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    v1.0.30
    OpenPayerPolicy UpdatesObstetrics/GynecologyAHCCCS Doula Services Coverage Update | OpenPayer
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    ModifiedArizona Health Care Cost Containment SystemPolicy 24-0006

    Doula Services

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    Adds AHCCCS coverage and payment for services provided by Arizona state-certified doulas to pregnant women and their families before, during, and after childbirth, when recommended by an authorized practitioner and documented in the member’s medical record.

    Policy Summary
    PayerArizona Health Care Cost Containment System
    PolicyDoula Services
    Policy CodePolicy 24-0006
    Change TypeAdded coverage and payment
    Effective DateOctober 1, 2024
    Next Review DateNot specified
    Key ActionDocument the doula services provided, including care coordination, social support, coaching, and emotional support, in the member’s medical record.
    SourceLink
    POLICY UPDATE CHANGES

    The State Plan adds coverage and payment for doula services.

    3Childbirth phases addressed
    $598,500Federal budget impact, FFY 2025
    $598,500Federal budget impact, FFY 2026
    AZ-certifiedRequired certification

    Certified Doula Services

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Certified doula services

    Doula services are covered when all of the following requirements are met:

    Covered doula services

    • Eligible provider: Services are provided by an Arizona state-certified doula.
    • Authorized recommendation: Services are recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under State law.
    • Covered population and timing: Services are provided to pregnant women and their families before, during, or after childbirth.Before, during, or after childbirth
    • Documentation: Services are documented in the member's medical record.

    Documentation and Coverage Conditions

    Documentation Required

    Document doula services in the medical record

    Document the doula services in the member's medical record. Record the covered services furnished, which may include care coordination, social support, coaching, and emotional support.

    • Include the services provided in the member's medical record.
    • Covered services may include care coordination, social support, coaching, and emotional support.
    Denial Risk

    Meet all core coverage requirements

    Coverage requirements are not met when doula services are furnished by someone who is not an Arizona state-certified doula, are not recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under State law, or are not documented in the member's medical record.

    • Verify the doula is Arizona state-certified.
    • Obtain a recommendation from a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under State law.
    • Ensure services are documented in the member's medical record.

    Doula Services Overview

    Doulas are trained nonmedical professionals who provide support to pregnant women and their families before, during, and after childbirth. Covered support may include patient education and preventive services, care coordination, social support, coaching, and emotional support.

    Certified Doula

    Certified doula
    RoleTrained nonmedical professionals who support pregnant women and their families.
    Covered servicesAHCCCS-covered patient education and preventive services.
    TimingServices may be provided before, during, and after childbirth.
    Additional supportServices may include care coordination, social support, coaching, and emotional support.
    Policy Summary
    PayerArizona Health Care Cost Containment System
    PolicyDoula Services
    Policy CodePolicy 24-0006
    Change TypeAdded coverage and payment
    Effective DateOctober 1, 2024
    Next Review DateNot specified
    Key ActionDocument the doula services provided, including care coordination, social support, coaching, and emotional support, in the member’s medical record.
    SourceLink
    On This Page
    Certified Doula ServicesDocumentation and Coverage ConditionsDoula Services OverviewCertified Doula