Senate Bill #484 (2021)

AN ACT RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PERINATAL DOULA SERVICES

Provides for medical assistance health care for expectant mothers and would establish medical assistance coverage and reimbursement rates for perinatal doula services. Effective 7/1/22.

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  • 2021 – S 0484
  • 2021 – S 0484 SUBSTITUTE A
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  • LC002105
  • LC002105/SUB A
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  • S TATE OF RHODE IS LAND
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2021
  • ____________
  • A N A C T
  • RELATING TO HUMAN SERVICES – MEDICAL ASSISTANCE – PERINATAL DOULA
  • SERVICES
  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2021
  • ____________
  • A N A C T
  • RELATING TO HUMAN SERVICES – MEDICAL ASSISTANCE – PERINATAL DOULA
  • SERVICES
  • Introduced By: Senators Quezada, Cano, Mack, DiPalma, Felag, Lombardo, Calkin,
  • Acosta, Lawson, and Valverde
  • Date Introduced: March 04, 2021
  • Referred To: Senate Health & Human Services
  • It is enacted by the GeneralAssembly as follows:
  • SECTION 1. Findings.
  • (1) In the United States, maternal mortality rates are among the highest in the developed world and increased by twenty six and six tenths percent (26.6%) between 2000 and 2014.
  • (2) Ofthe four million (4,000,000) Americanwomenwho give birth eachyear,about seven hundred (700) suffer fatal complications during pregnancy, while giving birth, or during the postpartum period, and an additional fifty thousand (50,000) are severely injured.
  • (3) It is estimated that half of the maternal mortalities in the United States could be preventedandhalf of the maternalinjuries in the United States could be reduced or eliminated with better care.
  • (4) InRhode Island, the maternalmortality ratefor the five (5) years2013-2017 waseleven and two tenths (11.2) per one hundred thousand (100,000) live births. During this five (5) year period, there were six (6) cases of maternaldeaths.
  • (5) The severe maternal morbidity rate in RI for 2016 is two hundred nine (209) per ten thousand (10,000) delivery hospitalizations.
  • (6) In Rhode Island, there is also a large disparity for severe maternal morbidity among non-Hispanic Black women three hundred out of ten thousand (306/10,000) compared to non- Hispanic White women one hundred seventy nine and four tenths out of ten thousand (179.4/10,000).
  • (7) Data from the centers for disease control and prevention show that nationally, black women are three (3) to four (4) times more likely to die from pregnancy-related causes thanwhite women. There are forty (40) deaths per one hundred thousand (100,000) live births for black women, comparedto twelve andfour tenths (12.4) deaths per one hundred thousand (100,0000 live births for white women and seventeen and eight tenths (17.8) deaths per one hundred thousand (100,000) live births for women of other races.
  • It is enacted by the General Assembly as follows:
  • SECTION 1. Findings.
  • (1) In the United States, maternal mortality rates are among the highest in the developed world and increased by twenty six and six tenths percent (26.6%) between 2000 and 2014.
  • (2) Ofthefour million(4,000,000) Americanwomen who give birtheachyear,about seven hundred (700) suffer fatal complications during pregnancy, while giving birth, or during the postpartum period, and an additional fifty thousand (50,000) are severely injured.
  • (3) It is estimated that half of the maternal mortalities in the United States could be prevented and half of the maternal injuries in the United States could be reduced or eliminated with better care.
  • (4) In Rhode Island, the maternal mortalityratefor the five (5) years 2013-2017 was eleven and two tenths (11.2) per one hundred thousand (100,000) live births. During this five (5) year period, there were six (6) cases of maternal deaths.
  • (5) The severe maternal morbidity rate in RI for 2016 is two hundred nine (209) per ten thousand (10,000) delivery hospitalizations.
  • (6) In Rhode Island, there is also a large disparity for severe maternal morbidity among non-Hispanic Black women three hundred out of ten thousand (306/10,000) compared to non- Hispanic White women one hundred seventy nine and four tenths out of ten thousand (179.4/10,000).
  • (7) Data from the centers for disease control and prevention show that nationally, black women are three (3) to four (4) times more likely to die from pregnancy-related causes than white women. There are forty (40) deaths per one hundred thousand (100,000) live births for black women, compared to twelve and four tenths (12.4) deaths per one hundred thousand (100,0000 live births for white women and seventeen and eight tenths (17.8) deaths per one hundred thousand (100,000) live births for women of other races.
  • (8) Black women's risk of maternal mortality has remained higher than white women's risk for the past six (6) decades.
  • (9) Blackwomenin the United Statessufferfromlife-threatening pregnancycomplications twice as often as their white counterparts.
  • (10) High rates of maternal mortality among black women span income and education levels, as well as socioeconomic status; moreover, risk factors such as a lack of access toprenatal care and physicalhealth conditions do not fully explain the racialdisparity in maternalmortality.
