Program Introduction
To support healthy pregnancies, CalOptima Health encourages our members to attend all prenatal appointments and start prenatal care early through the Bright Steps Program (BSP). BSP is notified of pregnancies primarily through providers submitting a Pregnancy Notification Report (PNR). To streamline the notification process, providers caring for pregnant CalOptima Health members should submit a completed PNR within five days of an initial prenatal visit.
Once notified of a pregnancy, the BSP team reaches out to the member to offer telephonic services, including nutrition education, health education, support services, resources or referrals to local programs. BSP includes trimester and postpartum calls and mailed education materials. For approved Comprehensive Perinatal Services Program (CPSP) providers, these services are done at your office, with the BSP team checking in close to and after delivery. For more information on becoming an approved CPSP provider, visit www.ochealthinfo.com.
Doula Information for Medical Providers
Does a member receiving doula services impact provider services/billing claims?
No. Doula services are a separate benefit for CalOptima Health Medi-Cal members and have no impact on medical provider billing services.What is the benefit of members having a doula?
Members will be provided with evidence-based support services outside of typical medical services. Doula services are aimed at preventing perinatal complications and improving health outcomes for birthing people and infants. If members choose, doulas are a great option to offer additional support during and after pregnancy.
Information for Doulas
How can doulas become eligible and approved to provide services under Medi-Cal?
Doulas should refer to the Department of Health Care Services (DHCS) program guidelines and requirements for information on becoming certified and qualified to provide doula services under Medi-Cal.
Step 1 Doulas must use the DHCS Provider Application and Validation for Enrollment (PAVE) portal to submit their Medi-Cal enrollment application. Additional requirements include completing training programs and/or meeting specific experience and education requirements and complying with program standards and regulations. Additionally, all doulas must be at least 18 years old, have a current CPR certification and have completed Health Insurance Portability and Accountability Act (HIPAA) training prior to enrollment.
Step 2 To provide services to a CalOptima Health member in Orange County, doulas will need to contract with CalOptima Health and its delegated health networks. For information on contracting with CalOptima Health, please contact doula@caloptima.org.
What doula services are covered?
An initial visit, up to eight additional visits in any combination of prenatal and postpartum, support during labor and delivery, and up to two extended postpartum visits.What services are not covered?
Belly binding, birthing ceremonies, group classes on babywearing, massage, photography, placenta encapsulation, shopping, vaginal steams and yoga. Additionally, doula services do not include diagnosis of medical conditions, medical advice or any type of clinical exams or procedures.