Doula Cov Kev Pab Cuam Tshuam Cov Lus Nug
Doula Providers – Hospitals
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) them rau cov kev pabcuam doula hauv kev saib xyuas kev tswj hwm thiab cov txheej txheem xa khoom them nqi rau cov tswv cuab Medi-Cal cev xeeb tub thiab tom qab yug menyuam. Cov kev pab cuam suav nrog kev txhawb nqa uas tsis yog kev kho mob rau kev mus ntsib kws kho mob ua ntej yug menyuam thiab tom qab yug menyuam, thiab thaum lub sijhawm yug menyuam, kev rho menyuam, thiab kev rho menyuam.
1. Cov tswv cuab ntawm Medi-Cal hauv tsev kho mob puas muaj cai tos txais ib tus neeg tuaj xyuas uas lawv xaiv, thiab puas muaj qhov tshwj xeeb?
Yog lawm. Hauv qab siv tau xeev thiab tsoom fwv kev taw qhia, ib tug tswv cuab muaj cai tos txais cov qhua uas lawv xaiv rau. Txawm li cas los xij, ib lub tsev kho mob yuav tsum tsim kom muaj kev txwv lossis kev txwv tsim nyog rau cov cai no. Piv txwv li:
- Lub tsev kho mob txiav txim siab raws li qhov xwm txheej, raws li kev ntsuam xyuas ib rooj plaub zuj zus, tias qhov muaj ib tus qhua tshwj xeeb yuav ua rau muaj kev phom sij rau kev noj qab haus huv thiab/lossis kev nyab xeeb ntawm tus neeg mob, cov neeg ua haujlwm lossis lwm tus qhua lossis yuav cuam tshuam loj heev rau kev ua haujlwm ntawm lub chaw. Xws li yog tias tus qhua mob lossis muaj mob (piv txwv li, kev tswj kev kis kab mob), tus qhua yog lossis yuav cuam tshuam rau kev ua haujlwm ntawm tsev kho mob (piv txwv li, chav phais me me), lossis tus neeg mob qhia tias lawv tsis xav kom tus qhua tuaj.
- Txoj cai mus ntsib tsev kho mob tej zaum yuav txawv ntawm hom chav tsev, piv txwv li, cais cov cai rau cov tsev kho mob hnyav lossis rau cov chaw zov me nyuam yug tshiab.
2. Dab tsi yog "kev mus ntsib tus neeg mob" raws li tsoomfwv cov cai ntawm Lub Chaw Pabcuam Medicare thiab Medicaid (CMS) rau cov tsev kho mob?
Cov neeg mob muaj cai tos txais cov qhua uas tus neeg mob xaiv rau. Cov qhua no suav nrog, tab sis tsis txwv rau, tus txij nkawm lossis tus khub hauv tsev neeg (suav nrog tus txij nkawm lossis tus khub hauv tsev neeg uas yog tib tug poj niam lossis txiv neej), lwm tus tswv cuab hauv tsev neeg, lossis ib tug phooj ywg. Cov piv txwv ntxiv yuav suav nrog ib tug tswv cuab ntawm pawg ntseeg, tus xibhwb, tus xibhwb, lossis tus thawj coj kev ntseeg. Cov chaw kho mob uas raug cai ntawm CMS cov cai mus ntsib neeg mob yuav tsum xyuas kom meej tias lawv cov cai tsis ntxub ntxaug vim yog haiv neeg, xim tawv nqaij, lub tebchaws keeb kwm, kev ntseeg, poj niam txiv neej, kev txheeb xyuas poj niam txiv neej, kev nyiam poj niam txiv neej, lossis kev tsis taus. Tus neeg mob kuj muaj cai thim rov qab lossis tsis kam lees kev tso cai rau cov qhua tuaj xyuas txhua lub sijhawm. Cov cai no raug tiv thaiv raws li CMS cov cai ntawm Title 42 Code of Federal Regulations (CFR) Section 482.13(h), uas tau hais txog ntau ntxiv hauv lo lus nug #4 hauv qab no.