  • (11) A growing body of evidence indicates thatstressfromracismandracialdiscrimination results in conditions – including hypertension and pre-eclampsia – thatcontribute to poor maternal health outcomes among black women.
  • (12) Pervasive racial bias against black women and unequal treatment of black women exist in the health care system, often resulting in inadequate treatment for pain and dismissal of cultural norms with respectto health. A 2016 study by University of Virginia researchers found that white medical students and residents often believed biological myths about racial differences in patients, including that black patients have less-sensitive nerve endings and thicker skin than their white counterparts. Providers,however, are notconsistently required to undergo implicit bias, cultural competency, or empathy training.
  • (13) Currently, OregonandMinnesota are two(2) states thatpermitMedicaid coverage for doula services and New York City has launched a pilot program. Studies in Oregon, Minnesota, and Wisconsin have shown that using a doula can save money.
  • (14) Currently in the US, one in three(3) births is aC-section. Theycostabout fifty percent (50%) more than conventional births. Using a doula reducesthe chancesof the needfor a C-section by twenty-five percent (25%).
  • (15) According to the manuscript entitled "modeling the cost effectiveness of doula care associated with reductions in preterm birth and cesarean delivery", in Minnesota, women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7% vs. 6.3%, and 20.4% vs. 34.2%). Data show women with doula care hadtwenty- two percent (22%) lower odds of preterm birth. Cost-effectiveness analyses indicate potential
  • LC002105 - Page 2of 12 savings associatedwith doula support reimbursed at anaverage of nine hundred eighty six dollars ($986) (ranging from nine hundred twenty-nine dollars ($929) to one thousand forty-sevendollars ($1,047) across states).
  • (16) To require Medicaid and private insurance coverage for continuous, one-to-one, emotional and physical support services to pregnant persons by a trained, culturally competent, registered perinatal doula.
  • (17) Findings of a 2017 Cochrane, systematic review of twenty-six (26) trials involving fifteen thousand eight hundred fifty-eight (15,858) women revealedthatcontinuous support during labor may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labor, a decrease incesareanbirth, and decreases ininstrumental vaginal birth, use of any analgesia, use of regional analgesia, low five (5) minute Apgar score andnegative feelings about childbirth experiences. The study found no evidence of harms of continuous labor support.
  • (18) An update last year by Cochrane, found that pregnant women who received the continuous support thatdoulas provide were thirty-nine percent(39%) less likely to have cesarean birth.
  • SECTION2. Chapter 27-18of the GeneralLaws entitled"Accident andSickness Insurance Policies" is hereby amended by adding thereto the following section:
  • (9) Blackwomen inthe United States suffer fromlife-threateningpregnancycomplications twice as often as their white counterparts.
  • (10) High rates of maternal mortality among black women span income and education levels, as well as socioeconomic status; moreover, risk factors such as a lack of access to prenatal care and physical health conditions do not fully explain the racial disparity in maternal mortality.
  • (11)Agrowingbodyofevidenceindicatesthat stress fromracismandracial discrimination results in conditions – includinghypertension and pre-eclampsia –that contributeto poor maternal health outcomes among black women.
  • (12) Pervasive racial bias against black women and unequal treatment of black women exist in the health care system, often resulting in inadequate treatment for pain and dismissal of cultural norms with respect to health. A 2016 study by University of Virginia researchers found that white medical students and residents often believed biological myths about racial differences in patients, including that black patients have less-sensitive nerve endings and thicker skin than their white counterparts. Providers, however, are not consistently required to undergo implicit bias, cultural competency, or empathy training.
  • (13) Currently, Oregon and Minnesota are two (2) states that permit Medicaid coverage for doula services and New York City has launched a pilot program. Studies in Oregon, Minnesota, and Wisconsin have shown that using a doula can save money.
  • (14) Currentlyin the US, one in three(3) births is a C-section.Theycost about fiftypercent (50%) more than conventional births. Using a doula reduces the chances of the need for a C-section by twenty-five percent (25%).
  • (15) According to the manuscript entitled "modeling the cost effectiveness of doula care associated with reductions in preterm birth and cesarean delivery", in Minnesota, women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7% vs. 6.3%, and 20.4% vs. 34.2%). Data show women with doula care had twenty- two percent (22%) lower odds of preterm birth. Cost-effectiveness analyses indicate potential savings associated with doula support reimbursed at an average of nine hundred eighty six dollars ($986) (ranging from nine hundred twenty-nine dollars ($929) to one thousand forty-seven dollars ($1,047) across states).
