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Fidelis Care would like to inform providers that doula services will be included in the benefit package for Medicaid Managed Care, HIV Special Needs Plan, and Health and Recovery Plan members effective April 1, 2025.  Doula services can include up to eight (8) visits by a doula during and after pregnancy and continuous support during labor and childbirth.  If a member becomes pregnant within 12 months following a prior pregnancy, the eligibility for doula services will start over with the new pregnancy.  Any unused doula services from the prior pregnancy will not carry over.

Perinatal Visits

• Up to eight (8) perinatal visits per pregnancy are reimbursable.
• Each perinatal visit must be at least 30 minutes of direct interaction with the Medicaid member to be reimbursed.
• Perinatal visits can occur in-person or via telehealth.
• Reimbursement is not available for doula service visits/appointments that are not kept.
• Current NYS Medicaid Telehealth policy will apply to reimbursable perinatal services.

Labor and Delivery

• One Labor & Delivery encounter per pregnancy is reimbursable. The Labor & Delivery encounter must involve direct interaction with the Medicaid member.
• A licensed perinatal services provider must be in attendance for the doula to be reimbursed.
• Labor & Delivery doula services are to be provided in-person except in extenuating circumstances such as illness or precipitous birth, in which case the current NYS Medicaid Telehealth policy will apply.

Doula Services Provider Manual

• The provider manual provides an overview of the doula services benefit.  https://www.emedny.org/ProviderManuals/Doula/PDFS/Doula_Policy_Gui delines.pdf  The manual includes:
  • Provider guidelines and resources,
  • Enrollment and revalidation requirements,
  • Description of covered services,
  • Billing codes and fee schedule, and
  • Documentation guidance.

Doulas that have questions regarding contracting and billing, should email SM_DoulaExpansion@fideliscare.org.  If you have any additional questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.