AN ACT directing the DEPARTMENT of health and human services to conduct a statewide analysis of doula support services, to take certain actions to promote the availability of doula support services, and to provide coverage for doula services under the north carolina medicaid program state plan.

The General Assembly of North Carolina enacts:

part i. statewide analysis of doula support services

SECTION 1.(a)  In order to inform the development of coverage and reimbursement policies for doula support services in North Carolina, the Department of Health and Human Services shall conduct a statewide landscape analysis of doula support services. At a minimum, the following shall be assessed in the analysis:

(1)        The availability of doulas and doula services across the State.

(2)        The demographic and training background diversity of providers of doula services.

(3)        The standards for the attestation, training, and certification of doulas.

(4)        Practical options for health benefit plan policies to include coverage for, or incentivize the use of, doula support services during pregnancy, labor, delivery, and the postpartum period as part of value‑based payments, enhanced reimbursements, or as value‑added services.

In conducting the analysis, the Department shall convene focus groups with individuals performing doula support services across the State to further inform and acquire input on the development of coverage and reimbursement policies for these services.

No later than November 1, 2026, the Department shall submit a report of its analysis, including any recommendations requiring legislative action, to the Joint Legislative Oversight Committee on Health and Human Services.

SECTION 1.(b)  Upon the completion of the analysis and the submission of the report required under this section, the Department of Health and Human Services, Division of Public Health, shall do all of the following:

(1)        Partner with doula training programs and childbirth education organizations, such as Birth Arts International, Childbirth and Postpartum Professional Association, DONA International, and the International Childbirth Education Association, to help set standards for the attestation, training, and certification of doulas in North Carolina.

(2)        Develop doula services coverage and reimbursement options and strategies for commercial insurers offering health benefit plans in this State to consider.

(3)        Develop bill standards for the provision of doula services.

(4)        Create a statewide directory of providers offering doula support services, including the services they offer.

part ii. create medicaid access to doula support services

SECTION 2.(a)  The Department of Health and Human Services, Division of Health Benefits, shall submit a State Plan amendment to the Centers for Medicare and Medicaid Services adding coverage under the North Carolina Medicaid State Plan for antepartum, intrapartum, and postpartum services provided to a pregnant recipient by a doula. These services shall include services for labor and delivery support and at least four visits during the antenatal period and seven visits during the postpartum period. This coverage shall begin July 1, 2024.

SECTION 2.(b)  Effective July 1, 2023, there is appropriated from the General Fund to the Department of Health and Human Services, Division of Health Benefits, the sum of five hundred thousand dollars ($500,000) in nonrecurring funds for the 2023‑2024 fiscal year to be used to make necessary changes to the NCTracks Medicaid Management Information System to add the new coverage for doula services required under this section and to enroll new providers of that coverage.

SECTION 2.(c)  In preparation for the addition of the new coverage for doula services required under this section, the Department of Health and Human Services, Division of Health Benefits (DHB), shall study the following:

(1)        The necessary qualifications possessed by a doula in order to be enrolled as a North Carolina Medicaid provider, including educational requirements and the possession of any professional certification.

(2)        The scope, definitions, and clinical coverage policy to be used for the provision of these new services.

(3)        The billing codes and procedure codes to be utilized by the doula providers when submitting claims for services.

(4)        The way other states have implemented similar coverage, or plan to implement similar coverage, including any costs associated with that implementation and any costs or cost‑savings associated with the coverage of services provided by a doula.

(5)        The appropriate rate schedule for the new coverage.

(6)        Any anticipated costs and cost‑savings to the North Carolina Medicaid Program that may be incurred or achieved by providing coverage for services provided by a doula.

(7)        The potential impact that Medicaid coverage of services provided by a doula may have on infant mortality and maternal health in the State.

No later than March 1, 2024, DHB shall submit to the chairs of the Joint Legislative Oversight Committee on Medicaid and NC Health Choice and the Fiscal Research Division a report on the study conducted in accordance with this section and shall include in that report a copy of the State Plan amendment to establish coverage under the North Carolina Medicaid State Plan for antepartum, intrapartum, and postpartum services provided to a pregnant recipient by a doula, including the proposed reimbursement methodology to be utilized.

part iii. intent and effective date

SECTION 3.  It is the intent of the General Assembly to appropriate the necessary funding to the North Carolina Department of Health and Human Services to provide support and resources for implementation of this act.

SECTION 4.  This act is effective when it becomes law.