PURPOSE: This rule establishes the Department of Social Services’ MO HealthNet Division guidelines regarding coverage and reimbursement for community doula services. The goal of these services is to provide a stable source of psychosocial support and education throughout the perinatal period and during the birth utilizing specially trained lay providers to enhance relevant knowledge and encourage healthy behaviors that can lead to improved pregnancy-related outcomes.

PUBLISHER’S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.

1. (1) Administration. Doula services shall be administered by the MO HealthNet Division. Doula services covered and not covered, the limitations under which services are covered, and the maximum allowable fees for all covered services shall be determined by the MO HealthNet Division and shall be included in the MO HealthNet Physician Provider Manual, which is incorporated by reference and made part of this rule as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, and is available at its website https://mydss.mo.gov/media/pdf/physicians-provider-manual, August 6, 2024. This rule does not incorporate any subsequent amendments or additions.

   1. (A) In the administration of the rule, “doula services” means services that provide a stable source of psychosocial support and education throughout the perinatal period and during the birth utilizing trained providers, community-based doulas, with the aim of improving a range of maternal and infant health outcomes by enhancing relevant knowledge and encouraging healthy behaviors. Doula services are available to all pregnant women, prenatally, during delivery, and throughout the postpartum period as medically necessary preventive services when recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under state law and provided in accordance with currently accepted standards of medical or professional practice. This includes twelve (12) months after delivery.

2. (2) Provider Participation. To be eligible for participation in the doula services program—

   1. (A) Doula providers must be enrolled as MO HealthNet providers;

   2. (B) All doula providers must be at least eighteen (18) years of age and must possess a current certificate issued by a national or Missouri-based doula training organization whose curriculum meets the following definition and standards:

      1. 1. Curriculum that covers a doula’s role, which includes

breastfeeding support, perinatal mood and anxiety disorders, anticipatory care strategies, cultural competency, how to deliver perinatal education and support, how to increase client autonomy during birth, and how to support clients who may need additional care;

1. 2. Understanding the importance of health-related social

needs, including navigation of social services, trauma-informed care, and strategies specific to the community served;

1. 3. The student must successfully complete the training

program and be deemed competent to provide doula services. Certification is attained after evaluation by a birth professional or trainer;

1. 4. Completion of at least six (6) continuing education unit

1. (CEU) hours per year on topics related to the components listed in paragraphs (2)(B)1. and (2)(B)2., or equivalent continuing education as specified by the training organization; and

   1. 5. Holds liability insurance as an individual or through a

supervising organization; and

1. (C) For doulas whose training came from another source, or from multiple sources, MO HealthNet will determine eligibility for reimbursement as follows:

   1. 1. If there exists any statewide organization composed of

doula trainers from three (3) or more independent, well-established doula training organizations located in Missouri whose purpose includes validation of core competencies of trainings, then MO HealthNet may verify that an individual’s training and experience satisfies the above-stated criteria through a public roster maintained by such an organization; and

1. 2. If no such organization exists, future doula training or-

ganizations must prove that their training satisfies the above definition in order to be added to the written policy guide, which will include a list of all approved certification programs qualifying under subsections (2)(B) and (2)(C).

1. (3) Participant Eligibility. Any pregnant woman who is eligible for Title XIX benefits from the Family Support Division (FSD) and seeks doula services described in this rule shall be deemed eligible to receive these services.

2. (4) Doula Services.

   1. (A) Doula services are available to all pregnant women, prenatally, during delivery, and throughout the postpartum period. This includes twelve (12) months after delivery. Doula services include a combined total of six (6) prenatal and postpartum support sessions, one (1) birth attendance, and up to two (2) visits for general consultation on lactation. Community navigation services that occur outside these billable visits may be billed up to ten (10) times total over the course of the pregnancy and postpartum period. The focus of these services is to provide a stable source of psychosocial support and education in an informal setting utilizing trained non-medical, non-clinical providers, with the aim of reducing allostatic load and oxidative stress, enhancing relevant knowledge, and encouraging healthy behaviors that can lead to improved pregnancy-related outcomes (in particular, reduced preterm birth rates, reduced low-birthweight rates, reduced maternal morbidity and mortality, and reduced infant mortality). Reduced Caesarian section rates, improved maternal satisfaction with the birth experience, increased breastfeeding initiation and continuation rates, and enhanced parenting knowledge and confidence are also intended outcomes. Doula services available for reimbursement include—

      1. 1. Prenatal support sessions—promoting health literacy

and knowledge of what to expect during pregnancy and birth; what experiences are normal during pregnancy; how to relay concerns to providers, and providing information on topics such as nutrition, exercise, tobacco cessation, self-monitoring of existing health risks or conditions, in a manner that is culturally relevant and that is targeted to Medicaid participants. A doula may attend the participant’s obstetric (OB) visits in a supportive role;

1. 2. Community navigation of social services and assistance

programs—taking a community-based approach to connect expecting women and families with available resources, including understanding the services and supports available to pregnant and postpartum women on Medicaid and facilitating access to those resources based upon an assessment of social service needs;

1. 3. Attendance and support during birth—providing in-

formation about what to expect during birth, helping create a birth plan, and attending the birth to provide non-medical comfort measures, information, emotional support and advocacy throughout the labor, including support of personal and cultural preferences regarding childbirth and support of those who may otherwise feel disconnected from or marginalized by the healthcare system;

1. 4. Lactation education and support—may include any of

the following—

1. A. A session during pregnancy that is primarily focused

on the health benefits of breastfeeding for both mother and infant;

1. B. Attending the mother and infant immediately after

birth to provide guidance and goal setting to promote breastfeeding;

1. C. Providing ongoing support and education during

pregnancy on the health benefits of breastfeeding; and

1. D. Providing ongoing general education, support, and

referral to licensed lactation professionals if/when services are needed; or

1. 5. Postpartum support sessions—helping women know

what to expect, what is normal, how to relay concerns to providers; aiding the transition back to well-woman care, family planning, screening for postpartum depression; providing information on topics such as safe sleep, preventing unintended child injuries, nutrition, positive parenting skills; education about breastfeeding rights; and goal setting for the future including continuing education, finding employment and childcare, and transition to other insurance as needed.

1. (5) Records Retention. Providers who provide doula services must follow 13 CSR 70-3.030.

2. (6) Reimbursement Methodology.

   1. (A) MO HealthNet provides reimbursement to enrolled providers providing doula services who currently hold a certificate as described in subsection (2)(B) and are in good standing with the state.
   2. (B) Reimbursement for services is made on a fee-for-services basis. The maximum allowable fee for a unit of service has been determined by MO HealthNet to be a reasonable fee, consistent with efficiency, economy, and quality of care. Payment for covered services is the lower of the provider’s actual billed charge (should be the provider’s usual and customary charge to the general public for the service) or the maximum allowable per unit of service. Reimbursement shall only be made for services authorized by MO HealthNet or its designee. Services will be paid at the Medicaid fee schedule rate and will be published at https://mydss.mo.gov/mhd/cpt.

AUTHORITY: sections 208.201 and 660.017, RSMo 2016.* Original rule filed Aug. 7, 2024, effective April 30, 2025. *Original authority: 208.201, RSMo 1987, amended 2007, and 660.017, RSMo 1993, amended 1995.