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:

HOUSE DOCKET, NO. 2467        FILED ON: 1/19/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1139

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:
 

SECTION 1: Chapter 118E of the General Laws is hereby amended by inserting after section 10N the following section:-

Section 10-O: Medicaid Coverage for Doula Services.

(A) For purposes of this section, the term “doula services” shall have the following meaning:

“Doula Services” are physical, emotional, and informational support, but not medical care, provided by trained doulas to individuals and families during and after pregnancy, labor, childbirth, miscarriage, stillbirth or pregnancy loss. Doula services include but are not limited to:

(1)   continuous labor support;

(2)   prenatal, postpartum, and bereavement home or in-person visits throughout the perinatal period, lasting until 1 year after birth, pregnancy loss, stillbirth, or miscarriage;

(3)   accompanying pregnant individuals to health care and social services appointments;

(4)   providing support to individuals for loss of pregnancy or infant from conception through one year postpartum;

(5)   connecting individuals to community-based and state- and federally-funded resources, including those which address social determinants of health;

(6)   making oneself available (being on-call) around the time of birth or loss as well as providing support for any concerns of pregnant individuals throughout pregnancy and until one year after birth, pregnancy loss, stillbirth, or miscarriage.

(7)   providing support for other individuals providing care for a birthing parent, including a birthing parent’s partner and family members.

(B) Coverage of Doula Services:

(1) The Division shall provide coverage of doula services to pregnant individuals and postpartum individuals up to 12 months following the end of the pregnancy who are eligible for medical assistance under this chapter and/or through Title XIX or Title XXI of the Social Security Act. The Division shall provide the same coverage of doula services to pregnant and postpartum individuals who are not otherwise eligible for medical assistance under this chapter or Titles XIX or XXI of the Social Security Act solely because of their immigration status. 

(2) The Division must cover continuous support through labor and childbirth, and at least up to six doula visits across the prenatal and one year postpartum period, including at least two postpartum visits, without the need for prior authorization. The Division must also establish a procedure to cover additional doula visits as needed.

(C) Creation of Doula Advisory Committee: There is hereby created a Doula Advisory Committee.

(1) The committee shall consist of 10-12 members to be appointed by the commissioner of public health, or designee.

(a) All but 2 of the members must be practicing doulas from the community; the remaining 2 members must be individuals from the community who have experienced pregnancy as a MassHealth member and are not practicing doulas.

(b) Among the members described in (a) above:

(i)  at least 1 member must be a person who identifies as belonging to the LGBTQIA+ community;

(iii) at least 1 member must be a person who has experienced a severe maternal morbidity, a perinatal mental health or mood disorder, or a near-death experience while pregnant or in maternity care;

(iv) at least 1 member must be a person who identifies as a person with disabilities or disabled person;

(c) The members of the committee shall represent a diverse range of experience levels- from doulas new to the practice to more experienced doulas. 

(d) The members of the committee shall be from areas within the Commonwealth where maternal and infant outcomes are worse than the state average, as evidenced by the MA Department of Public Health’s most current perinatal data available at the time the member is appointed.

(e) The members of the committee shall represent an equitable geographic distribution from across the Commonwealth.

(2) The committee must be convened within six months of passage of this law.

(3) Of the initial appointments to the Doula Advisory Committee, half shall be appointed to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter, all terms shall be 2 years. The commissioner of public health, or designee, shall fill vacancies as soon as practicable.

(4) At least once every 8 weeks, the Division must meet with the Doula Advisory Committee to consult about at least the following:

(a)   the scope of doula services covered by MassHealth;

(b)  doula competencies required for reimbursement by MassHealth, and standards of proof or demonstration of those competencies;

(c)  the recruitment of a diverse workforce of doulas to provide services to MassHealth members;

(d)  the development of comprehensive and high quality continuing education and training that is free or low-cost to doulas committed to providing services to MassHealth members, as well as the development of mentorship and career growth opportunities for doulas providing services to MassHealth members;

(e)   the performance of any third party administrators of MassHealth’s doula coverage program, and standards and processes around billing for and prompt reimbursement of doula services;

(f)   establishing grievance procedures for doulas, MassHealth members, and health care providers about MassHealth’s coverage of doula services and/or the provision of doula services to MassHealth members;

(g)  outreach to the public and stakeholders about how to access doula care for MassHealth members, and about the availability of and advantages of doula care;

(h)   the evaluation and collection of data on the provision of, outcomes of, access to, and satisfaction with doula care services provided to MassHealth members;

(i)    maintaining a reimbursement rate for doula services that incentivizes and supports a diverse workforce representative of the communities served, and establishing a recurring timeframe to review that rate in light of inflation and changing costs of living in the commonwealth;

(j)   how to ensure that MassHealth’s doula reimbursement program is directed towards the goal of reducing inequities in maternal and birth outcomes among racial, ethnic, and cultural populations who reside in all areas within the commonwealth, as evidenced by the most current perinatal data supplied by the department of public health.

(5) Each year, the Doula Advisory Committee must, by a majority vote of a quorum of its members, select an individual to serve as its chairperson for a one year term. The Doula Advisory Committee may replace the chairperson in the same manner mid-term.

(6) The Doula Advisory Committee may, by a majority vote of a quorum of its members, reduce the frequency of meetings with MassHealth to less than once every 8 weeks.

(7) The division and the Department of Public Health shall seek resources to offer reasonable compensation to members of the Doula Advisory Committee for fulfilling their duties, and must reimburse members for actual and necessary expenses incurred while fulfilling their duties.

