Doula Services Frequently Asked Questions
Doula Providers - Managed Care Plans
The Department of Health Care Services (DHCS) covers doula services in both managed care and fee-for-service delivery systems for pregnant and postpartum individuals. Services include nonmedical support for prenatal and postpartum visits, and during labor and delivery, miscarriage, and abortion.
1. What do I need to do to provide services to Medi-Cal members who are enrolled in a Medi-Cal managed care plan (MCP) and receive reimbursement?
- 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. Why do some MCPs have additional requirements after I have enrolled in Medi-Cal with DHCS? (Added September 6, 2024)
3. What is Medi-Cal Managed Care Provider Screening and Enrollment? (Added September 6, 2024)
- All network providers, including doulas, must be screened and enrolled.
- 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 may direct their network providers, including doulas, to enroll through a state-level enrollment pathway, such as, PAVE. MCPs also has the option to develop and implement their own managed care provider screening and enrollment process that meets the requirements of APL 22-013.
- Doulas who enroll through PAVE may participate in both the Medi-Cal FFS program as well as contract with an MCP (provided the MCP chooses to contract with the provider). However, providers who only enroll through an MCP cannot participate in the Medi-Cal FFS program.
4. What is Medi-Cal Managed Care Provider Credentialing and Recredentialing? (Added September 6, 2024)
- As described in APL 22-013, all MCPs are required to verify the credentials of their Network Providers, including doulas.
- Credentialing means the process of determining a provider or an entity’s professional or technical competence, and may include registration, certification, licensure, and professional association membership. MCPs are required to credential all contracted providers that render services to assigned Members, in accordance with state and federal law.
- DHCS requires each MCP to verify every three years that each Network Provider delivering medical services continues to possess valid credentials.
- For specific credentialing requirements and processes, please reach out the MCP.
5. What is a Medi-Cal Managed Care Contract (Network Provider Agreement)? (Added September 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.
- Consistent with applicable state and federal requirements, MCPs develop network provider agreements that are reviewed and approved by both DHCS and the Department of Managed Health Care (DMHC).
- Please note most MCP provider network contracts were developed for licensed providers and any revisions to a MCP’s contract or process to be specific for doulas takes time. Updated contracts must go through the MCP’s internal, external, and regulatory review.
- For specific contracting requirements and processes, please reach out the MCP.
6. What can I do if a MCP is not my accepting application(s) and/or otherwise putting up barriers to enrolling, credentialing, or contracting? (Added September 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 Name
- Doula NPI
- What counties does the doula provide services?
- What MCP(s)s does the doula have contract(s) with?
- Name of the MCP(s)
- Name of any MCP representatives that you spoke to regarding the issue. Please include the email or phone number used to contact the MCP.
- Brief description of the issue
- Date(s) associated with the issue
- Contact information for follow-up (email and phone preferred)
7. Where can I find a contact information for MCPs if I have questions about contracting with them? (Added September 6, 2024)
- MCP point of contacts for doula services can, including enrollment and billing, be found at the “Resources” section of DHCS’ Doula Services Website.
- MCP point of contacts for general information can be found at Medi-Cal Managed Care Health Plan Directory.
8. Where can I get more information or provide feedback?
- Information about the doula benefit and stakeholder meetings is available on the DHCS Doula Services webpage.
- Please email DoulaBenefit@dhcs.ca.gov with any further feedback, questions, and comments.
