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24-877 Working Together with Doulas to Reduce Barriers to Providing Services

Date: 08/16/24

Find answers to doulas’ frequently asked questions

We value the relationship we have developed with the doulas in our network and want to respond to concerns raised by doulas to the Department of Health Care Services (DHCS). Several doula organizations added their name to an email sent to DHCS on June 24, 2024, stating their concerns about doula services as a Medi-Cal benefit and implementation issues with Managed Care Plan (MCP) contracts. The information in this update addresses these concerns.

Frequently asked questions

Topic

Questions…

Answer…

Contracts

Is the contract specific to doula services?

Are doulas asked to disregard any portion of the contract?

 

Yes, the contract is a standard health plan contract which has been customized for doulas, eliminating any nonapplicable sections. All remaining sections of the contract are required.

We are not asking doulas to disregard any portion of the contract.

The contract includes:

  • Required standard template language: definitions, what’s a benefit, disputes, policies, duties of the provider, provision of services, eligibility, subcontracting, duties for the MCP, payment, reporting to regulators, what can be requested, payment rates, billing and payment, recoupment, termination terms, compliance, binding arbitration, a signature page, provider information on the Medi-Cal program, and a disclosure form.
  • Doula specific information: Doula services information outlining responsibility, payment, an exhibit with rates, and a Business Associate Agreement (six pages total).  

Response times

What is the turnaround time to respond to contracting inquiries?

Our team will respond within one week from the initial contact.

Contracting process

Are doulas required to submit documents already submitted to DHCS’ Provider Application and Validation for Enrollment (PAVE)?

  • If a doula wants to contract with Health Net, on behalf of CalViva Health, and the doula is not on the PAVE list, then the approval letter from DHCS for PAVE enrollment is required. No other documents are needed.
  • The doula must be Medi-Cal enrolled with a National Provider Identifier (NPI) through PAVE. 

New doula contracts

Are we still open to contracting with doulas who contact us?

Yes, with individual doulas and doula groups who can contract in any county where the Plan operates.

Additional information requests

Do we request a resume or work history or an explanation for employment gap(s)?

No, the approval letter from DHCS for PAVE enrollment or showing on the PAVE list is all that is required. No other additional information is requested. 

Misinformation

Do we reference the Standing Recommendation?

We have updated our documents to reflect the state’s standing order for the initial set of services. 

TRI services add-on payments

The 2024 targeted add-on rate increase (TRI) became effective January 1, 2024.

Doula provider contracts do not need to be amended because the negotiated fee schedule in the contract is not changing.

  • The TRI rate is the same for all contracted doula providers performing the eligible services.
  • TRI is applied in addition to the fee schedule in the contract.
  • Doulas will receive retroactive payments back to January 1, 2024, by end of year in accordance with the DHCS APL.

Resource

Additional information

If you have questions regarding TRI rates, refer to the 2024 DHCS Targeted Rate Increase For Select Medi-Cal Services dedicated provider landing page. You may also contact the Provider Relations team via email.

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.

This information applies to Ancillary Providers - Doulas.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.



Last Updated: 08/15/2024