Txoj cai lij choj hauv tebchaws thiab xeev tso cai rau cov tsev kho mob txwv tsis pub mus xyuas vim ntau yam laj thawj. Piv txwv ntawm kev txwv kev tso cai thiab/lossis cov laj thawj pom muaj nyob rau hauv CMS Tsev Kho Mob Cov Lus Qhia Txhais [Tags A-0215 txog A-0217], thiab CMS Cov Lus Qhia Txhais Txog Kev Nkag Mus Rau Tsev Kho Mob Tseem Ceeb [Tags C-0154 txog C-0158].
3. Vim li cas cov doulas thiaj raug suav hais tias yog "cov qhua" ntawm tsev kho mob thaum lawv muab kev pabcuam rau cov tswv cuab Medi-Cal uas muaj kev txhawb nqa tsis yog kev kho mob rau kev mus ntsib ua ntej yug menyuam thiab tom qab yug menyuam, thiab thaum lub sijhawm yug menyuam, kev rho menyuam, thiab kev rho menyuam?
DHCS nkag siab thiab lees paub tias muaj kev nkag siab txog cov doulas uas raug suav hais tias yog "tus qhua," tshwj xeeb tshaj yog thaum tus doula nrog tus neeg yug menyuam mus rau hauv tsev kho mob. Txawm hais li ntawd los, raws li lub xeev thiab tsoomfwv cov lus qhia muaj ntau pawg uas yuav tsum tau hais txog raws li cov cai thiab cov txheej txheem ntawm tsev kho mob (P&Ps) thiab pawg "tus qhua" yog pawg ze tshaj plaws. Txog qhov kawg no, DHCS thiab cov neeg koom tes hauv tsev kho mob tsuas yog siv cov lus no hauv cov ntsiab lus nqaim los piav qhia txog pawg hauv cov ntawv sau P&P hauv tsev kho mob uas doulas tuaj yeem xa mus rau kom nkag siab zoo dua txog kev coj ua ntawm tsev kho mob.
4. Cov tsev kho mob puas yuav tsum muaj cov ntawv sau tseg uas muaj cov ntaub ntawv hais txog cov cai tuaj xyuas tus neeg mob, suav nrog cov neeg txhawb nqa?
Yes. Under applicable state and federal requirements, all hospitals must have written P&Ps regarding patient visitation rights. Some hospitals may specifically reference “doulas” while others may refer to a “support person” generally. The P&Ps must address inpatient and outpatient settings and include any clinically necessary or reasonable restrictions on visitation and the reasons for those restrictions. Additionally, all hospitals must inform patients in writing of their right to have visitors of their choosing.
Cov kev cai no tau teev tseg hauv Title 42 CFR Seem 482.13(h), uas suav nrog cov tsev kho mob uas tau txais nyiaj Medicaid hauv tsoomfwv, raws li nram no:
“(h) Ib lub tsev kho mob yuav tsum muaj cov cai thiab cov txheej txheem sau tseg txog cov cai tuaj xyuas ntawm cov neeg mob, suav nrog cov uas teev tseg txhua qhov kev txwv lossis kev txwv uas tsim nyog lossis tsim nyog uas lub tsev kho mob yuav tsum muab rau cov cai no thiab cov laj thawj rau kev txwv lossis kev txwv hauv kev kho mob. Ib lub tsev kho mob yuav tsum ua tau raws li cov cai hauv qab no:
(1) Qhia rau txhua tus neeg mob (lossis tus neeg txhawb nqa, yog tias tsim nyog) txog nws cov cai tuaj xyuas, suav nrog txhua qhov kev txwv lossis kev txwv rau cov cai no, thaum nws tau qhia txog nws lwm cov cai raws li ntu no.
(2) Qhia rau txhua tus neeg mob (lossis tus neeg txhawb nqa, yog tias tsim nyog) txog txoj cai, raws li nws txoj kev tso cai, kom tos txais cov qhua uas nws xaiv, suav nrog, tab sis tsis txwv rau, tus txij nkawm, tus khub hauv tsev neeg (suav nrog tus khub hauv tsev neeg sib deev), lwm tus neeg hauv tsev neeg, lossis tus phooj ywg, thiab nws txoj cai thim rov qab lossis tsis lees txais qhov kev tso cai ntawd txhua lub sijhawm.