(8) The division, in partnership with the Doula Advisory Committee, shall conduct at least 1 public hearing or forum each year until three years after passage of this law. The purposes of these hearings or forums shall be to gather feedback from the public and to inform the public about MassHealth’s coverage of doula care.

SECTION 2. Chapter 32A of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after section 27 the following section:

Section 28. (a) Any coverage offered by the commission to any active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for all doula services as defined in Section XX.

(b) Nothing in this section shall be construed to deny or restrict in any way the group insurance commission’s authority to ensure plan compliance with this chapter.

SECTION 3. Chapter 118E of the General Laws, as so appearing, is hereby amended by inserting after section 10I the following section:

10J (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for all doula services as defined in Section XX.

(b) Nothing in this section shall be construed to deny or restrict in any way the group insurance commission’s authority to ensure plan compliance with this chapter.

SECTION 4. Chapter 175 of the General Laws, as so appearing, is hereby amended by inserting after section 47W(c) the following:

(d) An individual policy of accident and sickness insurance issued pursuant to section 108 that provides hospital expense and surgical expense and any group blanket policy of accident and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical expense insurance, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the Commonwealth, (hereinafter “policy”) shall provide benefits for residents of the Commonwealth and all group members having a principal place of employment within the Commonwealth coverage for all doula services as defined in Section XX.

(e) Nothing in this section shall be construed to deny or restrict in any way the division of insurance’s authority to ensure compliance with this chapter.

SECTION 5. Chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after section 8W(c) the following:

(d) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the Commonwealth and that provides benefits for outpatient services shall provide to all individual subscribers and members within the Commonwealth and to all group members having a principal place of employment within the Commonwealth coverage for all doula services as defined in Section XX.

(e) Nothing in this section shall be construed to deny or restrict in any way the division of insurance’s authority to ensure compliance with this chapter.

SECTION 6. Chapter 176B of the General Laws, as so appearing, is hereby amended by inserting after section 4W(c) the following:

(d) Any subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within or without the Commonwealth and that provides benefits for outpatient services shall provide to all individual subscribers and members within the Commonwealth and to all group members having a principal place of employment within the Commonwealth coverage for all doula services as defined in Section XX.

(e) Nothing in this subsection shall be construed to deny or restrict in any way the division of insurance’s authority to ensure medical service agreement compliance with this chapter.

SECTION 7. Chapter 176G of the General Laws, as so appearing, is hereby amended by inserting after section 4O(c) the following:

(d) Any individual or group health maintenance contract that is issued, renewed or delivered within or without the Commonwealth and that provides benefits for outpatient prescription drugs or devices shall provide to residents of the Commonwealth and to persons having a principal place of employment within the Commonwealth coverage for all doula services as defined in Section XX.

(e) Nothing in this subsection shall be construed to deny or restrict in any way the division of insurance’s authority to ensure health maintenance contract compliance with this chapter.

SECTION 8. Sections 1 through 6 of this act shall apply to all policies, contracts and certificates of health insurance subject to chapters 32A,  chapter 118E, chapter 175, chapter 176A, chapter 176B, and chapter 176G which are delivered, issued or renewed on or after September 1, 2024.

SECTION 9. Chapter 29 of the Massachusetts General Laws is hereby amended by inserting after section 2QQQQQ the following section:-

Section 2RRRRR. (a) There shall be established and set up on the books of the commonwealth a separate fund known as the Doula Workforce Development Trust Fund, hereinafter called the fund. The fund shall be administered by the department of career services which shall contract with the Commonwealth Corporation to administer the fund. The fund shall be credited with: (i) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; (ii) interest earned on such revenues; and (iii) funds from public and private sources; and other gifts, grants and donations for the growth, training and continuous support of the doula workforce. Amounts credited to the fund shall not be subject to further appropriation and any money remaining in the fund at the end of a fiscal year shall not revert to the General Fund.

(b) The Commonwealth Corporation shall make expenditures from the fund for the purposes of:

(i) the development and expansion of comprehensive doula training available across the commonwealth. including the development of doula training focused on meeting the needs of MassHealth members;

(ii) ensuring that doulas committed to serving MassHealth members have access to high quality doula training at no- or low-cost to them;

(iii) the recruitment and retention of doulas from communities with high concentrations of MassHealth members, as well as areas within the commonwealth where maternal and infant outcomes are worse than the state average, as evidenced by the MA Department of Public Health’s perinatal data.

(iv) expanding doula mentoring opportunities across the state, which provide new doulas the opportunity to attend births and incentivize experienced practicing doulas to take on mentees.

(v) leveraging funds to secure future federal funding to support doula workforce development in the commonwealth.

(c) The director of career services shall annually, not later than December 31, report to the secretary of administration and finance, the house and senate committees on ways and means and the joint committee on labor and workforce development on the efforts undertaken in support of section (b) above; the number of doulas recruited and trained as a result of activities taken in support of (b) above, including but not limited to sex, gender identity, race, and ethnicity of such doulas; the amount of grants and identities of grantees awarded in support of section (b) above; and the availability of doula training at no- or low-cost to doulas committed to serving MassHealth members. 

SECTION 10: Chapter 111 of the General Laws is hereby amended by inserting in section 70E after “Every patient or resident of a facility shall have the right:”:

(p) to have their birth doula’s continuous presence during labor and delivery. Facilities shall not place an undue burden on a patient’s doula’s access to clinical labor and delivery settings, and shall not arbitrarily exclude a patient’s doula from such settings.