Birthworker (Doula) Hub

Information regarding the Doula voluntary certification and licensure through the Arizona Department of Health Services. Refer to slides 53-66 of the above PowerPoint.

• Arizona Department of Health Services (ADHS) Doula Home Page
• ADHS Doula Licensing Information
• Doula Certification Initial Application Checklist
• Certified Doula Fee Table
• Current Federal Poverty Guidelines

Documents Required

• Doula Code of Ethics Agreement
• Doula High School/High School Equivalency Attestation

Reciprocity Initial Applications for Out-of-State Licensure

• Doula Reciprocity Application Checklist
• Attestation of Licensure in Another State
• Doula Reciprocity Application

Pathway 1

• Birth Observation Form
• Primary Doula Attestation
• Doula Competency Attestation – demonstrating at least 30 hours of in-person instruction or a combination of in-person and online instruction in core competency topics

Pathway 2

• Birth Observation Form
• Primary Doula Attestation
•Proof of current certification from a nationally recognized Doula organization

Pathway 3

• Birth Observation Form
• Primary Doula Attestation
• Doula Competency Attestation – demonstrating community training in non-western Doula practices and confirmation of completed core competency training through culturally specific training or education

Pathway 4

• Birth Observation Form
• Primary Doula Attestation
• Doula Competency Attestation – demonstrating other related individualized or experiential training or education and confirmation of completed core competency training through culturally specific training or education

Pathway 5

For practicing Doulas working in the state for at least five (5) years before September 29, 2021.

• Proof of current certification from a nationally recognized doula organization
• Letters of Recommendation Form

Renewal Applications

• Continuing Education Attestation

Changes Affecting a License

• Doula Modification Application Address/Name Change
• Doula Replacement/Duplicate Certificate Request

In order to become an AHCCCS registered provider, the first step is achieving the ADHS Doula Voluntary Certification. Refer to slides 67-76 of the above PowerPoint.

• AHCCCS Doula Home Page
• AHCCCS Online Provider Portal
• Provider Enrollment Policy Manual

Step 1: Prepare Documentation in Advance

• W9 Tax Form
• Current professional certifications or licensures
• Any provider intending to operate within the boundaries of Tribal lands must have an active, valid Tribal Business License
• Doula Profile Form (not yet attached)
• Provider basic information

Step 2: Register with the AHCCCS Provider Enrollment Portal

• Register with APEP
• AHCCCS Provider Enrollment Portal (APEP)

Step 3: Make Sure You Have Read Required Documentation

• Provider Participation Agreement

Here, we provide basic information on next steps after successfully registering as an AHCCCS provider. Refer to slides 77-84 of the above PowerPoint.

AHCCCS Provider Welcome Letter

• Providing Services to Fee-for-Service (FFS) Members can immediately begin.
• Providing Services to MCO Members will require a separate contract with the health plan.
• AHCCCS Available Health Plans
• Responsibility to report changes like: changes in ownership, changes in correspondence (email, physical address, etc.), pay-to and service location changes & licensure actions

• Responsibility to stay up-to-date on information: policy and billing manuals, newsletters and bulletins, fee schedules, Medicaid email notification options, various training resources.
• AHCCCS Email Notification Sign-Up

• Responsibility to stay up-to-date on policies and manuals
• AHCCCS Medical Policy Manual (AMPM) 410, Maternity Care Services
• AHCCCS Contractor’s Operation Manual (ACOM)
• Fee-for-Service Provider Billing Manual
• IHS/Tribal Provider Billing Manual (if applicable)

• Billing for services and AHCCCS Online Provider Portal
• AHCCCS Online Provider Portal

• Affordable Care Act of 2010 information

This information is indicative of general AHCCCS guidelines for providers – they are not specific to Doula services. Refer to slides 1-34 of the above PowerPoint.

AMPM 410, Maternity Care Services

Doula services are covered for AHCCCS members during pregnancy, labor and delivery, and up to one year postpartum under the following conditions:

• The Doula is certified through ADHS
• The Doula is an AHCCCS-registered provider
• The services provided are within the scope of practice for Doulas pursuant to AAC R9-16-901 through 909
• The Doula services are provided in complement to, and do not replace, prenatal, labor and delivery, and postpartum care provided by a physician, Certified Nurse Midwife, Licensed Midwife, or other licensed provider for which maternity care is within their scope of practice
• The member is referred for Doula services by a provider
• AHCCCS Medical Policy Manual (AMPM) 410, Maternity Care Services

Questions on billing and claims?
• Division of Fee for Service Management (DFSM)
• Doula Services, Policy and Billing Overview

Codes: What Codes are Reimbursable?

