Establishes a 14 member doula Medicaid reimbursement work group within the department of health to set reimbursement rates for doulas in the state Medicaid program and address other criteria related to their practice; requires the work group to conduct a study and evaluate the costs, benefits and issues that may be associated with Medicaid reimbursement for doulas and for providing doula care to Medicaid recipients; makes related provisions.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5465
SPONSOR: Solages TITLE OF BILL:
An act to establish a work group to set reimbursement rates for doulas
in the state Medicaid program and address other criteria related to
their practice
PURPOSE:
The purpose of this legislation is to establish a work group composed of
majority doulas and other 'multidisciplinary experts to examine and
study the benefits, costs, and issues related to Medicaid reimbursement
for doulas providing doula care services to Medicaid recipients across
the state.
SUMMARY:
Section 1. Declares work group purpose.
Section 2. Establishes the work group.
Section 3. Details work group composition.
Section 4. Describes work group compensation and reimbursement.
Section 5. Sets appointment timeframe.
Section 6. Describes work group duties.
Section 7. Establishes final report deadline.
Section 8. Sets the effective date.
JUSTIFICATION:
Historically excluded and low-income communities in the United States
are at disproportionately higher risk of poor birth outcomes, maternal
mortality, and other pregnancy-related complications. On April 13, 2022,
the New York State Department of Health released a report titled "New
York State Report on Pregnancy Associated Deaths in 2018," detailing the
state of maternal health affairs in the state. According to the report,
from 2016-2018, New York improved to 23rd in the United States with a
maternal mortality rate of 18.1 deaths per 100,000 lives versus the rate
of 24.4 between 2008-2010
1. While the decreased rate is noticeable,
BIPOC people experienced pregnancy-related deaths four to five times
more than non-Hispanic White pregnant people.
The emerging popularity of doula care is a promising approach in
addressing maternal health and combating maternal health disparities.
Research suggests that a doula's presence during pregnancy, birth, and
the postpartum period will result in decreases in negative birthing
outcomes
2. Despite the benefits of doula care, only a small percent-
age of pregnant people use a doula due to lack of information and
economic barriers. The proposed work group takes a step toward increas-
ing doula accessibility and properly compensating doulas, which in turn
will also help expand the workforce.
Further, in 2019, the Department of Health launched a Doula Medicaid
pilot program to target high maternal mortality rates and reduce racial
disparities in health outcomes in Erie County. The pilot program
enrolled 760 people in one of six different Medicaid Care Plans or Medi-
caid-Fee -for-Service programs. The pilot programs covered up to four
visits with a doula before delivery, up to four visits with the doula
after delivery, and doula support during labor and delivery. The intent
and purpose of this legislation is to create a Medicaid reimbursement
work group that will identify and examine a framework that would provide
New York's Medicaid recipients with quality doula care services while
simultaneously providing doulas with equitable and sustainable
reimbursements for their services.
RACIAL JUSTICE IMPACT:
Pregnant people of color face disproportionately higher rates of preg-
nancy complications, mistreatment during childbirth, and maternal
mortality. Doulas help combat this inequality by finding low-cost
resources, avoiding unnecessary medical interventions, advocating for
the patient, and by serving as a guide for the pregnant person. Doulas
can also help reduce the impacts of racism and racial bias in healthcare
by providing individually tailored, culturally appropriate, and
patient-centered care. This legislation supports the integration of
doulas into New York State's Medicaid system, working to increase acces-
sibility, and adequately compensate doulas.
GENDER JUSTICE IMPACT:
Establishing a work group tasked with examining and recommending the
best practices for integrating doulas in New York States' Medicaid
program aims to ensure the accessibility of and equitable reimbursement
for doula care. This bill benefits both expecting mothers and doulas as
it supports the integration of doulas and recognizes the importance of
their work. 94.3% of the doula workforce is made up of women
3. The
proposed work group will ensure that doulas are compensated fairly so
they do not have to struggle while providing this needed care. This
legislation seeks to improve maternal care and a health sector which is
experiencing a labor shortage and stagnant wages.
LEGISLATIVE HISTORY:
2021-22: A10364; referred to health.
FISCAL IMPLICATIONS:
TBD.
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.
1
vvvvw.health.ny.gov%2PcommunityÏ/02Fadults%2Fwomen%2Fdocs%2Fmaternal_mort
al ity_rev i ew20l 8.pdf&usg=A0vVaw0-0wMSmSvaW4-Ley5Gw7Vd.
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/.
