The Department of Medical Assistance Services (DMAS) is pleased to announce that Virginia is the 4th state in the nation to offer community doula services as a benefit for Medicaid members. We encourage existing doulas and interested individuals to apply for certification as a state-certified community doula and join the Virginia Medicaid program as a provider!
What is a State-Certified Community Doula? A state-certified community doula is a trained, community-based, non-medical professional who offers a broad set of non-clinical, continuous support services to pregnant women throughout pregnancy, at labor and delivery, and during the postpartum period. Community doulas provide support to pregnant and postpartum women through their grounding within the community, languages, and value systems of the populations they serve. The emotional, physical, and informational support provided by doulas include childbirth education, lactation support, and referrals for health or social services. A state-certified community doula is certified by the Virginia Certification Board and is a trusted source of support for birthing families.
What are the benefits of becoming a state-certified community doula? Community doulas experience a unique and rewarding career that supports mothers on their journey of pregnancy and childbirth. Doulas educate mothers to be healthy and have healthy babies, and empower them to confidently make some of the most important decisions of their lives.
Who can apply to become a state-certified doula? Anyone who is interested can begin the process! Any person seeking to be a state-certified doula must meet the requirements set by the Virginia Department of Health (VDH). To learn more about the steps to become a Community Doula please see the Community Doula Roadmap.
Steps to Becoming a State-Certified Community Doula
Effective January 6, 2022, the Virginia Department of Health (VDH) established the minimum requirements to be considered a certified doula in Virginia based on the core competencies for doula certification used by national organizations and community-based organizations in Virginia.
Steps to Completing State-Certification:
- Complete Required Training and Education. Doulas are required to complete a minimum of 60 hours of Virginia Department of Health (VDH) approved training and education in the required topic areas prior to certification by the Virginia Certification Board (VCB). Applicants must complete all required trainings facilitated by an approved training entity by VCB. For more information training and education requirements, see the Community Doula State Certification Flyer.
- A State-Certified Doula Application must be completed in its entirety.
- There is a fee of $100 for the initial certification or $75 for recertification. Fees are made payable to the VCB.
- The completed application, certification fee, copies of certificates of attendance, other required documents, and fee must be submitted to the Virginia Certification Board (VCB) in one of the following ways:
- Mail: Virginia Certification Board (VCB) 298 S. Progress Avenue, Harrisburg, PA, 17109
- Email: email@example.com *Please Note* Only PDFs are permitted. Photos of applications are not accepted.
- Fax: 717-540-4458 *Please Note* Receiving a confirmation of fax does not indicate it has been received. To confirm receipt of application, email firstname.lastname@example.org.
- For more information on how to become state certified, visit the Virginia Certification Board, email email@example.com, or call (804) 741-2319.
Doula providers are required to obtain a National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). This is a unique 10-digit number used to identify health care providers. The NPI is required on the Provider Enrollment Application. Obtain an individual National Provider Identifier.
For more information, learn how to apply for an NPI from the Centers for Medicare & Medicaid Services (CMS).
As a community doula, you must enroll with DMAS as a Virginia Medicaid provider to provide services to members. Provider enrollment is managed through the Provider Enrollment Public Portal through the Medicaid Enterprise System (MES), which gives providers access to the secure online provider enrollment functions.
Steps for Medicaid Provider Enrollment:
- Complete the Medicaid enrollment application by accessing the Provider Enrollment Wizard on the PRSS Public Portal and clicking "Provider Enrollment".
- Proof of State Certification as a community doula - VCB state certificate will need to be uploaded as an attachment to the provider enrollment application.
- Proof of Liability Insurance - Doulas are also required to attach proof of medical liability insurance with the Medicaid Enrollment Application. Doulas will need to purchase proof of liability insurance at the $1 million per claim/$3 million per year - policy levels in order to provide doula services to Medicaid members (costs to purchase insurance may vary).
- For more information on Medicaid Enrollment please view the Doula Enrollment Tips and FAQs.
Most Virginia Medicaid members belong to a managed care organization (MCO) or health insurance plan. In order to provide services and bill for services provided to those members, a doula will need to collaborate with MCOs. Six MCOs participate in Virginia's Medicaid managed care programs. Doulas must enroll as a Virginia Medicaid provider prior to MCO contract execution. To contract with the MCOs, doulas will need to review and sign provider agreements with each MCO. These agreements are unique to each MCO; thus, doulas are required to sign agreements with each MCO with which they want to partner.
Managed Care Organization (MCO) Contracting Resources
Aetna Better Health of Virginia
Anthem HealthKeepers Plus
Molina Complete Care
Optima Family Care
As a Community Doula Provider, you will find the links to important training resources to assist you with understanding the Medicaid Enrollment System (MES), Medicaid enrollment, claims and billing. Please visit the MES Public Training landing page to become familiar with the system, then visit the Provider Training area to view important resources and to sign up for self-guided or live training.
Doulas will not operate under the supervision of a clinician of medical provider. Prior authorizations are not required for doula care. Doulas must secure and retain the record of a licensed practitioner’s recommendation for each member prior to initiating their doula care. Recommendations for doula care is not the same as a prior authorization. For the doula benefit, VA Medicaid defines a “licensed practitioner” as:
- Licensed clinicians
- Licensed midwives
- Nurse practitioners
- Physician assistants and
- Other Licensed Mental Health Professionals
A Licensed Mental Health Professional is defined as a: physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, or certified psychiatric clinical nurse specialist.
Reimbursement for doula care includes payment for prenatal care, labor and delivery, and postpartum care. Doula services, rendered from the date of conception, as documented in the member’s medical record, through 180 days (six months) after delivery, may be reimbursed contingent on the individual/member maintaining Medicaid or FAMIS MOMs eligibility. FAMIS Prenatal members will be eligible to receive services through 60 days postpartum. Note: Doulas are only reimbursed for actual services rendered when all billing requirements are met.
The provider manuals are a great resource for billing providers. Chapters 5 in each provider manual contains billing guidelines. Access the Provider Manuals Library.
The Provider HELPLINE can assist with a number of services to include verifying member eligibility. The Provider HELPLINE is available Monday-Friday, 8:00 a.m. - 5:00 p.m. • 1-804-786-6273 • 1-800-552-8627
We would love to hear from you! Join our Community Doula Program email list to receive the latest information and stay up to date. Email firstname.lastname@example.org with your name, email, and phone number to be added to our list. Please include “Community Doula Program” in the subject line of the email.