OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
S.B. 93 Bill Analysis
135th General Assembly
Click here for S.B. 93’s Fiscal Note
Version: As Introduced
Primary Sponsors: Sens. Reynolds and Hicks-Hudson
Effective date:
Emma Carroll, Research Analyst
SUMMARY
 Establishes programs in the Medicaid Program and Department of Rehabilitation and
Correction for the coverage or provision of doula services.
 Requires each doula participating in either program to hold a certificate issued by the
Ohio Board of Nursing and each doula participating in the Medicaid Program to have a
valid provider agreement.
 Requires the Nursing Board to establish a registry of certified doulas.
 Establishes the Doula Advisory Board within the Nursing Board.
DETAILED ANALYSIS
S.B. 93 establishes two programs relating to the provision and coverage of doula
services and requires each doula participating in one of those programs to hold a certificate
issued by the Ohio Board of Nursing.1 As defined under the bill, a doula is a trained, nonmedical
professional who advocates for, and provides continuous physical, emotional, and
informational support to, a pregnant woman during the antepartum, intrapartum, or
postpartum periods.2
Doula program – Medicaid
The bill requires the Medicaid Program to operate a program to cover doula services.3
The program is to begin one year after the bill’s effective date. The doula services must be
1 R.C. 4723.89, 4723.90, 5120.658, and 5164.071.
2 R.C. 4723.89(A)(1).
3 R.C. 5164.071.
April 5, 2023
Office of Research and Drafting LSC Legislative Budget Office
provided by a doula who has a valid Medicaid provider agreement and holds a certificate issued
by the Nursing Board (discussed in greater detail below).
Medicaid payments
Under the program, Medicaid payments for doula services are to be determined on the
basis of each pregnancy, regardless of whether multiple births occur as a result of that
pregnancy.4
Annual reports
The bill establishes several reporting requirements related to the Medicaid Program,
including the following:5
 Outcome measurements and incentives for the program must be consistent with the
state’s Medicare-Medicaid Plan Quality Withhold methodology and benchmarks;
 The Medicaid Director must complete an annual report regarding program outcomes,
including those related to maternal health and morbidity and estimated fiscal impacts;
 The Medicaid Director must provide a copy of the annual report to the Joint Medicaid
Oversight Committee.
Rulemaking
The Medicaid Director is required by the bill to adopt rules implementing the bill’s
provisions.6
Doula program – Department of Rehabilitation and Correction
Under the bill, the Department of Rehabilitation and Correction is to operate a program
providing doula services to inmates participating in any prison nursery program. The doula
services must be rendered by a doula holding a certificate issued by the Nursing Board. The
Department may adopt rules – in accordance with the Administrative Procedure Act –
implementing the bill’s provisions.7
Ohio Board of Nursing certification
In order to be eligible to participate in a program established by the bill, a doula must
hold a certificate issued by the Nursing Board. Accordingly, the bill provides for the certification
and regulation of doulas in Ohio by the Nursing Board. The Nursing Board is required to seek
and consider the opinion of the Doula Advisory Board (see “Doula Advisory Board”
