Doula 서비스 자주 묻는 질문
Doula Providers – Hospitals
캘리포니아주 보건의료서비스국(DHCS)은 메디칼(Medi-Cal) 가입자를 대상으로 관리형 의료 및 진료비 지불 방식 모두에서 둘라 서비스를 지원합니다. 제공되는 서비스에는 산전 및 산후 방문, 진통 및 분만, 유산 및 낙태 과정에서의 비의료적 지원이 포함됩니다.
1. 메디칼(Medi-Cal) 가입자는 입원 시 본인이 선택한 방문객을 맞이할 권리가 있습니까? 예외 사항이 있습니까?
예. 해당되는 경우 상태 그리고 연방 지침에 따라 회원은 자신이 지정한 방문객을 맞이할 권리가 있습니다. 그러나 병원은 그러한 권리에 대해 임상적으로 필요한 합리적인 제한이나 제약을 설정해야 할 수도 있습니다. 예를 들어:
- The hospital reasonably determines, based on a case-by-case assessment, that the presence of a particular visitor would endanger the health and/or safety of a patient, staff member or other visitor or would significantly disrupt the operations of the facility. Such as if the visitor is ill or sick (e.g., infection control), the visitor is or would significantly disrupt the operations of the hospital (e.g., small operating rooms), or the patient indicates they do not want the visitor present.
- 병원 방문 정책은 중환자실이나 신생아실과 같이 병실 유형에 따라 다를 수 있습니다(예: 중환자실이나 신생아실에 대한 별도의 정책).
2. What constitutes “patient visitation” under federal Centers for Medicare and Medicaid Services (CMS) regulations for hospitals?
Patients have the right to receive the visitors for whom the patient designates. These visitors can include, but are not limited to, a spouse or a domestic partner (including a same-sex spouse or domestic partner), another family member, or a friend. Additional examples may include a member of the clergy, chaplain, minister, or faith leader. Facilities subject to the CMS patient visitation regulations must ensure their policies do not discriminate on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. The patient also has the right to withdraw or deny consent to any such visitors at any time. These rights are protected under CMS regulations at Title 42 Code of Federal Regulations (CFR) Section 482.13(h), which are addressed in more detail in question #4 below.
연방 및 주 법률은 병원이 다양한 이유로 면회를 제한할 수 있도록 허용합니다. 권한 제한 및/또는 사유의 예는 CMS 병원 해석 지침[태그 A-0215~A-0217] 및 CMS 중요 접근 병원 해석 지침[태그 C-0154~C-0158]에서 확인할 수 있습니다.
3. Why are doulas considered “visitors” at hospitals when they are providing a service to Medi-Cal members involving non-medical support for prenatal and postpartum visits, and during labor and delivery, miscarriage, and abortion?
DHCS는 특히 둘라가 산모와 함께 병원에 들어갈 때 둘라를 "방문객"으로 간주하는 것에 대한 민감성을 이해하고 인정합니다. 하지만 관련 주 및 연방 지침에 따라 병원 정책 및 절차(P&P)에서 다뤄야 하는 범주는 한정되어 있으며, "방문객" 범주가 가장 근접한 범주입니다. 이를 위해 DHCS와 병원 파트너들은 산파들이 개별 병원의 관행을 더 잘 이해할 수 있도록 참고할 수 있는 병원 정책 및 절차(P&P) 내의 범주를 설명하는 좁은 맥락에서만 이 용어를 사용하고 있습니다.
4. Do hospitals have to have written P&Ps that include information regarding patient visitation rights, including for support persons?
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.
These requirements are outlined in Title 42 CFR Section 482.13(h), which includes hospitals that receive federal Medicaid dollars, as follows:
“(h) A hospital must have written policies and procedures regarding the visitation rights of patients, including those setting forth any clinically necessary or reasonable restriction or limitation that the hospital may need to place on such rights and the reasons for the clinical restriction or limitation. A hospital must meet the following requirements:
(1) Inform each patient (or support person, where appropriate) of his or her visitation rights, including any clinical restriction or limitation on such rights, when he or she is informed of his or her other rights under this section.
(2) Inform each patient (or support person, where appropriate) of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time.
(3) Not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.”
5. Given that Medi-Cal members have visitation rights to individuals of their choosing, can a hospital prevent members from having access to their doulas in the hospital?
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.
단, 산모 도우미 또는 방문객의 출입은 병원 정책 및 절차에 따라 제한될 수 있으며, 여기에는 질병, 소란스럽거나 위협적인 행동, 중요한 건강 또는 안전 규칙에 관한 합리적인 지시 불이행, 산모 또는 다른 환자의 의료 방해 등 다양한 요인에 대한 병원의 개별적인 평가가 포함될 수 있습니다.
6. What can be done if a doula experiences difficulty with, or is denied access to, providing support to Medi-Cal member?
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.
또한, 회원들은 불만을 제기할 수 있습니다. 더 자세한 정보는 여기에서 확인할 수 있습니다. 불만 제기 | DHCS.
의료 서비스 제공자는 MCP에 연락하여 정해진 규정 준수 절차에 따라 이러한 사례를 보고하도록 권장됩니다. 문제가 해결되지 않을 경우, 서비스 제공자는 DoulaBenefit@dhcs.ca.gov 로 이메일을 보내 다음 정보를 제공할 수 있습니다.
- 병원 이름;
- 문제와 관련하여 상담한 병원 담당자의 이름;
- 문제에 대한 간략한 설명;
- 문제와 관련된 날짜, 그리고
- 후속 조치를 위한 연락처 정보(이메일 및 전화 선호).
DHCS는 이러한 문제를 해결하고 접근 장벽을 낮출 수 있는 기회를 모색하기 위해 병원-둘라 워킹그룹을 정기적으로 구성하여 열린 대화를 나누고 있습니다.
7. Where can I learn more about a hospital’s P&Ps?
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.