Doula benefit

Member eligibility

To be eligible for doula services, Commercial members must be pregnant or have been pregnant in the last 12 months and meet the following criteria:

• Be enrolled in a commercial plan with Sharp Health Plan through either of the following groups:
  • The California Public Employees' Retirement System (CalPERS)
  • The Federal Employees Health Benefits Program (FEHB)
• OR be enrolled in the Sharp Health Plan Maternal Mental Health Case Management Program (MMHCMP)

Servicios cubiertos

Finding a Doula

San Diego based Happy Mama Doulas is currently the participating doula service provider.

Doula contracting

If you are interested in becoming a contracted doula with Sharp Health Plan, you will be required to apply for both contracting and credentialing. Visit our Become a contracted provider page for more information and next steps.

Doula credentialing

Doulas must be credentialed by Sharp Health Plan and meet minimum qualifications for inclusion in the network. Doulas may hold licensure as a nurse practitioner, midwife or other mid-level or allied health practitioner. Doulas may also hold certification in doula services; however, doula certification is not required by the Plan.

The minimum qualifications are:

• Be at least 18 years of age and possess a National Practitioner Identification number.
• Hold current adult and infant CPR certification from the American Red Cross or American Heart Association.
• Attest to the completion of basic HIPAA training or hold HIPAA certification.
• Meet at least one of the two Qualification pathways, as designated by the California Department of Health Care Services for doula provider eligibility.
• Doulas are re-credentialed every three years and must provide an updated credentialing application inclusive of a signed and dated attestation and release statement at the time of recredentialing.
• Doulas must complete three (3) hours of continuing education in maternal, perinatal, and/or infant care every three years. Doulas shall maintain evidence of completed training and make available to the Plan.

Doula qualification pathways

Per the California Department of Health Care Services, there are two qualification pathways for doula provider eligibility:

Training Pathway

Training Pathway applicants must provide documentation of:

• At least 16 hours of training in lactation support; childbirth education; foundations on anatomy of pregnancy and childbirth; non-medical comfort measures, prenatal support, and labor support techniques; and developing a community resource list.
• Documented evidence of support at a minimum of three births, including but not limited to, beneficiary logs with the dates, service(s) provided, time/duration of services provided, information on the nature of the care, and signatures from the supervising healthcare practitioner (physician, nurse practitioner, physician assistant, midwife) and beneficiary.

Experience Pathway

Experience Pathway applicants must provide documentation of:

• At least five (5) years of active doula experience in either a paid or volunteer capacity within the previous seven years.
• Letters of recommendation that attest to the applicant's skills in prenatal, labor, and postpartum care as demonstrated by:
  • Three (3) written client testimonial letters or professional letters of recommendation from any of the following: a physician, licensed behavioral health provider, nurse practitioner, nurse midwife, licensed midwife, enrolled doula, or community-based organization.
    • Letters must be dated within the last seven years.
    • One letter must be from either a licensed provider, a community-based organization, or an enrolled doula.

If you are interested in becoming a contracted doula with Sharp Health Plan, please contact us at shp.credentialing@sharp.com or call at 1‑858‑303‑9062.

Preguntas

If you're a provider and have a question about the doula benefit or any other provider-related matter, email us at provider.relations@sharp.com or call 1‑858‑499‑8330. Our fax number is 1‑858‑303‑9049.

If members have additional questions, please have them contact Customer Care at customer.service@sharp.com or 1‑800‑359‑2002.