Senate approves optional doula verification for TennCare reimbursement

The Tennessee Senate on third and final consideration passed Senate Bill 44, which creates an optional verification process for doulas who want to receive reimbursements from TennCare managed care organizations (MCOs) and private insurers.

The bill responds to a recommendation in the Doula Services Advisory Committee report that the state establish an official verification so doulas can be reimbursed for services provided to TennCare enrollees. Senator Raum Lamar, sponsor of the bill, said the verification is voluntary and "will not disrupt current practice of doulas who do not wish to undergo the verification process." Lamar said the advisory committee recommended fee waivers for doulas facing financial hardship and that the Department of Health estimated verification costs would be lower than earlier fiscal estimates.

Senators raised questions about how fee waivers would be funded. Senator Sarah Watson asked whether the state or another entity would fill revenue gaps created by waived verification fees. Lamar said independent organizations and doula scholarship programs could subsidize fees and that the Department of Health did not plan to administer a scholarship program.

Supporters called the bill a targeted step to reduce maternal mortality among low-income TennCare enrollees. Senator Massey said Tennessee's maternal mortality rate remains unacceptably high and described the bill as "one little piece of the puzzle" to improve outcomes. Senator Bolling and others described doulas as reputable providers who can help prevent pregnancy complications. Several senators emphasized the bill is optional for both doulas and TennCare.

The Senate adopted a Finance Committee amendment requiring the commissioner of health to use the advisory committee's findings to establish by rule a verification and certification verification process, including fee collection rules. A Health and Welfare Committee amendment was withdrawn. The tally on final passage was 22 ayes and 5 nays; the bill was declared passed.

The bill assigns rulemaking and implementation responsibilities to the Tennessee Department of Health; the department will develop rules for verification, fee collection, and fee-waiver procedures as authorized by the amendment. The advisory committee report, which the sponsor said was finalized and is on his desk, will be used to define the competencies for verification.

Senate Bill 44 gives doulas who opt into verification a route to receive TennCare or insurer reimbursements, while preserving the right of doulas to continue private, out-of-pocket practice without state verification.

Implementation details — including final fee amounts, waiver criteria, and an effective date for rulemaking — will be determined when the Department of Health promulgates rules and establishes fee schedules under the statute.