MedicaidAdministrativeMedium impact
Doula Network Adequacy Standards for the Maryland HealthChoice Program Correction
Maryland Medicaid·MD · OB-GYN·Provider Transmittal
Effective date
Nov 9, 2023
We identified it
Jun 20, 2026
Summary
Maryland HealthChoice Program establishes quantitative doula network adequacy standards by geographic region, requiring MCOs to maintain minimum doula provider counts (4 in urban Baltimore, 4 per suburban county, 2 per rural region). Until standards are met, MCOs must enter into single case agreements (SCAs) with out-of-network doulas and use the free agent flag for claims submission. This is a correction to prior guidance regarding certifying organizations.
Action Required
Immediately: MCO billing teams must (1) verify all contracted doulas have individual NPIs in billing system; (2) implement federal exclusion checks for all out-of-network doulas contracted via SCA; (3) verify doula certifications from approved organizations (Birth in Color, Birth Supporters United, or Doula Trainings International); (4) configure billing software to add out-of-network doula NPIs to MCO network file; (5) set up process to submit doula service encounters using free agent flag in CMAS/MMIS. Billing staff must ensure claims for out-of-network doula SCAs are processed per HealthChoice Doula Program Manual. NOTE: Free agent process is temporary pending network adequacy. When adequacy is achieved (future transmittal), only Medicaid-enrolled doulas will be billable within 90 days.