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A BILL TO BE ENTITLED
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AN ACT
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relating to Medicaid coverage and reimbursement for doula services |
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and reports on the provision of those services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.02481 to read as follows: |
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Sec. 32.02481. MEDICAL ASSISTANCE FOR DOULA SERVICES. (a) |
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In this section: |
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(1) "Doula" means a nonmedical birthing coach who |
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provides doula services. |
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(2) "Doula services" means nonmedical childbirth |
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education, coaching, and support services, including emotional and |
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physical support provided during pregnancy, labor, delivery, and |
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for up to twelve months after birth during the postpartum period, or |
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provided intermittently during pregnancy and the postpartum |
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period. The term includes the referral of pregnant and postpartum |
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individuals to community-based organizations, social service |
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organizations, and licensed perinatal professionals. |
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(3) "Recipient" means a medical assistance program |
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recipient. |
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(b) The commission shall ensure that medical assistance |
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reimbursement is provided to a doula in accordance with this |
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section for the provision of doula services to a pregnant or |
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postpartum recipient. |
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(c) To be eligible for reimbursement under the medical |
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assistance program, a doula must: |
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(1) be at least 18 years of age; |
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(2) have an assigned national provider identifier |
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number, as defined by Section 531.021182, Government Code; |
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(3) be accredited by a doula training organization |
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recognized by a regional or statewide doula association, including |
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the Texas Doula Association, and provide to the commission a |
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certified copy of the accreditation; |
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(4) provide to the commission documentation |
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evidencing: |
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(A) completion of not less than 24 in-person or |
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virtual classroom hours that include any combination of doula |
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training, childbirth education and training, or postpartum |
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training; |
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(B) attendance at a breastfeeding peer support |
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training or other certified lactation counselor training; |
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(C) attendance at one or more childbirth |
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education trainings; |
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(D) attendance at two or more child births; |
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(E) completion of a cultural competency |
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training; |
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(F) completion of a training on the Health |
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Insurance Portability and Accountability Act of 1996 (42 U.S.C. |
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Section 1320d et seq.) and other patient confidentiality laws; and |
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(G) completion of a cardiopulmonary |
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resuscitation training; |
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(5) complete applicable medical assistance program |
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application and enrollment processes; and |
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(6) satisfy any other requirements the commission |
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determines appropriate. |
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(d) A doula who is included on an exclusion list published |
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by a statewide or regional doula association, including the Texas |
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Doula Association, or who engages in the practice of medicine may |
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not: |
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(1) enroll as a provider under the medical assistance |
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program; or |
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(2) otherwise receive reimbursement under the |
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program. |
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(e) Notwithstanding Subsection (c), a doula who does not |
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meet the qualifications described by that subsection may receive |
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medical assistance reimbursement if the doula provides to the |
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commission documentation the commission determines sufficient |
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evidencing that the doula has provided doula services for not less |
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than 12 consecutive months before reimbursement is provided. A |
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doula who is eligible to receive reimbursement under this |
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subsection must: |
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(1) complete any applicable medical assistance |
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program application and enrollment processes; and |
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(2) complete any courses or training necessary to meet |
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the qualifications described by Subsection (c) not later than 12 |
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months after the doula's enrollment in the medical assistance |
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program under this subsection. |
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(f) The executive commissioner by rule shall prescribe the |
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services for which a doula may receive medical assistance |
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reimbursement, which may include: |
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(1) providing culturally informed services to support |
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a recipient during pregnancy and the postpartum period; |
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(2) advocating for and supporting a recipient's |
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perinatal choices, including choices related to childbirth, |
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breastfeeding, and parenting; |
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(3) providing support through the use of traditional |
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comfort measures or the provision of educational materials during |
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pregnancy, labor, and childbirth and assisting a recipient in the |
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transition to parenthood, including through home visits; |
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(4) offering evidence-based counseling and education |
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on infant care, family dynamics, feeding, emotional and physical |
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recovery from birth, and other issues related to pregnancy or the |
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postpartum period; |
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(5) providing physical and emotional support during |
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and after labor; |
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(6) facilitating access to community-based support |
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services to improve birth outcomes, including transportation, |
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housing, substance use cessation, family violence resources, and |
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other state or federal assistance programs; |
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(7) referring recipients to health care providers to |
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receive medical care or counseling as necessary; |
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(8) working as part of a recipient's multidisciplinary |
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team; and |
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(9) providing counseling or bereavement support on |
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pregnancy or infant loss. |
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(g) The commission may authorize a doula to provide any of |
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the services described by Subsection (f) using telecommunications |
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or information technology. |
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(h) The commission shall establish: |
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(1) a separate provider type for doulas for purposes |
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of enrollment as a provider; and |
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(2) a medical assistance reimbursement rate for the |
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provision of doula services to a recipient. |
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(i) The commission shall establish a statewide registry |
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accessible to the public on the commission's Internet website that |
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contains a list of doulas enrolled as a provider under the medical |
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assistance program. |
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(j) Not later than September 1 of each year, the commission, |
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in collaboration with each managed care organization that has a |
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doula in the organization's provider network, shall prepare and |
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submit to the legislature a written report on cost and utilization |
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information related to the reimbursement and provision of doula |
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services under this section. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2023. |