Doula Services FAQ
Doula Providers – Managed Care Plans
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) suav nrog cov kev pabcuam doula hauv ob qho tib si tswj kev saib xyuas thiab them nqi-rau-kev pabcuam kev pabcuam rau cov menyuam cev xeeb tub thiab tomqab yug menyuam. Cov kev pabcuam muaj xws li kev pabcuam tsis yog khomob rau kev mus ntsib ua ntej yug menyuam thiab tomqab yug menyuam, thiab thaum lub sijhawm ua haujlwm thiab yug menyuam, nchuav menyuam, thiab rho menyuam tawm.
1. Kuv yuav tsum ua dab tsi los muab kev pab cuam rau Medi-Cal cov tswv cuab uas tau cuv npe hauv Medi-Cal tswj kev saib xyuas (MCP) thiab tau txais cov nyiaj them rov qab?
- The following steps are separate and distinct requirements as outlined in various state and federal laws and DHCS policy.
- Doulas must apply and enroll as a Medi-Cal provider through DHCS’ Provider Application and Validation for Enrollment (PAVE) portal. In addition to meeting Medi-Cal’s requirements for qualifications, which are listed in the Medi-Cal Provider Manual: Doula Services, doulas also need to meet state and local business requirements when submitting their application. Prior to enrolling, doulas may refer to DHCS’ Medi-Cal Doula Provider Enrollment Checklist to help determine what documents are needed. Please see question #3 for more information.
- Doulas must meet Medi-Cal managed care credentialing requirements. This is a federal requirement for MCPs to ensure the integrity of their provider networks. Please see question #4 for more information.
- Doulas must apply and enter into Medi-Cal managed care contracts (Network Provider Agreements) with MCPs to receive reimbursement for Doula Services provided to Medi-Cal members. Doulas may choose to contract with multiple MCPs, depending on the geographic service area (county) the Medi-Cal members are in. Please see question #5 for more information.
2. Vim li cas qee qhov MCPs muaj cov kev cai ntxiv tom qab kuv tau tso npe rau hauv Medi-Cal nrog DHCS? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- Enrollment in PAVE, managed care credentialing, and MCP contracting processes are separate and distinct. Each process has its own requirements as required by various state and federal laws and DHCS policy.
- DHCS tsis tuaj yeem sau ib hom kev cog lus tshwj xeeb rau MCPs thiab doulas. MCPs tsis tas yuav tsum tau cog lus nrog txhua tus neeg muab kev pabcuam rau npe los ntawm PAVE.
- Some screening and enrollment requirements overlap with credentialing and recredentialing requirements. Any such overlap does not require an MCP to duplicate any of the activities described All Plan Letter (APL) 22-013. However, if an MCP relies on the screening and enrollment activities conducted by another MCP, or by DHCS, the MCP must comply with allcredentialing and re-credentialing requirements.
- Pab txo ba rriers, DHCS is working closely with MCPs and Plan Associations to encourage simplification of their credentialing and/or contracting processes for doulas and to ensure MCPs are providing sufficient technical assistance to support doulas become network providers. DHCS also continues to issue guidance and best practice recommendations to MCPs.
3. Dab tsi yog Medi-Cal Cov Kev Pabcuam Kev Tshuaj Xyuas thiab Kev Sau Npe? (Hloov kho lub Yim Hli 19, 2025)
- Txhua tus neeg muab kev pabcuam hauv network, suav nrog doulas, yuav tsum tau tshuaj xyuas thiab tso npe.
- Pursuant to APL 22-013 and applicable state and federal requirements, MCP network providers that have a state-level enrollment pathway must enroll in the Medi-Cal program. The doula state-level enrollment pathway is PAVE.
- MCPs tuaj yeem coj lawv cov neeg muab kev pabcuam network, suav nrog doulas, rau npe los ntawm txoj hauv kev rau npe nkag hauv xeev, xws li PAVE. MCPs kuj muaj kev xaiv los tsim thiab siv lawv tus kheej cov kev tswj xyuas tus kws kho mob tshuaj xyuas thiab cov txheej txheem rau npe kawm uas ua tau raws li qhov yuav tsum tau ua ntawm APL 22-013.