  • (16) Findings of a 2017 Cochrane, systematic review of twenty-six (26) trials involving fifteen thousand eight hundred fifty-eight (15,858) women revealed that continuous support during labor may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labor, a decrease in cesarean birth, and decreases in instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five (5) minute Apgar score and negative feelings about childbirth experiences. The study found no evidence of harms of continuous labor support.
  • (17) An update last year by Cochrane, found that pregnant women who received the continuous support that doulas provide were thirty-nine percent (39%) less likely to have cesarean birth.
  • SECTION2.Chapter27-18 oftheGeneral Lawsentitled"AccidentandSicknessInsurance Policies" is hereby amended by adding thereto the following section:
  • 27-18-85. Perinatal doulas.
  • (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas if the services are within the perinataldoulas' area of professional competence as definedby regulations promulgated by the doula certification organization. No insurer or hospital or medical service corporation may require supervision, signature, or referralby anyother health careprovider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospitalor medicalservice corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider. Direct payment for perinatal doulas shall be contingent upon services rendered in accordance with rules and regulations promulgated by the doula certification organization.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state that is required to cover perinatal doula services as defined in subsection
  • LC002105 - Page 3of 12 (a) of this section, shall report utilization and costinformation related toperinatal doula services to the office of the health insurance commissioner onor before July 1, 2023 andeachJuly 1thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accidentonly; (4) Long-termcare;(5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
  • (a) As used in this section, "doula" or "perinatal doula" means a trained professional providingcontinuous physical, emotional,and informational support toa pregnant individual,from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas' area ofprofessionalcompetenceasdefinedbythedoulacertificationstandarddevelopedandmaintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider.
  • (c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover perinatal doula services as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023 and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (d) This section shall not apply to insurance coverage providing benefits for:
  • (1) Hospital confinement indemnity;
  • (2) Disability income;
  • (3) Accident only;
  • (4) Long-term care;
  • (5) Medicare supplement;
  • (6) Limited benefit health;
  • (7) Specified disease indemnity;
  • (8) Sickness or bodily injury or death by accident or both; and
  • (9) Other limited benefit policies.
  • SECTION 3. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section:
  • 27-19-77. Perinatal doulas.
  • (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas if the services are within the perinataldoulas' area of professional competence as definedby regulations promulgated by the doula certification organization. No insurer or hospital or medical service corporation may require supervision, signature, or referralby anyother health careprovider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospitalor medicalservice corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider. Direct payment for perinatal doulas shall be contingent upon services rendered in accordance with rules and regulations promulgated by the doula certification organization.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state that is required to cover perinatal doula services as defined in subsection (a) of this section, shall reportutilization and costinformation related toperinatal doula services to the office of the health insurance commissioner onor before July 1, 2023 andeachJuly 1thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accidentonly; (4) Long-termcare;(5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
  • LC002105 - Page 4of 12
  • (a) As used in this section, "doula" or "perinatal doula" means a trained professional providingcontinuous physical, emotional,and informational support toa pregnant individual,from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas' area ofprofessionalcompetenceasdefinedbythedoulacertificationstandarddevelopedandmaintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider.
  • (c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover perinatal doula services as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023 and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (d) This section shall not apply to insurance coverage providing benefits for:
  • (1) Hospital confinement indemnity;
  • (2) Disability income;
  • (3) Accident only;
  • (4) Long-term care;
  • (5) Medicare supplement;
  • (6) Limited benefit health;
  • (7) Specified disease indemnity;
  • (8) Sickness or bodily injury or death by accident or both; and
  • (9) Other limited benefit policies.
  • SECTION 4. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section:
  • 27-20-73. Perinatal doulas.
