Doula Cov Kev Pab Cuam Tshuam Cov Lus Nug
Doula Providers – Hospitals
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) suav nrog cov kev pabcuam doula hauv ob qho tib si tswj kev saib xyuas thiab them nqi-rau-kev pabcuam kev pabcuam rau cov menyuam cev xeeb tub thiab tomqab yug menyuam. Cov kev pabcuam muaj xws li kev pabcuam tsis yog khomob rau kev mus ntsib ua ntej yug menyuam thiab tomqab yug menyuam, thiab thaum lub sijhawm ua haujlwm thiab yug menyuam, nchuav menyuam, thiab rho menyuam tawm.
1. Cov neeg mob hauv tsev kho mob puas muaj cai rau tus qhua ntawm lawv xaiv, thiab puas muaj kev zam? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- Yog lawm. Hauv qab siv tau xeev thiab tsoom fwv kev taw qhia, tus neeg mob muaj cai tau txais cov qhua uas lawv xaiv. Yog xav paub ntxiv txog tsoom fwv cov cai, thov mus saib nqe lus nug #4 hauv qab no.
- Txawm li cas los xij, lub tsev kho mob yuav tsum tsim kom muaj ib qho chaw kho mob uas tsim nyog lossis tsim nyog txwv lossis kev txwv ntawm cov cai no. Piv txwv li:
- Lub tsev kho mob tsis tso cai rau txhua tus neeg tuaj saib, txawm hais tias qhov no tsis yog ib qho kev coj ua thiab tsuas yog tso cai rau qee qhov xwm txheej.
- Lub tsev kho mob tsim nyog txiav txim siab, raws li qhov kev ntsuam xyuas los ntawm rooj plaub, tias qhov muaj ntawm a tshwj xeeb Tus neeg tuaj xyuas 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 neeg tuaj xyuas lossis yuav cuam tshuam rau kev ua haujlwm ntawm lub chaw. Qee qhov piv txwv ntawm no yuav suav nrog yog tias tus qhua mob lossis mob (xws li, tswj kev kis kab mob), tus qhua tuaj yeem cuam tshuam rau kev ua haujlwm hauv tsev kho mob (xws li, chav ua haujlwm 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. What constitutes “patient visitation” under federal Centers for Medicare and Medicaid Services (CMS) regulations for hospitals? (Added September 6, 2024)
- Cov neeg mob muaj cai tau txais cov qhua uas tus neeg mob xaiv. Cov neeg tuaj xyuas no tuaj yeem suav nrog, tab sis tsis txwv rau, tus txij nkawm lossis tus khub hauv tsev (nrog rau tus txiv neej sib deev lossis tus khub hauv tsev), lwm tus neeg hauv tsev neeg, lossis phooj ywg. Cov piv txwv ntxiv muaj xws li ib tug tswv cuab ntawm cov txiv plig, tus txiv plig, tus thawj coj, los yog tus thawj coj ntawm kev ntseeg. Cov chaw ua haujlwm raws li CMS cov cai mus ntsib tus neeg mob yuav tsum xyuas kom lawv cov cai tsis muaj kev ntxub ntxaug raws li haiv neeg, xim, lub tebchaws tuaj, kev ntseeg, poj niam txiv neej, poj niam txiv neej, kev xav ntawm kev sib deev, lossis kev tsis taus. Tus neeg mob kuj muaj cai thim los yog tsis kam tso cai rau cov neeg tuaj xyuas no txhua lub sijhawm. Cov cai no raug tiv thaiv raws li CMS cov cai ntawm Title 42 Code of Federal Regulations (CFR) Seem 482.13(h), uas tau hais nyob rau hauv cov lus nug #4 hauv qab no.
- Tsoom Fwv Teb Chaws thiab lub xeev txoj cai tso cai rau tsev kho mob txwv kev mus ntsib ntau yam laj thawj. Piv txwv ntawm kev txwv kev tso cai thiab/lossis yog vim li cas muaj nyob rau hauv CMS Tsev Kho Mob Txhais Lus Qhia [Tags A-0215 to A-0217], thiab CMS Critical Access Hospital Interpretive Guidelines [Tags C-0154 to C-0158].
