88R10192 SCP-D
By: Walle H.B. No. 3394
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid coverage and reimbursement for doula services
and reports on the provision of those services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.02481 to read as follows:
Sec. 32.02481. MEDICAL ASSISTANCE FOR DOULA SERVICES. (a)
In this section:
(1) "Doula" means a nonmedical birthing coach who
provides doula services.
(2) "Doula services" means nonmedical childbirth
education, coaching, and support services, including emotional and
physical support provided during pregnancy, labor, delivery, and
for up to twelve months after birth during the postpartum period, or
provided intermittently during pregnancy and the postpartum
period. The term includes the referral of pregnant and postpartum
individuals to community-based organizations, social service
organizations, and licensed perinatal professionals.
(3) "Recipient" means a medical assistance program
recipient.
(b) The commission shall ensure that medical assistance
reimbursement is provided to a doula in accordance with this
section for the provision of doula services to a pregnant or
postpartum recipient.
(c) To be eligible for reimbursement under the medical
assistance program, a doula must:
(1) be at least 18 years of age;
(2) have an assigned national provider identifier
number, as defined by Section 531.021182, Government Code;
(3) be accredited by a doula training organization
recognized by a regional or statewide doula association, including
the Texas Doula Association, and provide to the commission a
certified copy of the accreditation;
(4) provide to the commission documentation
evidencing:
(A) completion of not less than 24 in-person or
virtual classroom hours that include any combination of doula
training, childbirth education and training, or postpartum
training;
(B) attendance at a breastfeeding peer support
training or other certified lactation counselor training;
(C) attendance at one or more childbirth
education trainings;
(D) attendance at two or more child births;
(E) completion of a cultural competency
training;
(F) completion of a training on the Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C.
Section 1320d et seq.) and other patient confidentiality laws; and
(G) completion of a cardiopulmonary
resuscitation training;
(5) complete applicable medical assistance program
application and enrollment processes; and
(6) satisfy any other requirements the commission
determines appropriate.
(d) A doula who is included on an exclusion list published
by a statewide or regional doula association, including the Texas
Doula Association, or who engages in the practice of medicine may
not:
(1) enroll as a provider under the medical assistance
program; or
(2) otherwise receive reimbursement under the
program.
(e) Notwithstanding Subsection (c), a doula who does not
meet the qualifications described by that subsection may receive
medical assistance reimbursement if the doula provides to the
commission documentation the commission determines sufficient
evidencing that the doula has provided doula services for not less
than 12 consecutive months before reimbursement is provided. A
doula who is eligible to receive reimbursement under this
subsection must:
(1) complete any applicable medical assistance
program application and enrollment processes; and
(2) complete any courses or training necessary to meet
the qualifications described by Subsection (c) not later than 12
months after the doula's enrollment in the medical assistance
program under this subsection.
(f) The executive commissioner by rule shall prescribe the
services for which a doula may receive medical assistance
reimbursement, which may include:
(1) providing culturally informed services to support
a recipient during pregnancy and the postpartum period;
(2) advocating for and supporting a recipient's
perinatal choices, including choices related to childbirth,
breastfeeding, and parenting;
(3) providing support through the use of traditional
comfort measures or the provision of educational materials during
pregnancy, labor, and childbirth and assisting a recipient in the
transition to parenthood, including through home visits;
(4) offering evidence-based counseling and education
on infant care, family dynamics, feeding, emotional and physical
recovery from birth, and other issues related to pregnancy or the
postpartum period;
(5) providing physical and emotional support during
and after labor;
(6) facilitating access to community-based support
services to improve birth outcomes, including transportation,
housing, substance use cessation, family violence resources, and
other state or federal assistance programs;
(7) referring recipients to health care providers to
receive medical care or counseling as necessary;
(8) working as part of a recipient's multidisciplinary
team; and
(9) providing counseling or bereavement support on
pregnancy or infant loss.
(g) The commission may authorize a doula to provide any of
the services described by Subsection (f) using telecommunications
or information technology.
(h) The commission shall establish:
(1) a separate provider type for doulas for purposes
of enrollment as a provider; and
(2) a medical assistance reimbursement rate for the
provision of doula services to a recipient.
(i) The commission shall establish a statewide registry
accessible to the public on the commission's Internet website that
contains a list of doulas enrolled as a provider under the medical
assistance program.
(j) Not later than September 1 of each year, the commission,
in collaboration with each managed care organization that has a
doula in the organization's provider network, shall prepare and
submit to the legislature a written report on cost and utilization
information related to the reimbursement and provision of doula
services under this section.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. This Act takes effect September 1, 2023.