• T1032 – Services performed by a Doula Birth Worker, per 15 minutes (up to 2 hours, or 8 units) with a rate of $16.28
• This code can be billed for each visit

• T1033 – Services performed by a Doula Birth Worker, per diem (once every 9 months) with a rate of $781.32
• This code can only be billed once every 9 months (once per pregnancy) and is typically billed at the end of the pregnancy

Submitting Claims

Claims are typically submitted electronically. If submitting via paper, then Doula services should be billed on the CMS 1500 Claim Form.

• Billing on the CMS 1500 Claim Form
• How to Submit a CMS 1500/Professional Claim Using the AHCCCS Online Provider Portal
• The process of submitting claims should begin with the very first date that the Doula provides a covered service to a member
• There is no retroactive billing meaning a Doula cannot bill for services performed before the Doula was registered or before the member received a referral
• There is NO prior authorization required!

Timely Filing

• An initial claim for services provided to a member must be received by AHCCCS no later than 6 months after the date of service, unless the claim involves retro-eligibility.
• A clean claim must be processed by AHCCCS no later than 12 months from the initial date of service.
• As long as the initial claim is received within that initial 6-month window, corrections can still be submitted up to 12 months after the date of service.
• DO NOT void the initial claim if you are past the 6-month window. Voiding and resubmitting a claim “restarts the clock.”
• How to Status a Claim Using the AHCCCS Online Provider Portal
• Correcting Claims, Voiding Claims and Replacing Claims

If you choose to become a provider, it is vital that you maintain documentation to prove compliance with AHCCCS and State policies regarding Doula services. Here’s a basic overview of best practices for successful reimbursement! Refer to slides 35-50 & 87-110 of the above PowerPoint.

What documentation should a Doula keep on hand? Below, find a brief list of items that you should maintain detailed records on for successful reimbursement.

• Proof of Doula voluntary certification
• Referral from the referring provider
• Information on documented medical necessity showing that the member is pregnant or was within one-year postpartum
• Detailed visit notes

Referrals

A referral for Doula services is REQUIRED. A recommendation/referral for services is contained in the members’ medical record. Without this on hand, a provider cannot bill for services rendered. Providers recommending services are limited to those affiliated with the corresponding Provider Types with the category of service COS01. Refer to slide 12 of the Doula Services, Policy, and Billing Overview slides.
• Doula Services, Policy and Billing Overview

You can design your own referral forms based on the information you receive from referring providers. Health plans will also have example referral forms. Below are some example referral forms.

• Medi-Cal Doula Services Recommendation
• Doula Services Referral Form Molina Healthcare of California
• Birth Doula Services Referral Form

Writing Good Visit Notes

Visit notes must, if pulled for an audit, substantiate a medical necessity and that an AHCCCS approved service was provided. Here are some things to keep in mind:

• Consider the referral form
• Consider the expecting family’s wishes
• Consider the intake form from the expecting family (see example intake forms below)
• Consider what you would document in terms of services – what are key points of a good visit note? What are commonly missed points? What challenges with documentation do you encounter?

• Doula & Lactation Services New Client Intake Form
• Morgane Richardson Doula Client Intake Form
• Mother Baby Support Doula Client Visit Forms

Liability Insurance

Doulas are not required to carry liability insurance, however, carrying liability insurance (malpractice insurance) helps a Doula to protect their personal assets and ensures that legal fees, possible settlement monies, and judgements arising from negligence accusations will be covered. Liability insurance IS required in specific settings, such as:

• Hospitals
• Doula-Specific Groups (not all, but depending on the collective, organization, or agency, this may be a requirement)
• Reimbursement (if working with clients through health insurance, liability insurance may be a requirement for reimbursement, but NOT through AHCCCS)

Please note that the Arizona Advisory Council on Indian Healthcare and the Inter Tribal Council of Arizona DO NOT endorse these liability insurance companies. They are offered merely as examples of some possible avenues for pursuing insurance.