3. Why are doulas considered “visitors” at hospitals when they are providing a service to patients involving nonmedical support for prenatal and postpartum visits, and during labor and delivery, miscarriage, and abortion? (Added September 6, 2024)
- DHCS understands and acknowledges that there is sensitivity around doulas being considered a “visitor,” particularly when a doula accompanies a birthing individual into the hospital. That said, under applicable state and federal guidance there are a finite number of categories that must be addressed under hospital policies and procedures (P&Ps) and the “visitor” category is the closest category. To this end, DHCS and hospital partners are only using this term in the narrow context to describe the category within written hospital P&Ps that doulas can reference to better understand individual hospital practices.
4. Cov tsev kho mob puas yuav tsum tau sau ntawv P&Ps uas suav nrog cov ntaub ntawv hais txog txoj cai mus ntsib tus neeg mob, suav nrog rau cov neeg txhawb nqa? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- 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 Tshooj 482.13(h), uas suav nrog cov tsev kho mob uas tau txais nyiaj Medicaid tseem ceeb hauv qab no:
“(h) Lub tsev kho mob yuav tsum tau sau cov cai thiab cov txheej txheem hais txog txoj cai mus ntsib cov neeg mob, suav nrog cov kev teeb tsa kev kho mob tsim nyog lossis kev txwv tsim nyog lossis kev txwv tsis pub muaj kev txwv rau lub tsev kho mob li cas. txwv. Lub tsev kho mob yuav tsum ua raws li cov cai hauv qab no:
(1) Qhia rau txhua tus neeg mob (lossis tus neeg txhawb nqa, yog qhov tsim nyog) ntawm nws txoj cai mus ntsib, suav nrog kev txwv kev kho mob lossis kev txwv ntawm cov cai li no, thaum nws raug ceeb toom txog nws txoj cai nyob rau hauv nqe lus no.
(2) Qhia rau txhua tus neeg mob (lossis tus neeg txhawb nqa, qhov tsim nyog) ntawm txoj cai, raws li nws qhov kev pom zoo, kom tau txais cov qhua uas nws xaiv, suav nrog, tab sis tsis txwv rau, tus txij nkawm, tus khub hauv tsev (xws li poj niam txiv neej pw hauv tsev), lwm tus neeg hauv tsev neeg, lossis phooj ywg, thiab nws txoj cai thim lossis tsis lees txais qhov kev pom zoo no txhua lub sijhawm.
(3) Tsis txwv, txwv, lossis txwv tsis pub muaj cai tuaj xyuas vim yog haiv neeg, xim, keeb kwm ntawm lub tebchaws, kev ntseeg, poj niam txiv neej, poj niam txiv neej, kev nyiam poj niam txiv neej, lossis kev tsis taus.
(4) E nsure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.”
5. Vim tias cov neeg mob muaj cai mus ntsib cov tib neeg uas lawv xaiv, lub tsev kho mob puas tuaj yeem tiv thaiv Medi-Cal cov tswv cuab kom tsis txhob nkag mus rau lawv cov doulas hauv tsev kho mob? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- 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.
- However, as noted in #1 above, a doula’s access or any visitor’s access may be limited or restricted as described in the hospitals P&Ps, which can include case-by-case assessments by the hospital of factors including, but not limited to, being ill, exhibiting disruptive or threatening behavior, declining to comply with reasonable instructions regarding important health or safety rules, or interfering with the medical care of the birthing individual or another patient(s).
6. Yuav ua li cas yog tias tus doula ntsib teeb meem nrog, los yog raug tsis pom zoo, muab kev txhawb nqa rau lawv cov neeg siv khoom / tus neeg mob? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- 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.
- Yog tias koj muaj teeb meem nrog lub tsev kho mob tshwj xeeb, thov hu rau DHCS ntawm 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. Where can I learn more about a hospital’s P&Ps? (Added September 6, 2024)
- 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.
8. Kuv tuaj yeem tau txais cov ntaub ntawv ntxiv los yog muab cov lus qhia txog cov teeb meem kev nkag mus rau hauv tsev kho mob qhov twg? (Ntxiv rau lub Cuaj Hlis 6, 2024)
- Cov ntaub ntawv hais txog qhov txiaj ntsig doula muaj nyob rau ntawm DHCS Doula Services lub vev xaib.
- Thov xa email rau DoulaBenefit@dhcs.ca.gov nrog rau cov lus nug ntxiv.