4 R.C. 5164.071(B).
5 R.C. 5164.071(C).
6 R.C. 5164.071(D).
7 R.C. 5120.658.
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As Introduced
Office of Research and Drafting LSC Legislative Budget Office
below) when an individual is seeking to be eligible for Medicaid reimbursement as a certified
doula.8
Use of doula title
Beginning one year after the bill’s effective date, the bill prohibits a person from using
or assuming the title “certified doula” unless the person holds a certificate issued by the
Nursing Board. In the case of a violation, the bill authorizes the Board to impose a fine, to be set
in rules, on such a person, following an adjudication held in accordance with the Administrative
Procedure Act. It also requires the Attorney General, on the Board’s request, to bring and
prosecute to judgment a civil action to collect any fine imposed that remains unpaid.9
Certificate issuance
S.B. 93 requires the Nursing Board to adopt rules, in accordance with the Administrative
Procedure Act, establishing standards and procedures for issuing certificates to doulas. The
rules must include all of the following:10
 Requirements for certification as a doula, including a requirement that a doula either be
certified by a doula certification organization or, if not certified, have education and
experience that the Board considers appropriate;
 Requirements for renewal of a certificate and continuing education;
 Requirements for training on racial bias, health disparities, and cultural competency as a
condition of initial certification and renewal;
 Certificate application and renewal fees, as well as a waiver of fees for applicants with a
family income not exceeding 300% of the federal poverty line;
 Requirements and standards of practice for certified doulas;
 The amount of a fine to be imposed for using or assuming the title “certified doula”
without holding a Board-issued certificate;
 Any other standards and procedures the Board considers necessary to implement the
bill’s provisions.
For purposes of the certification requirement described above, a doula certification
organization is an organization that is recognized, at an international, national, state, or local
level, for training and certifying doulas.11
8 R.C. 4723.89.
9 R.C. 4723.89(B) and (F).
10 R.C. 4723.89(D).
11 R.C. 4723.89(A)(2).
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As Introduced
Office of Research and Drafting LSC Legislative Budget Office
Doula registry
Under the bill, the Nursing Board must develop and regularly update a registry of doulas
holding Board-issued certificates. The bill also requires the Board to make the registry available
to the public on its website.12
Doula Advisory Board
The bill creates a Doula Advisory Board within the Nursing Board.13
Membership
The Advisory Board consists of 16 members. The Nursing Board must appoint the
following 14 members:
 Three members representing communities most impacted by negative maternal and
fetal health outcomes;
 Five members who are doulas with current, valid certification from a doula certification
organization;
 Two members who are public health officials, physicians, nurses, or social workers;
 Two members who are consumers;
 Two members representing a doula certification program or organization established in
Ohio.
Additionally, the Executive Director of the Commission on Minority Health and the
Director of Health must each appoint one member representing their respective agencies.14
When appointing members to the Advisory Board, the Nursing Board must make a good
faith effort to select members who represent counties with higher rates of infant and maternal
mortality, in particular those counties with the largest disparities. The Nursing Board also must
give priority to individuals with direct service experience providing care to infants and pregnant
and postpartum women.15
Terms of membership and vacancies
Of the initial appointments made by the Nursing Board, half are to be appointed to one-
year terms and half appointed to two-year terms. Thereafter, all terms are for two years. The
bill requires the Nursing Board, the Executive Director of the Commission on Minority Health,
12 R.C. 4723.89(E).
13 R.C. 4723.90.
14 R.C. 4723.90(B)(1).
15 R.C. 4723.90(B)(2).
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As Introduced
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and the Director of Health to fill any vacancy as soon as practicable. Members may be
reappointed for an unlimited number of terms.16
Chairperson, meetings, and reimbursements
By a majority vote of a quorum of its members, the Advisory Board must select, and may
replace, a chairperson. The Advisory Board is required by the bill to meet at the call of the
chairperson as often as he or she determines is necessary for timely completion of Advisory
Board duties.17
The Nursing Board is responsible for providing meeting space, virtual meeting
technology, staff services, and other technical assistance to the Advisory Board.18
Advisory Board duties
The bill requires the Advisory Board to do all of the following:19
 Provide general advice, guidance, and recommendations to the Nursing Board regarding
doula certification and the adoption of certain rules;
 Advise the Nursing Board regarding individuals seeking to be eligible for Medicaid
reimbursement as certified doulas;
 Provide general advice, guidance, and recommendations to the Department of Medicaid
regarding its doula program;
 Make recommendations to the Medicaid Director regarding the adoption of rules
governing its program.
HISTORY
Action Date
Introduced 03-23-23
ANSB0093IN-135/ts
16 R.C. 4723.90(D) and (E).
17 R.C. 4723.90(C) and (F).
18 R.C. 4723.90(G).
19 R.C. 4723.90(H).
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As Introduced