D.C. Mun. Regs. tit. 29, r. 29-11203

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-11203 - REIMBURSEMENT

11203.1

DHCF shall establish fees and reimbursement for only those doula services outlined in Subsection 11201.2. Reimbursement for doula services shall be made according to the District of Columbia Medicaid fee schedule available online at http://www.dc-medicaid.com.

11203.2

Doula services shall only be billed once per visit for each pregnancy. Doula services provided for a beneficiary experiencing a multiple pregnancy (i.e., twins, triplets, etc.) are not eligible for additional payment.

11203.3

Doula services may be reimbursed for dates of service from the date of confirmed pregnancy through one hundred and eighty (180) days after the end of a pregnancy.

11203.4

Each perinatal service visit, including labor and delivery, shall be billed and reimbursed on a per visit basis.

11203.5

Each postpartum service visit shall be billed and reimbursed as a unit of service, billed in fifteen (15) minute increments and shall not exceed twenty-four (24) units or six (6) hours per visit.

11203.6

A value-based incentive payment shall be provided to a qualifying doula when:

(a) A labor and delivery claim has been received for a beneficiary;

(b) At least one (1) postpartum service visit has been provided by the doula to the beneficiary; and

(c) The beneficiary is subsequently seen by an obstetric clinician for at least one (1) postpartum visit within seven (7) to eighty-four (84) days following the doula visit.

D.C. Mun. Regs. tit. 29, r. 29-11203

Final Rulemaking published at 69 DCR 14819 (12/2/2022)