MedicaidAdministrativeMedium impact
Doula Network Adequacy Standards for the Maryland HealthChoice Program
Maryland Medicaid·MD · OB-GYN, Family Medicine·Doulas
Effective date
Oct 17, 2022
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has established minimum doula network requirements for MCOs by geographic region. When network adequacy standards aren't met, MCOs must immediately enter single case agreements with out-of-network doulas and use the free agent billing flag for encounters.
Action Required
Immediately: Maryland Medicaid MCOs must assess doula network adequacy against new regional minimums (4 doulas in urban/suburban counties, 2 in rural regions). For inadequate networks, enter single case agreements with out-of-network doulas who have approved certifications. Billing teams must add out-of-network doula NPIs to MCO network files and submit encounters using the free agent flag. Verify doula NPIs, perform federal exclusion checks, and ensure billing follows HealthChoice Doula Program Manual guidelines.