General Provisions

(1) Scope and Purpose. 101 CMR 319.00 governs the rates of payments used by all governmental units in making payments to eligible doula providers for doula services rendered to publicly aided individuals. (2) Applicable Dates of Service. Rates contained in 101 CMR 319.00 are effective for dates of service provided on and after December 8, 2023, unless otherwise indicated. (3) Coverage. The rates of payment contained in 101 CMR 319.00, or determined in accordance with the provisions of 101 CMR 319.00, are full compensation for doula services rendered to publicly aided individuals as well as for any related administrative or supervisory duties in connection with the provision of services, without regard to where these services are rendered. (4) Disclaimer of Authorization of Services. 101 CMR 319.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 319.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided individuals. (5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association’s Current Procedural Terminology (CPT). The publication of such updates and corrections will list (a) codes for which the code numbers change, with the corresponding cross-references between new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced; (b) codes for which the code number remains the same, but the description has changed; (c) deleted codes for which there are no corresponding new codes; and (d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed. (6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 319.00, and as otherwise specified in 101 CMR 319.00.