  • (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas if the services are within the perinataldoulas' area of professional competence as definedby regulations promulgated by the doula certification organization. No insurer or hospital or medical service corporation may require supervision, signature, or referralby anyother health careprovider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospitalor medicalservice corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider. Direct payment for perinatal doulas shall be contingent upon services rendered in accordance with rules and regulations promulgated by the doula certification organization.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state that is required to cover perinatal doula services as defined in subsection (a) of this section, shall reportutilization and costinformation related toperinatal doula services to the office of the health insurance commissioner onor before July 1, 2023 andeachJuly 1thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accidentonly; (4) Long-termcare;(5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
  • (a) As used in this section, "doula" or "perinatal doula" means a trained professional providingcontinuous physical, emotional,and informational support toa pregnant individual,from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas' area ofprofessionalcompetenceasdefinedbythedoulacertificationstandarddevelopedandmaintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider.
  • (c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover perinatal doula services as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023 and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (d) This section shall not apply to insurance coverage providing benefits for:
  • (1) Hospital confinement indemnity;
  • (2) Disability income;
  • (3) Accident only;
  • (4) Long-term care;
  • (5) Medicare supplement;
  • (6) Limited benefit health;
  • (7) Specified disease indemnity;
  • (8) Sickness or bodily injury or death by accident or both; and
  • (9) Other limited benefit policies.
  • SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:
  • 27-41-90. Perinatal doulas.
  • (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas if the services are within the perinataldoulas' area of professional competence as definedby regulations promulgated by the doula certification organization. No insurer or hospital or medical
  • LC002105 - Page 5of 12 service corporation may require supervision, signature, or referralby anyother health careprovider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospitalor medicalservice corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider. Direct payment for perinatal doulas shall be contingent upon services rendered in accordance with rules and regulations promulgated by the doula certification organization.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewedin this state that is required to cover perinatal doula services as defined in subsection (a) of this section, shall reportutilization and costinformation related toperinatal doula services to the office of the health insurance commissioner onor before July 1, 2023 andeachJuly 1thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accidentonly; (4) Long-termcare;(5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
  • SECTION 6. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby amended by adding thereto the following chapter:
  • CHAPTER 8.16
  • RHODE ISLAND DOULA REIMBURSEMENT ACT
  • 40-8.16-1. Short title.
  • This actshall be known andmaybe citedas the "Rhode Island Doula ReimbursementAct."
  • 40-8.16-2. Definitions.
  • As used in this chapter:
  • (1) "Accountable care"means an accountable care entity that helps coordinate the medical care provided to Medicaid-eligible patients.
  • (2) "Antepartum" means the period of pregnancy before labor or childbirth. Services provided during this period are rendered to the pregnant individual.
  • (3) "Community-based organization (CBO)" means a public or private nonprofit organization that is representative of a community or significant segments of a community and engaged in meeting that community's needs in the areas of social, human, or health services.
  • (4) "Competencies" means key skills and applied knowledge necessaryfor doulas to be
  • LC002105 - Page 6of 12 effective in the work field and carry out their roles.
  • (5) "Contact hour" means an hour of classroom, group, or distance learning training, and does not include homework time, preparatory reading, or practicum.
  • (6) "Doula" or "perinatal doula" means a trained professional providing continuous physical, emotional and informational support to a pregnant individual, from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to CBOs and certified and licensed perinatal professionals in multiple disciplines.
  • (7) "Doula certification organization" means the Rhode Island certification board.
  • (8) "Doula services" means services provided by a certified doula as enumerated in § 40- 8.16-4.
  • (9) Doula training organization" means an entity, nationally or internationally, recognized by the doula certification organization for training perinataldoulas whoseeducational requirements includes the core curriculum topics described in this chapter. These doula training organizations shall include, but not be limited to, the International Childbirth Education Association (ICEA),the Doulas of North America (DONA), ToLabor, Birthworks, the Childbirth and Postpartum Professional Association (CAPPA), Childbirth International, the International Center for Traditional Childbearing, and Commonsense Childbirth, Inc.
