassHealth Doula Provider
134shall be deemed as meeting all credentialing requirements.
135 SECTION 5. Chapter 176G of the General Laws, is hereby amended by inserting after
136section 4NN the following section:- Section 4OO. (a) For the purpose of this section, the term
137“doula services” shall have the following meaning:
138 “Doula Services” are physical, emotional, and informational support, but not medical
139care, provided by trained doulas to individuals and families from conception until twelve months
140after pregnancy, labor, childbirth, adoption, miscarriage, stillbirth or abortion. Doula services
141include but are not limited to: (1) continuous labor and delivery support, inclusive of all
142outcomes; (2) support for pregnancy loss or infant loss, including bereavement home or in-
143person visits; (3) accompanying individuals to health care and social services appointments; (4)
144connecting individuals to community-based and state- and federally-funded resources, including
145those which address social determinants of health; (5) being on-call around the time of birth,
146adoption, loss or abortion, as well as providing on-call support in-person or via telehealth for
147individuals’ questions or concerns; (6) support for other individuals providing care for a birthing 8 of 10
148or adoptive parent, including spouses, partners, and other family members. (7) educational and
149informational support including but not limited to childbirth preparation, newborn care, perinatal
150mental health, and postpartum recovery. (8) empowering individuals to advocate for their
151preferences, needs and rights during pregnancy, labor and delivery, and postpartum.
152 (b) Any individual or group health maintenance contract that is issued or renewed within
153or without the commonwealth (hereinafter “policy”) shall provide coverage for all doula
154services. Coverage provided under this section for doula services shall not be subject to any
155deductible, coinsurance, copayment or any other cost-sharing requirement. (c) No policy shall
156require a referral for doula services by any other health care provider as a condition of
157reimbursement. (d) Doulas shall be reimbursed for their services at a rate at least equivalent to
158MassHealth’s reimbursement rate for doula services. (e) A policy shall cover, without prior
159authorization, a minimum of twenty hours of prenatal and postpartum doula services per
160pregnancy, and continuous support throughout labor and delivery, inclusive of all pregnancy
161outcomes. Within the authorized number of doula hours, policies shall not impose limitations on
162the amount of time a doula can bill per patient per day. (f) Policies must establish a process to
163approve coverage of additional hours of doula services in cases where the patient has heightened
164risk or need. (g) Policies shall follow the doula credentialing requirements developed by the
165Massachusetts Department of Public Health, and may not impose any additional credentialing
166requirements. Additionally, any doula approved as a MassHealth Doula Provider shall be
167deemed as meeting all credentialing requirements.
168 SECTION 6. Sections 2 through 6 of this act shall apply to all policies, contracts and
169certificates of health insurance subject to chapters 32A, chapter 175, chapter 176A, chapter
170176B, and chapter 176G which are delivered, issued or renewed on or after September 1, 2026. 9 of 10
171SECTION 7. Doula Advisory Committee: There is hereby created a Doula Advisory Committee.
172(1) The committee shall consist of 10-12 members to be appointed by the Governor, or designee.
173(a) All but 2 of the members shall be practicing doulas from the community representing a range
174of experience levels and a diversity of lived experience; the remaining 2 members shall be
175individuals from the community who have experienced pregnancy as a MassHealth member and
176are not practicing doulas. (b) The members of the committee shall represent an equitable
177geographic distribution from across the Commonwealth, including representation from areas
178within the Commonwealth where maternal and infant outcomes are worse than the state average,
179as evidenced by the MA Department of Public Health’s most current perinatal data available at
180the time the member is appointed. (2) The committee shall be convened within six months of
181passage of this law. (3) Of the initial appointments to the Doula Advisory Committee, half shall
182be appointed to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter,
183all terms shall be 2 years. The Governor, or designee, shall fill vacancies as soon as practicable.
184 (4) At least once every 8 weeks, the Division of Medical Assistance shall meet with the
185Doula Advisory Committee to consult about MassHealth’s coverage of doula services, including
186but not limited to the following: (a) the standards and processes around billing for and prompt
187reimbursement of doula services; (b) establishing grievance procedures for doulas, MassHealth
188members, and health care providers about MassHealth’s coverage of doula services, the
189provision of doula services to MassHealth members, and bias that doulas face as they try to
190integrate into birth teams; (c) maintaining a reimbursement rate for doula services that
191incentivizes and supports a diverse workforce representative of the communities served, and
192establishing a recurring timeframe to review that rate in light of inflation and changing costs of
193living in the commonwealth; (5) Each year, the Doula Advisory Committee must, by a majority 10 of 10
194vote of a quorum of its members, select an individual to serve as its chairperson for a one year
195term. The Doula Advisory Committee may replace the chairperson in the same manner mid-
196term. (6) The Doula Advisory Committee may, by a majority vote of a quorum of its members,
197reduce the frequency of meetings with MassHealth to less than once every 8 weeks. (7) The
198Division of Medical Assistance shall seek resources to offer reasonable compensation to
199members of the Doula Advisory Committee for fulfilling their duties, and shall reimburse
200members for actual and necessary expenses incurred while fulfilling their duties.
201 SECTION 8. Chapter 111 of the General Laws is hereby amended by inserting in section
20270E after “Every patient or resident of a facility shall have the right:”: (i) to have their birth
203doula’s continuous presence during labor and delivery. Facilities shall not place an undue burden
204on access of a patient’s doula to clinical labor and delivery settings, and shall not arbitrarily
205exclude a patient’s doula from such settings. A doula shall not be counted as a patient's guest or
206support person.