OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 142 Bill Analysis
134th General Assembly
Click here for H.B. 142’s Fiscal Note
Version: As Passed by the House
Primary Sponsors: Reps. Crawley and Brinkman
Effective Date:
Emma Carroll, Research Analyst
SUMMARY
 Establishes in the Medicaid Program and Department of Rehabilitation and Correction
five-year programs 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 Board of Nursing to establish a registry of certified doulas.
 Establishes, for purposes of the program operated under the Medicaid Program, the
Doula Advisory Board within the Board of Nursing.
DETAILED ANALYSIS
H.B. 142 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 The bill also specifies that all of its provisions expire five
years after the bill’s effective date.
Doula program – Medicaid
The bill requires the Medicaid Program to operate a program to cover doula services.2
The program is to begin one year after the bill’s effective date and conclude five years after that
date. The doula services must be provided by a doula who has a valid Medicaid provider
agreement and holds a certificate issued by the Ohio Board of Nursing.
1 R.C. 4723.89, 4723.90, 5120.658, and 5164.071.
2 R.C. 5164.071.
June 10, 2022
Office of Research and Drafting LSC Legislative Budget Office
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.
Annual reports
The bill establishes several reporting requirements related to the Medicaid Program,
including the following:
 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 final annual report must include recommendations related to whether the program
should be continued;
 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.
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.3 As with the
Medicaid Program’s doula program, the doula services must be rendered by a doula holding a
certificate issued by the Board of Nursing. The Department may adopt rules – in accordance
with the Administrative Procedure Act – implementing the bill’s provisions.4
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 Board of Nursing. Accordingly, the bill provides for the
certification and regulation of doulas in Ohio by the Board.5 Note that the Board’s certification
and regulation of doulas is to expire five years after the bill’s effective date.
3 R.C. 5120.658.
4 R.C. Chapter 119, not in the bill.
5 R.C. 4723.89.
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As Passed by the House
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Use of doula title
Beginning on the date that occurs 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 Board of Nursing. In the case of a violation, the bill authorizes the
Board to impose a fine 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.
Certificate issuance
H.B. 142 requires the Board of Nursing 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:
 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.
Doula registry
Under the bill, the Board of Nursing 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.
Doula advisory board
The bill creates – for the period of the Medicaid Program’s program – a Doula Advisory
Board within the Board of Nursing.
Membership
The advisory board consists of at least 13 but not more than 15 members, all appointed
by the Board of Nursing. Of these members, at least one must represent the organization
Birthing Beautiful Communities and another the organization Restoring Our Own through
Transformation.
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As Passed by the House
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The overall composition of the advisory board must be as follows:
 At least three members representing communities most impacted by negative maternal
and fetal health outcomes;
 At least six members who are doulas with current, valid certification from a doula
certification organization;
 At least one member who is a public health official, physician, nurse, or social worker;
 At least one member who is a consumer.
When appointing members to the advisory board, the Board of Nursing 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 Board also must
give priority to individuals with direct service experience providing care to infants and pregnant
and postpartum women.
Terms of membership and vacancies
Of the initial appointments, 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 Board
to fill any vacancy as soon as practicable.
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 board
duties. If requested, a member must receive per diem compensation for fulfilling his or her
duties as well as reimbursement of actual and necessary expenses incurred.
The Board of Nursing is responsible for providing meeting space, staff services, and
other technical assistance to the advisory board.
Advisory board duties
The bill requires the advisory board to do all of the following:
 Provide general advice, guidance, and recommendations to the Board of Nursing
regarding doula certification and the adoption of rules;
 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.
Definitions
 Doula is defined as a trained, nonmedical professional who provides continuous
physical, emotional, and informational support to a pregnant woman during the
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As Passed by the House
Office of Research and Drafting LSC Legislative Budget Office
antepartum, intrapartum, or postpartum periods, regardless of whether the woman’s
pregnancy results in a live birth.
 Doula certification organization is an organization that is recognized at an international,
national, state, or local level for training and certifying doulas and includes any of the
following: Birthing Beautiful Communities, Restoring Our Own through Transformation,
The International Childbirth Education Association, DONA International, The Association
of Labor Assistants and Childbirth Educators, Birthworks International, Childbirth and
Postpartum Professional Association, Childbirth International, The International Center
for Traditional Childbearing, Commonsense Childbirth Inc., and any other recognized
organization the Board of Nursing considers appropriate.
HISTORY
Action Date
Introduced 02-23-21
Reported, H. Health 05-04-21
Re-referred, H. Rules & Reference 05-05-21
Reported, H. Families, Aging, and Human Services 05-23-22
Passed House (82-3) 06-01-22
ANHB0142PH-134/ec
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As Passed by the House


Statutes affected:
As Introduced: 4723.89, 4723.90, 5120.658, 5164.071
As Reported By House Committee: 4723.89, 4723.90, 5120.658, 5164.071
As Re-referred to House Committee: 4723.89, 4723.90, 5120.658, 5164.071
As Passed By House: 4723.89, 4723.90, 5120.658, 5164.071