  • (10) "Fee-for-service"means a payment model where services are unbundled and paid for separately.
  • (11) "Insurer" means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, program that provides free or low-cost health coverage tolow-income individuals, or other insurer offering andinsuring health services;the term shall in addition include any entity defined as an insurer under § 42-62-4.
  • (12) "International board-certified lactation consultant" or "IBCLC" means a health care professional who specializes in the clinical management of breastfeeding.
  • (13) "Intrapartum" means the period of pregnancy during labor and delivery or childbirth. Services at this period are rendered to the pregnant individual.
  • (14) "Managed care"means providing for the delivery of Medicaid health benefits and additional servicesthrough contractedarrangementsbetweenstateMedicaid agenciesandmanaged care organizations (MCOs) that accepta setper member per month (capitation) payment for these services.
  • (15) "Postpartum" means one year after a pregnancy ends.
  • (16) "Private insurers" means insurance schemes financed through private health
  • LC002105 - Page 7of 12 premiums, i.e., payments that a policyholder agrees to make for coverage under a given insurance policy, where an insurance policy generally consists of a contract that is issued by an insurer to a covered person.
  • (17) "Registry" means a list of doulas, maintained by the doula certification organization, that satisfies the qualifications for registration set forth by the doula certification organization.
  • (18) "State medical assistance program"means a federalfinancialaid of medical expenses of needy persons.
  • 40-8.16-3. Coverage of doula services.
  • (a) Doula services shallbe eligible for coverage throughout Rhode Island for child-bearing individuals through private insurance and Medicaid.
  • (b) Doula services shall be covered by the state medical assistance program if the doula seeking reimbursement has completed the following:
  • (1) Applied for and being given a NationalProvider Identification Number (NPI#);
  • (2) Completed and received approval for all required state medical assistance program provider enrollment forms;
  • (3) Provided acopy of adoula training certificate or anauthentic, original, signed anddated letter from a doula training organization verifying that the doula has attended and completed its training or curriculum. To be considered authentic, a letter must be on the doula training organization's letterhead and signed by an authorized representative;
  • (4) Provided a signed and datedattestation of being trained in the following competencies through one program or a combination of programs, the result of which is meeting all doula core competency requirements outlined below:
  • (i) Aneducationthat includes anycombination of childbirth education, birth doula training, antepartum doula training, and postpartum doula training;
  • (ii) Attendance at a minimum of one breastfeeding class or holding a valid lactation certification;
  • (iii) Attendance at a minimum of one childbirth class or valid childbirth education certification;
  • (iv) Completion of cultural competency training;
  • (v) Completion of HIPAA / client confidentiality training;
  • (vi) Completion of CPR certification for children and adults; and
  • (vii) Completion of SafeServ certification for mealpreparation.
  • (c) Once enrolled as a state medical assistance program provider, a doula shall be eligible to enroll as a provider with fee-for-service, managed care,and accountable care payers, affiliated
  • LC002105 - Page 8of 12 with the state medicalassistance program.
  • (d) In order to follow federal Medicaid and private insurance requirements applicable to covered services, doula services shallbe reimbursed on a fee-for-service schedule.
  • (e) Notwithstanding the provisions of subsection (b) of this section, a doula who can provide alternative and sufficient documentation of training and practice as a doula for a period of at least six (6) months prior to the passage of this chapter shall not be required to provide the certificate or letter required by subsection (b)(3) of this section, and shall have six (6) months to complete the training requirements of subsection (b)(4) of this section.
  • 40-8.16-4. Scope of practice.
  • A doula may provide services to a pregnant individual such as:
  • (1) Services to support pregnant mothers andpeople, improve birth outcomes, andsupport new mothers and families with cultural specific antepartum, intrapartum, and postpartum services, referrals, and advocacy;
  • (2) Advocating for and supporting physiological birth, breastfeeding, and parenting for their client;
  • (3) Supporting the antepartum,intrapartum, andpostpartum period with traditional comfort measures andeducational materials, as wellas assistance during the transition to parenthood in the initial postpartum period through home visits;
  • (4) Empowering individuals andfamilies with evidenced-basedinformation to choose best practices for birth, breastfeeding, and infant care;
  • (5) Providing continuous support to the laboring individual until the birth of the baby at any location of delivery;
  • (6) Referring clients to their appropriate provider for medical advice for care outside of the doula scope of practice;
  • (7) Working as a member of the individual's multidisciplinary team; and