- Doulas uas tso npe los ntawm PAVE tuaj yeem koom nrog ob qho kev pab cuam Medi-Cal FFS nrog rau kev cog lus nrog MCP (muab MCP xaiv cog lus nrog tus kws kho mob). Txawm li cas los xij, cov kws kho mob uas tsuas yog tso npe los ntawm MCP tsis tuaj yeem koom nrog Medi-Cal FFS qhov kev pab cuam.
4. Dab tsi yog Medi-Cal Managed Care Provider Credentialing thiab Recredentialing? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- As described in APL 22-013, all MCPs are required to verify the credentials of their Network Providers, including doulas.
- Kev lees paub txhais tau hais tias tus txheej txheem ntawm kev txiav txim siab tus kws kho mob lossis ib lub koom haum tus kws tshaj lij lossis kev muaj peev xwm, thiab tej zaum yuav suav nrog kev sau npe, ntawv pov thawj, ntawv tso cai, thiab koom nrog koom nrog kev tshaj lij. MCPs yuav tsum tau lees paub tag nrho cov chaw muab kev cog lus uas muab kev pabcuam rau cov tswvcuab, raws li lub xeev thiab tsoomfwv txoj cai lij choj.
- DHCS xav kom txhua tus MCP txheeb xyuas txhua peb lub xyoos uas txhua tus neeg muab kev pabcuam Network muab cov kev pabcuam khomob tseem muaj cov ntaub ntawv pov thawj siv tau.
- Rau cov kev cai tshwj xeeb thiab cov txheej txheem, thov hu rau MCP.
5. Daim ntawv cog lus Medi-Cal Managed Care Contract (Network Provider Agreement) yog dab tsi? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- MCPs are required to maintain contracts with their network providers (Network Provider Agreement). A Network Provider Agreement means a written agreement between an MCP and a network provider. At a high-level, “contracting” refers to the process between MCPs and providers (individual or groups), including doulas, to become network providers.
- Raws li lub xeev thiab tsoomfwv cov cai, MCPs tsim cov ntawv cog lus hauv network uas tau tshuaj xyuas thiab pom zoo los ntawm DHCS thiab Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DMHC).
- Thov nco ntsoov tias feem ntau MCP cov chaw muab kev pabcuam network tau tsim rau cov chaw muab ntawv tso cai thiab cov kev hloov kho rau MCP daim ntawv cog lus lossis cov txheej txheem kom meej meej rau doulas yuav siv sijhawm. Cov ntawv cog lus hloov tshiab yuav tsum dhau los ntawm MCP lub sab hauv, sab nraud, thiab kev tshuaj xyuas.
- Yog xav tau kev cog lus tshwj xeeb thiab cov txheej txheem, thov hu rau MCP.
6. Kuv tuaj yeem ua li cas yog tias MCP tsis yog kuv daim ntawv thov kev lees paub thiab/lossis ua lwm yam teeb meem rau kev tso npe, kev lees paub, lossis kev cog lus? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- If you are having challenges with a specific MCP, please reach out to DHCS via email at DoulaBenefit@dhcs.ca.gov and provide the following information. Please do not mention any Medi-Cal member by name or include any protected health information in your email.
- Doula npe
- Doula NPI
- Lub nroog twg lub doula muab kev pabcuam?
- MCP (cov) Doula puas muaj daim ntawv cog lus nrog?
- Lub npe ntawm MCP
- Lub npe ntawm ib tus neeg sawv cev ntawm MCP uas koj tau hais txog qhov teeb meem. Thov sau email lossis xov tooj uas siv los tiv tauj MCP.
