Library: Policy

317:30-5-1217. General coverage

Issued 7-1-23

(a) Covered benefits. The following benefits are covered:

(1) Prenatal/postpartum visits. There is a total of eight (8) prenatal/postpartum visits allowed for the member. The doula must work with the member to determine how best to utilize the benefit to meet the needs of the member.

(2) Labor and delivery. There is one (1) labor and delivery visit allowed, regardless of the duration.

(b) Visit requirements. Each covered visit is subject to the following requirements:

(1) The minimum visit length is sixty (60) minutes.

(2) Visits must be face-to-face.

(A) Prenatal and postpartum visits may be conducted via telehealth.

(B) Labor and delivery services may not be conducted via telehealth.

(c) Service locations. Service location requirements for each covered visit are as follows:

(1) Prenatal and postpartum. Doulas must coordinate directly with the member and their family to determine the most appropriate service location for prenatal and postpartum visits. Service locations may include the following:

(A) Member's place of residence;

(B) Doula's office;

(C) Physician's office;

(D) Hospital; or

(E) In the community.

(2) Labor and delivery services. There is no coverage for home birth(s).

(d) Referral requirements. Doula services must be recommended by a physician or other licensed practitioner of the healing arts who is operating within the scope of their practice under State law.

(1) The following providers may recommend doula services:

(A) Obstetricians;

(B) Certified Nurse Midwifes;

(C) Physicians;

(D) Physician Assistants; or

(E) Certified Nurse Practitioners.

(2) The SoonerCare Referral Form must be completed and submitted, noting the recommendation for doula services.

(e) Prior authorization (PA) requirements. A prior authorization (PA) is not required to access the standard doula benefit package. A PA may be submitted, for members with extenuating medical circumstances, if there is need for additional visits beyond the eight (8) prenatal/postpartum visits.

(f) Medical records requirements. The medical record must include, but is not limited to, the following:

(1) Date of service;

(2) Person(s) to whom services were rendered;

(3) Start and stop time for the service(s);

(4) Specific services performed by the doula on behalf of the member;

(5) Member/family response to the service;

(6) Any new needs identified during the service; and

(7) Original signature of the doula, including the credentials of the doula.

(g) Auditing review. All doula services are subject to post-payment reviews and audits by the OHCA.

(h) Reimbursement. All doula services, that are outlined in Part 114 of this Chapter, are reimbursed per the methodology established in the Oklahoma Medicaid State Plan. There are no allotted incentive payments.