  • (8) Offering evidence-based information on newborn and infant feeding, emotional and physical recovery from childbirth, and other issues related to the antepartum, intrapartum, and postpartum period.
  • (b) A doula shall not engage in the "practice of medicine," as defined in § 5-37-1.
  • 40-8.16-5. Establishing a statewide registry of perinatal doulas.
  • (a) The doula certification organization shall promulgate rules and regulations that establish a statewide certification for perinatal doulas solely for the purpose of establishing the qualifications necessary for doulas to qualify for reimbursement under this chapter.
  • (b) Individuals seeking entry on a statewide registry of doulas shall, at a minimum:
  • LC002105 - Page 9of 12
  • (1) Be at least eighteen (18) years of age;
  • (2) Not be listed on the doula certification organization's provider exclusion list;
  • (3) Successfully complete training in all competencies as outlined in § 40-8.16-3;
  • (4) Receive andmaintain certification by anapproved doula certification organization; and
  • (5) Maintain personal liability insurance either individually or through a collaborative, association, or business of doulas thatcanprove liability insurance coverage for all doulas working through, with or under them.
  • 40-8.16-6. Payment for doula services.
  • (a) Medicalassistance coverage for doula services:
  • (1) Chapter 8 of title 40 shallinclude "doula services"as describedin §§ 40-8.16-4and 40- 8.16-5; and
  • (2) The coverage available for doula services per pregnancy, regardless of the number of infants involved, which shall be billed on a fee-for-service basis, shall be available through one year postpartum, shall not be less than eight hundred fifty dollars ($850.00), and shall be eligible towards the following activities, such as: prenatalvisits, physical and emotional support during a childbearing individual's labor and birth, telephone or virtual communications betweendoula and client, time spent being on call for the birth, postpartum visits, and time spent on administrative time, such as documentation or paperwork.
  • (b) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medicalservicesplan contractdelivered, issuedfor delivery, or renewedin this state shall provide coverage for the services of perinatal doulas if the services are within the perinatal doulas' area of professional competence as defined by regulations promulgated by the doula certification organization. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement. Noinsurer or hospital or medical service corporation or patient maybe required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider. Direct payment for perinatal doulas shall be contingent upon services rendered in accordance with rules and regulations promulgated by the doula certification organization.
  • (c) The state medical assistance program, managed care organizations, and accountable care payers that are required to cover perinatal doula services under § 40-8.16-3, shall report utilization and cost information relatedto perinatal doula services to the executive office of health and human services on or before July 1, 2023 and eachJuly 1 thereafter. The executive office of health and human services shall define the utilization and costinformation required to be reported.
  • (d) This chapter shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accidentonly; (4) Long-termcare;(5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
  • SECTION 7. This act shalltake effect on July 1, 2022. ======== LC002105 ========
  • (a) As used in this section, "doula" or "perinatal doula" means a trained professional providingcontinuous physical, emotional,and informational support toa pregnant individual,from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.
  • (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas' area ofprofessionalcompetenceasdefinedbythedoulacertificationstandarddevelopedandmaintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other health care provider.
  • (c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover perinatal doula services as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023 and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
  • (d) This section shall not apply to insurance coverage providing benefits for:
  • (1) Hospital confinement indemnity;
  • (2) Disability income;
  • (3) Accident only;
  • (4) Long-term care;
  • (5) Medicare supplement;
  • (6) Limited benefit health;
  • (7) Specified disease indemnity;
  • (8) Sickness or bodily injury or death by accident or both; and
  • (9) Other limited benefit policies.
  • SECTION 6. This act shall take effect on July 1, 2022. ======== LC002105/SUB A ========
  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T RELATING TO HUMAN SERVICES – MEDICAL ASSISTANCE – PERINATAL DOULA
  • OF
  • A N A C T
  • RELATING TO HUMAN SERVICES – MEDICAL ASSISTANCE – PERINATAL DOULA
  • SERVICES
  • ***
  • This actwould provide for medical assistance healthcare for expectantmothers and would establish medical assistance coverage and reimbursement rates for perinataldoula services.
  • This act would take effect on July 1, 2022. ======== LC002105 ========
  • ***
  • This act would provide for health care coverage by health insurance companies for perinatal doula services.
  • This act would take effect on July 1, 2022. ======== LC002105/SUB A ========