3 Jittps://www.zippia.com/doula-jobs/demographics/.
STATE OF NEW YORK
________________________________________________________________________
5465
2023-2024 Regular Sessions
IN ASSEMBLY
March 10, 2023
___________
Introduced by M. of A. SOLAGES -- read once and referred to the Commit-
tee on Health
AN ACT to establish a work group to set reimbursement rates for doulas
in the state Medicaid program and address other criteria related to
their practice
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The legislature acknowledges the excluded history that
2 healthcare workers and doulas have as members of historically excluded
3 communities, and acknowledges the exclusionary forces these professions
4 have had in gaining the recognition, certification, and equitable
5 compensation for the critical work they do in pregnancy, maternal
6 health, maternal mental health, and childcare. The legislature declares
7 that it is the purpose of this work group to examine and recommend the
8 best practices for integrating doulas into New York state's Medicaid
9 healthcare system and ensuring the state is prepared and ready to
10 elevate the critical work doulas perform across historically excluded
11 communities across the state of New York.
12 § 2. There is hereby established in the department of health, the
13 doula Medicaid reimbursement work group, hereinafter referred to as the
14 "work group." The majority of the members of the work group shall be
15 composed of doulas, as well as multi-disciplinary experts in the field
16 of doula services and maternal health who serve and are representative
17 of the racial, ethnic, geographic and socioeconomic diversity of birth-
18 ing people in communities across the state served by the state's Medi-
19 caid program.
20 § 3. The work group shall be composed of fourteen members, which shall
21 include eight members to be appointed by the governor as follows:
22 a. the commissioner of the department of health or his, her, or their
23 designee;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04570-01-3
A. 5465 2
1 b. five representatives who may either be practicing doulas, or doulas
2 in training, or individuals with expertise in the field of doula
3 services;
4 c. one representative serving maternal health needs;
5 d. one representative from the medical insurance industry;
6 e. and six additional members, three appointed on the recommendation
7 of the temporary president of the senate; and three appointed on the
8 recommendation of the speaker of the assembly.
9 § 4. The governor shall designate the commissioner of the department
10 of health or his, her, or their designee, as chair of the board. Members
11 of the work group shall receive no compensation for their services, but
12 shall be reimbursed for actual expenses incurred during the performance
13 of their duties on the work group. Reimbursement shall allow for histor-
14 ically excluded communities to participate wholly in the performance of
15 their duties on the work group by providing, if necessary, reimburse-
16 ments for reasonable expenses incurred that may include, but not be
17 limited to, travel, meals and lodging.
18 § 5. Appointments shall be made within ninety days of the effective
19 date of this act. Vacancies in the work group shall be filled in the
20 same manner provided for original appointments. The appointee makeup of
21 the work group shall be majority doulas, as well as multi-disciplinary
22 experts in the field of doula services and maternal health who serve and
23 are representative of the racial, ethnic, geographic, and socioeconomic
24 diversity of birthing people in communities across the state.
25 § 6. The work group shall conduct a study and evaluation of the costs,
26 benefits and issues that may be associated with Medicaid reimbursement
27 for doulas and for providing doula care to Medicaid recipients. The work
28 group shall consider factors including but not limited to:
29 a. identifying evidence-based practices related to when and how doula
30 care results in improvements to maternal and infant mortality rates;
31 b. identifying successful Medicaid doula programs and initiatives in
32 other states and recommend programs, tools, and funding sources that are
33 needed to implement similar programs and initiatives in New York state;
34 c. establishing a criteria for adequate and equitable Medicaid
35 reimbursement rates for a primary doula;
36 d. establishing a criteria for adequate and equitable Medicaid
37 reimbursement for a substitute doula, in the event the primary doula is
38 unavailable to provide doula services to Medicaid patients during deliv-
39 ery;
40 e. considering the appropriate quantity and selection of antepartum,
41 intrapartum, or postpartum doula visits to qualify for Medicaid
42 reimbursement;
43 f. examining the need for doula liability coverage and insurance;
44 g. considering the need for continuing education for doulas; and
45 h. recommending the state file an amendment to the Medicaid state plan
46 to include payment for doula services rendered for antepartum, intrapar-
47 tum, or postpartum doula services provided to a birthing person or to a
48 person at a reasonable time postpartum for labor and delivery support by
49 a doula.
50 § 7. The work group, on or before December 31, 2023, shall submit a
51 final report containing all findings and recommendations to the gover-
52 nor, the temporary president of the senate, and the speaker of the
53 assembly.
54 § 8. This act shall take effect on the ninetieth day after it shall
55 have become a law.