(3) Tsis txwv, txwv, lossis tsis pub lwm tus mus xyuas vim yog haiv neeg, xim tawv nqaij, lub tebchaws keeb kwm, kev ntseeg, poj niam txiv neej, kev txheeb xyuas poj niam txiv neej, kev nyiam poj niam txiv neej, lossis kev tsis taus.
5. Vim tias cov tswv cuab ntawm Medi-Cal muaj cai mus xyuas cov tib neeg uas lawv xaiv, puas yog tsev kho mob yuav tiv thaiv cov tswv cuab kom tsis txhob siv lawv cov doulas hauv tsev kho mob?
No. If the patient designates their doula as their support person, then a hospital generally must allow a doula to accompany Medi-Cal members into the hospital, including triage and assessment, labor and delivery, and post-delivery/recovery, if the hospital’s written P&Ps allows a support person (visitor, doula, etc.) to accompany birthing individuals. The P&Ps must address inpatient and outpatient settings and include any clinically necessary, reasonable restrictions on visitation rights and the reasons for those restrictions. If there is a specific hospital that is denying Medi-Cal members access to their doulas, please refer to question #6 below for instructions about reporting that information to DHCS.
Txawm li cas los xij, kev nkag mus rau doula lossis kev nkag mus rau txhua tus qhua yuav raug txwv lossis txwv raws li tau piav qhia hauv tsev kho mob P&Ps, uas tuaj yeem suav nrog kev ntsuam xyuas ib rooj plaub los ntawm tsev kho mob ntawm cov yam xws li, tab sis tsis txwv rau, mob, ua rau muaj kev cuam tshuam lossis kev hem thawj, tsis kam ua raws li cov lus qhia tsim nyog txog kev noj qab haus huv lossis kev nyab xeeb tseem ceeb, lossis cuam tshuam rau kev kho mob ntawm tus neeg yug menyuam lossis lwm tus neeg mob.
6. Yuav ua li cas yog tias tus kws pab tswv yim (doula) ntsib teeb meem nrog, lossis raug tsis pub nkag mus rau, kev muab kev txhawb nqa rau tus tswv cuab Medi-Cal?
DHCS can and does work closely with the California Hospital Association (CHA), other hospital associations, and individual hospitals, to address these types of concerns, and work to resolve the individual’s circumstance. Additionally, DHCS can provide technical assistance directly to hospitals to clarify that doula services are a covered Medi-Cal benefit and that Medi-Cal members have a right to visitors/support persons of their choosing, which includes doulas.
Tsis tas li ntawd xwb, cov tswv cuab tuaj yeem xa daim ntawv tsis txaus siab. Koj tuaj yeem nrhiav tau cov ntaub ntawv ntxiv ntawm no Sau Daim Ntawv Thov | DHCS.
Cov neeg muab kev pab cuam raug txhawb kom tiv tauj MCP thiab tshaj tawm cov xwm txheej zoo li no, ua raws li lawv cov txheej txheem ua raws li txoj cai. Yog tias qhov teeb meem tseem tsis tau daws, tus neeg muab kev pab tuaj yeem tiv tauj DHCS email ntawm DoulaBenefit@dhcs.ca.gov thiab muab cov ntaub ntawv hauv qab no:
- Lub npe tsev kho mob;
- Lub npe ntawm ib tus neeg sawv cev hauv tsev kho mob uas koj tau hais txog qhov teeb meem;
- Cov lus piav qhia luv luv ntawm qhov teeb meem;
- Hnub tim (s) txuam nrog qhov teeb meem; thiab
- Tiv tauj cov ntaub ntawv rau kev taug qab (email thiab xov tooj nyiam).
DHCS tau tsim ib pawg neeg ua haujlwm hauv tsev kho mob-doula rov ua haujlwm los koom nrog kev sib tham qhib los daws qhov kev txhawj xeeb no thiab txheeb xyuas cov hauv kev los txo cov kev cuam tshuam rau kev nkag mus.
7. Kuv tuaj yeem kawm paub ntxiv txog P&Ps ntawm tsev kho mob qhov twg?
Every hospital has its own P&Ps, and no two are the same. Therefore, it is best to inquire about a particular hospital’s P&Ps by visiting the hospital’s website or by contacting the hospital directly.