Votes

NOTE: Electronic voting records are unofficial and may not be accurate. For an official vote tally, check the House or Senate Journal from the day of the vote.

Floor vote for PERINATAL DOULA SERVICES

May 04, 2021 at 5:20pm
Yeas: 36 / Nays: 0 / Not voting: 2 / Recused: 0
Legislator Vote
Sen. Acosta Y
Sen. Algiere Y
Sen. Anderson Y
Sen. Archambault Y
Sen. Bell Y
Sen. Burke Y
Sen. Calkin NV
Sen. Cano Y
Sen. Ciccone Y
Sen. Coyne Y
Sen. Cruz Y
Sen. DiMario Y
Sen. DiPalma Y
Sen. Euer Y
Sen. Felag Y
Sen. Gallo Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Kallman Y
Sen. Lawson Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Mack Y
Sen. McCaffrey Y
Sen. Mendes Y
Sen. Miller Y
Sen. Morgan NV
Sen. Murray Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Rogers Y
Sen. Ruggerio Y
Sen. Seveney Y
Sen. Sosnowski Y
Sen. Valverde Y

Floor vote for PERINATAL DOULA SERVICES

May 04, 2021 at 5:20pm
Yeas: 36 / Nays: 0 / Not voting: 2 / Recused: 0
Legislator Vote
Sen. Acosta Y
Sen. Algiere Y
Sen. Anderson Y
Sen. Archambault Y
Sen. Bell Y
Sen. Burke Y
Sen. Calkin NV
Sen. Cano Y
Sen. Ciccone Y
Sen. Coyne Y
Sen. Cruz Y
Sen. DiMario Y
Sen. DiPalma Y
Sen. Euer Y
Sen. Felag Y
Sen. Gallo Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Kallman Y
Sen. Lawson Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Mack Y
Sen. McCaffrey Y
Sen. Mendes Y
Sen. Miller Y
Sen. Morgan NV
Sen. Murray Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Rogers Y
Sen. Ruggerio Y
Sen. Seveney Y
Sen. Sosnowski Y
Sen. Valverde Y

Floor vote for DOULA SERVICES

July 01, 2021 at 5:25pm
Yeas: 37 / Nays: 0 / Not voting: 1 / Recused: 0
Legislator Vote
Sen. Acosta Y
Sen. Algiere Y
Sen. Anderson Y
Sen. Archambault Y
Sen. Bell Y
Sen. Burke Y
Sen. Calkin NV
Sen. Cano Y
Sen. Ciccone Y
Sen. Coyne Y
Sen. Cruz Y
Sen. DiMario Y
Sen. DiPalma Y
Sen. Euer Y
Sen. Felag Y
Sen. Gallo Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Kallman Y
Sen. Lawson Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Mack Y
Sen. McCaffrey Y
Sen. Mendes Y
Sen. Miller Y
Sen. Morgan Y
Sen. Murray Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Rogers Y
Sen. Ruggerio Y
Sen. Seveney Y
Sen. Sosnowski Y
Sen. Valverde Y

Floor vote for DOULA SERVICES

July 01, 2021 at 5:26pm
Yeas: 37 / Nays: 0 / Not voting: 1 / Recused: 0
Legislator Vote
Sen. Acosta Y
Sen. Algiere Y
Sen. Anderson Y
Sen. Archambault Y
Sen. Bell Y
Sen. Burke Y
Sen. Calkin NV
Sen. Cano Y
Sen. Ciccone Y
Sen. Coyne Y
Sen. Cruz Y
Sen. DiMario Y
Sen. DiPalma Y
Sen. Euer Y
Sen. Felag Y
Sen. Gallo Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Kallman Y
Sen. Lawson Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Mack Y
Sen. McCaffrey Y
Sen. Mendes Y
Sen. Miller Y
Sen. Morgan Y
Sen. Murray Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Rogers Y
Sen. Ruggerio Y
Sen. Seveney Y
Sen. Sosnowski Y
Sen. Valverde Y