• Professional liability insurance for birth and postpartum Doulas. This does not cover home births, so is best for doulas working in clinic/hospital settings
• Professional liability insurance that covers homebirths, supports Doulas who work independently or in non-traditional settings
• Professional liability insurance that covers homebirths, supports Doulas who work independently or in non-traditional settings
• Understanding Liability Insurance for Doulas: What You Need to Know

Continuing Education Units (CEUs)

According to the Arizona Administrative Code, Doulas shall complete 15 hours of continuing education hours within the three years prior to renewing certification. A CEU should consist of courses related to core competencies and exceed an introductory level of knowledge such as:

• Health and social service systems
• Health promotion education
• Client and community assessment
• Health education for behavior change
• Provide direct services
• Home visits to provide education, assessment, and social support
• Support, advocacy, and health system navigation for clients
• A continuing education course developed, endorsed, or sponsored by the Department of Health Services

CEU Resources and policy:

• Arizona Administrative Code – Health Services
• Arizona Revised Statute 36-766.09
• ADHS Doula Approved Education & Training Requirements
• ADHS Continuing Education for Doulas
• Continuing Education Attestation

CPR and First Aid

To become voluntarily certified through ADHS, a Doula must have documentation from a course recognized by the American Heart Association for First Aid & Cardiopulmonary Resuscitation (CPR)

• American Heart Association CPR and First Aid Training

Fingerprint Clearance Cards

Fingerprint clearance cards are awarded through the Department of Public Safety.

• DPS Fingerprint Clearance Card Information
• Fingerprint Clearance Application Portal
• How do I apply for a new fingerprint clearance card?
• DPS phone number for questions: 602-223-2000

Voluntary Doula Certification – ADHS

• Arizona Department of Health Services (ADHS) Doula Home Page
• ADHS Doula Licensing Information
• Doula Certification Initial Application Checklist
• Certified Doula Fee Table
• ADHS Continuing Education for Doulas
• ADHS Doula Approved Education & Training Requirements

All Applications

• Doula Code of Ethics Agreement
• Doula High School/High School Equivalency Attestation

Initial Applications

• Birth Observation Form
• Letters of Recommendation Form
• Primary Doula Attestation
• Doula Competency Attestation

Reciprocity Initial Applications

• Doula Reciprocity Application Checklist
• Doula Reciprocity Application
• Attestation of Licensure in Another State

Renewal Applications

• Continuing Education Attestation

Modifications to Certification

• Doula Modification Application Address/Name Change
• Doula Replacement/Duplicate Certificate Request

Important Portals

• AHCCCS Online Provider Portal
• Register with APEP
• AHCCCS Provider Enrollment Portal (APEP)
• AHCCCS Service Now Portal
• Service Now Portal Login Guide
• Service Now Portal Information

AHCCCS Provider Doula-Specific Links & Resources

• AHCCCS Doula Home Page
• W9 Tax Form
• Provider Participation Agreement
• AHCCCS Available Health Plans
• AHCCCS Email Notification Sign-Up

AHCCCS Billing & Claims

• Division of Fee for Service Management (DFSM)
• Doula Services, Policy and Billing Overview
• AHCCCS Billing Doula FAQs
• Billing on the CMS 1500 Claim Form
• How to Submit a CMS 1500/Professional Claim Using the AHCCCS Online Provider Portal

American Heart Association

• American Heart Association CPR and First Aid Training

Department of Public Safety (DPS) Fingerprinting

• DPS Fingerprint Clearance Card Information
• Fingerprint Clearance Application Portal
• How do I apply for a new fingerprint clearance card?
• DPS phone number for questions: 602-223-2000

Arizona Department of Health Services (ADHS) – Bureau of Professions and Occupations
• Department of Health Services
• 150 North 18th Avenue, Suite 410, Phoenix, Az 85007
• Telephone: 602-364-2079
• Email: blpo@azdhs.gov

Manuals & Policy Information

• Fee-for-Service Provider Billing Manual
• Provider Enrollment Policy Manual
• AHCCCS Medical Policy Manual (AMPM) 410, Maternity Care Services
• Arizona Administrative Code – Health Services
• Arizona Revised Statute 36-766.09
• Doula Fact Sheet for House Bill 2670
• Current Federal Poverty Guidelines
• FFS Provider Billing Manual, Chapter 10, Individual Practitioner Services
• How to Submit a CMS 1500/Professional Claim Using the AHCCCS Online Provider Portal
• Service Now/EDI Portal Information
• How to Status a Claim Using the AHCCCS Online Provider Portal
• Correcting Claims, Voiding Claims and Replacing Claims