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ARIZONA STATE SENATE
Fifty-Fourth Legislature, Second Regular Session
doulas; voluntary certification
Purpose
Institutes certification requirements, regulations and standards for doulas.
Background
The Department of Health Services (DHS)
provides and coordinates public health services and programs in Arizona by
licensing and regulating various health care providers and health care
institutions (A.R.S.
§ 36-132). A health professional group seeking regulation or increase in
scope of practice must submit a written report (sunrise application) by
November 1 to the President of the Senate and the Speaker of the House of
Representatives that addresses: 1) why regulation is necessary; 2) the efforts
made to address the problem; 3) the alternatives considered; 4) the benefit to
the public if regulation is granted; 5) the extent to which regulation might
harm the public;
6) the maintenance of standards; 7) a description of the health professional
group proposed for regulation; and 8) the expected costs of regulation (A.R.S.
§ 32-3105).
In 2019, a sunrise application was submitted requesting certification and standardization of practice for doulas (doula sunrise application). According to the Doulas of North America International (DONA), a doula is a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible. DONA establishes standards of practice and a code of ethics that all certified doulas must adhere to (DONA).
There is no anticipated fiscal impact to the state General Fund associated with this legislation. According to the doula sunrise application, the estimated cost of developing and maintaining a doula certification program is equivalent to a 0.25 full-time equivalent position at DHS.
Provisions
Certification Application Requirements
1. Allows a person to apply to the Director of DHS (Director) for a certificate to practice as a state-certified doula on a form prescribed by the Director.
2. Requires an applicant for a doula certification to provide:
a) documentation of completing at least 30 hours of in-person instruction or a combination of in-person and online instruction in core competency topics;
b) documentation confirming that core competencies have been met through culturally specific training or education, subject to review by the Director; or
c) other related individualized or experiential training or education, subject to review by the Director.
3. Requires an applicant for a doula certification to provide DHS-approved documentation of:
a) one observation of a birth after training is completed; and
b) attending
at least three births while serving as the primary doula support person and a
DHS-approved and acceptable evaluation from the laboring mother and from the
medical provider who assisted the laboring mother.
4. Requires an applicant for a doula certification to complete instructions on first aid and cardiopulmonary resuscitation and submit a code of ethics agreement as prescribed by the Director.
5. Allows an individual who does not qualify for state doula certification but who has been practicing as a doula in Arizona for at least five years before the general effective date to apply to DHS for certification by submitting:
a) proof of current certification from a national doula organization in lieu of proof of the prescribed minimum qualifications; and
b) three letters of recommendation from health care professionals who have worked with the individual within the preceding two years and can attest to the individual's competency in providing doula services.
6. Requires the Director to grant a certificate to a doula who meets the prescribed qualifications, pays the applicable fees and possesses a valid fingerprint clearance card.
7. Validates a doula certificate for three years after the date of issuance and authorizes certificate renewals to certificate holders who apply to the Director and pay applicable fees.
8. Requires a doula certificate holder to file a renewal application at least 30 days and not more than 90 days before the date the current doula certificate expires.
9. Requires a state-certified doula to complete 15 hours of related continuing education and submit documentation of completion with a renewal application.
Regulation and Violations
10. Requires the Director, by rule, to:
a) outline the scope of practice and the core competencies of state-certified doulas regarding the skills and areas of knowledge that are essential to expand health and wellness, to reduce health disparities and to promote culturally relevant practices within diverse communities;
b) describe and define reasonable and necessary minimum qualifications for certification;
c) adopt standards and requirements to establish state-certified doula education and training programs in Arizona;
d)
adopt standards to approve or accept continuing education courses for
renewing
state-certified doula certificates; and
e) establish the criteria for granting, denying, suspending and revoking state-certified doula certificates in order to protect the public health and safety.
11. Requires the Director to prescribe a sliding fee scale for doula certification fees in rule.
12. Requires the Director, by rule, to establish and collect nonrefundable fees for state-certified doula certification and deposits the fees in the Health Services Licensing Fund.
13. Allows the Director to consult with subject matter experts from an integrated public health program at a higher education institution located in Arizona to develop rules regarding doulas.
14. Allows the Director to adopt rules that are necessary to administer and enforce doula certification standards and allow for reciprocity agreements.
15. Requires the Director to waive the minimum training and education requirements for doula certificate applicants who provide documentation of current certification with a nationally recognized doula organization.
16. Allows the Director to deny, suspend or revoke a state-certified doula's certification who:
a) violates state law or DHS Rules; or
b) indulges in conduct or a practice that is detrimental to the public health or safety.
17. Authorizes DHS to deny, suspend or revoke a state-certified doula certificate.
18. Allows a doula certificate applicant or state-certified doula to request a hearing to review a denied, suspended or revoked certification and requires DHS to conduct the hearing in accordance with prescribed administrative hearing procedures.
19. Specifies that a state-certified doula employed by an Indian tribe who violates doula certification standards is under tribal government jurisdiction and deems internal hearings, appeals or penalties resulting from disciplinary actions by a tribal government to be the final decision for a certification denial, suspension or revocation.
20. Specifies that, if a state-certified doula is determined to have violated doula certification standards, the information provided to the Director may result in a certification denial, suspension or revocation.
21. Allows the Director to investigate information that indicates a person may be violating prescribed doula certification standards and requirements.
22. Allows the Director, in connection with an investigation, to examine and copy documents and other physical evidence related to the conduct or competency of a state-certified doula.
23. Specifies that the doula certification standards do not require a doula to be certified by DHS in order to practice as a doula in Arizona.
24. Prohibits the state and any
political subdivision of the state from providing a preference in awarding a
public contract for state-certified doula services or an entity that employs
state-certified doulas.
Doula Community Advisory Committee (Advisory Committee)
25. Establishes the Advisory Committee, consisting of at least nine doulas appointed by the Director.
26. Limits the term of an Advisory Committee member to two years.
27. Obligates the Director to consult with the Advisory Committee regarding implementation of doula certification standards and rules.
28. Requires the Advisory Committee to:
a) develop a list of acceptable organizations that provide certification based on the prescribed minimum qualifications and core competencies;
b) identify classes that address culturally relevant doula practices; and
c) review DHS Rules and advise the Director of any necessary updates regarding doulas.
29. Terminates the Advisory Committee on July 1, 2028.
Miscellaneous
30. Defines doula as a trained nonmedical professional who may:
a) provide continuous physical, emotional and informational support to families before, during and after childbirth for a period of one year after birth or in the case of loss; and
b) serve as a liaison between the birth parents and medical and social services staff to improve the quality of medical, social and behavioral outcomes.
31. Defines relevant terms.
32. Subjects state-certified doulas to a central registry check and fingerprint background check.
33. Exempts DHS from rulemaking requirements relating to doula certification for 18 months after the general effective date.
34. Makes technical and conforming changes.
35. Becomes effective on the general effective date.
House Action
HHS 2/6/20 DPA 9-0-0-0
3rd Read 2/27/20 48-12-0
Prepared by Senate Research
March 16, 2020
CRS/AB/kja