Community Doula Program (2024)

Steps to Becoming a State-Certified Community Doula

Learn how to become a state-certified community doula with Virginia Medicaid in this Doula Engagement video, or by following the detailed steps below.

Effective January 6, 2022, the Virginia Department of Health (VDH) established the minimum requirements to be considered a certified doula in Virginia based on the core competencies for doula certification used by national organizations and community-based organizations in Virginia.

Steps to Completing State-Certification:

1. Complete Required Training and Education. Doulas are required to complete a minimum of 60 hours of Virginia Department of Health (VDH) approved training and education in the required topic areas prior to certification by the Virginia Certification Board (VCB). Applicants must complete all required trainings facilitated by an approved training entity by VCB. For more information training and education requirements, see the Community Doula State Certification Flyer.
2. A State-Certified Doula Application must be completed in its entirety.
3. There is a fee of $100 for the initial certification or $75 for recertification. Fees are made payable to the VCB.
4. The completed application, certification fee, copies of certificates of attendance, other required documents, and fee must be submitted to the Virginia Certification Board (VCB) in one of the following ways:
   1. Mail: Virginia Certification Board (VCB) 298 S. Progress Avenue, Harrisburg, PA, 17109
   2. Email: info@vacertboard.org *Please Note*Only PDFs are permitted. Photos of applications are not accepted.
   3. Fax: 717-540-4458 *Please Note* Receiving a confirmation of fax does notindicate it has been received. To confirm receipt of application, emailinfo@vacertboard.org.
5. For more information on how to become state certified, visit the Virginia Certification Board, email info@vacertboard.org, or call (804) 741-2319.

Doula providers are required to obtain a National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). This is a unique 10-digit number used to identify health care providers. The NPI is required on the Provider Enrollment Application. Obtain an individual National Provider Identifier.

For more information, learn how to apply for an NPI from the Centers for Medicare & Medicaid Services (CMS).

As a community doula, you must enroll with DMAS as a Virginia Medicaid provider to provide services to members. Provider enrollment is managed through the Provider Enrollment Public Portal through the Medicaid Enterprise System (MES), which gives providers access to the secure online provider enrollment functions.

Steps for Medicaid Provider Enrollment:

1. Complete the Medicaid enrollment application by accessing the Provider Enrollment Wizard on the PRSS Public Portal and clicking "Provider Enrollment".
2. Proof of State Certification as a community doula - VCB state certificate will need to be uploaded as an attachment to the provider enrollment application.
3. Proof of Liability Insurance - Doulas are also required to attach proof of medical liability insurance with the Medicaid Enrollment Application. Doulas will need to purchase proof of liability insurance at the $1 million per claim/$3 million per year - policy levels in order to provide doula services to Medicaid members (costs to purchase insurance may vary).
4. For more information on Medicaid Enrollment please view the Doula Enrollment Tips and FAQs.

Most Virginia Medicaid members belong to a managed care organization (MCO) or health insurance plan. In order to provide services and bill for services provided to those members, a doula will need to collaborate with MCOs. Six MCOs participate in Virginia's Medicaid managed care programs. Doulas must enroll as a Virginia Medicaid provider prior to MCO contract execution. To contract with the MCOs, doulas will need to review and sign provider agreements with each MCO. These agreements are unique to each MCO; thus, doulas are required to sign agreements with each MCO with which they want to partner.

Managed Care Organization (MCO) Contracting Resources

Doulas will not operate under the supervision of a clinician of medical provider. Prior authorizations are not required for doula care. Doulas must secure and retain the record of a licensed practitioner’s recommendation for each member prior to initiating their doula care. Recommendations for doula care is not the same as a prior authorization. For the doula benefit, VA Medicaid defines a “licensed practitioner” as:

• Licensed clinicians
• Physicians
• Licensed midwives
• Nurse practitioners
• Physician assistants and
• Other Licensed Mental Health Professionals

A Licensed Mental Health Professional is defined as a: physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, or certified psychiatric clinical nurse specialist.

1. Doula Care Form for Licensed Providers - English
2. Doula Care Form for Licensed Providers - Spanish

Reimbursem*nt for doula care includes payment for prenatal care, labor and delivery, and postpartum care. Doula services, rendered from the date of conception, as documented in the member’s medical record, through 180 days (six months) after delivery, may be reimbursed contingent on the individual/member maintaining Medicaid or FAMIS MOMs eligibility. FAMIS Prenatal members will be eligible to receive services through 60 days postpartum. Note: Doulas are only reimbursed for actual services rendered when all billing requirements are met.

The provider manuals are a great resource for billing providers. Chapters 5 in each provider manual contains billing guidelines. Access the Provider Manuals Library.