- Cov lus piav qhia luv luv ntawm qhov teeb meem
- Hnub tim (s) cuam tshuam nrog qhov teeb meem
- Cov ntaub ntawv tiv tauj rau kev taug qab (email thiab xov tooj nyiam)
7. Kuv tuaj yeem nrhiav cov ntaub ntawv tiv tauj rau MCPs qhov twg yog kuv muaj lus nug txog kev cog lus lossis kev them nqi? (Ntxiv rau lub Cuaj Hlis 10, 2025)
- Yog tias koj muaj lus nug thiab xav tham nrog ib tus neeg nrog MCP rau kev pab, thov email rau DoulaBenefit@dhcs.ca.gov thiab suav nrog lub npe ntawm MCP thiab lub ntsiab lus ntawm koj cov lus nug. DHCS yuav ua raws li lub npe thiab cov ntaub ntawv tiv toj rau txoj kev npaj.
8. Kuv yuav ua li cas yog tias kuv muaj teeb meem nrog kev them nyiaj rov qab los ntawm MCP? (ntxiv rau lub Cuaj Hlis 10, 2025)
- Thov saib cov FAQ rau Cov Txheej Txheem Kev Txiav Txim Kev Tsis Txaus Siab.
9. Puas yog Medi-Cal MCPs puas muaj ib daim ntawv cog lus rau Medi-Cal thiab kev lag luam kev lag luam?
- DHCS tsis tau sau ib hom kev cog lus tshwj xeeb rau MCPs thiab doulas. MCPs raug txhawb kom hloov pauv thaum cog lus nrog Doulas ntev npaum li nws koom nrog DHCS txoj cai ntawm doula kev pab them nqi. Cov phiaj xwm uas muaj ib daim ntawv cog lus / qauv rau Medi-Cal thiab cov kab kev lag luam ntawm kev lag luam yuav tsum qhia qhov txawv ntawm cov khoom pov thawj uas ua tau raws li lub xeev, tsoomfwv thiab cov ntawv cog lus. Thov xa cov lus nug ntsig txog kev cog lus rau koj MCP.
10. Puas muaj tus qauv rau tus naj npawb ntawm doulas nrog leej twg MCP yuav tsum tau cog lus nrog kom tswj tau lub network txaus?
- Raws li ib feem ntawm lawv lub network, MCPs yuav tsum xyuas kom meej thiab saib xyuas cov chaw muab kev pabcuam txaus hauv lawv qhov chaw pabcuam, suav nrog doulas, kom ua tiav cov kev pabcuam Medi-Cal raws sijhawm. Txhawm rau txhawb nqa lub network doula txaus, MCPs yuav tsum ua kom muaj kev cog lus rau ob tus neeg doulas thiab doula pawg thiab ua haujlwm nrog lawv cov tsev kho mob network / chaw yug me nyuam kom tsis txhob muaj kev cuam tshuam rau kev nkag mus rau cov kws kho mob no thaum nrog cov tswv cuab rau kev mus ntsib ua ntej, kev ua haujlwm thiab kev yug me nyuam, thiab kev mus ntsib tom qab yug me nyuam tsis hais txog qhov tshwm sim (tseem yug me nyuam, rho menyuam, yug me nyuam, yug me nyuam).
- Yog tias MCPs tsis muaj doulas txaus hauv lub network, MCP yuav tsum npaj rau cov kev pabcuam sab nraud thiab npog cov kev pabcuam nrog lub network doula. DHCS tsis qhia meej txog tus lej ntawm doulas rau kev cog lus raws li qhov yuav sib txawv thiab tam sim no tsis muaj qhov pom zoo / tus qauv raws li cov ntaub ntawv, cov tswvcuab / tus neeg mob nyiam, thiab cov chaw muab kev pabcuam. DHCS cia siab tias MCPs yuav xyuas kom nkag mus rau qhov txiaj ntsig doula thiab tseem saib xyuas kev nkag mus.
11. Kuv tuaj yeem tau txais cov ntaub ntawv ntau ntxiv lossis muab kev tawm tswv yim nyob qhov twg?
- Cov ntaub ntawv hais txog qhov txiaj ntsig doula muaj nyob rau ntawm DHCS Doula Services lub vev xaib.
- Thov xa email rau DoulaBenefit@dhcs.ca.gov nrog rau cov lus nug ntxiv.