导乐服务常见问题
助产士提供商-一般常见问题解答
卫生保健服务部 (DHCS) 为孕妇和产后人员提供管理式护理和按服务收费的分娩陪护服务。 服务包括产前和产后访问以及分娩、流产和堕胎期间的非医疗支持。
1. 助产士提供哪些服务可以获得报销？
- 助产士可在围产期提供各种类型的支持，包括怀孕期间、分娩、流产和堕胎期间以及产后一年内。 服务包括指导；健康导航；产前、产后、分娩和新生儿/婴儿护理的循证教育；哺乳支持；制定分娩计划；以及社区资源联系。 请参阅Medi-Cal 提供商手册：Doula 服务以获取更多信息。
2. 会员需要满足什么要求才能享受助产服务？（添加于 8 月16 、 2024 ）
- Doula services are considered a preventive benefit. Federal law requires that all preventive services first be recommended by a physician or other licensed practitioner of the healing arts. To increase access to services, DHCS issued a standing recommendation for doula services by the DHCS Medical Director, Karen Mark, MD, PhD. This fulfills the federal requirement for a recommendation to initiate doula services and Medi-Cal members do not need to separately obtain a recommendation. Doulas should reference this standing order in their records for the Medi-Cal member.
- If a Medi-Cal member has used all eight perinatal visits and wishes to receive additional doula services during the postpartum period, the member can ask a licensed provider to complete the Medi-Cal Doula Services Recommendation form and give the form to the doula. (Added August 16, 2024)
3. 谁可以推荐助产士服务？（更新于10 9 月、 2025 9 月）
- Since the DHCS Medical Director, Dr. Karen Mark, MD, PhD, has issued a standing recommendation for doula services, Medi-Cal members do not need a separate recommendation from a physician or other licensed provider for the initial set of services as described in the Medi-Cal Provider Manual: Doula Services. However, Medi-Cal members will need a new recommendation to receive up to nine additional postpartum visits. This recommendation must be made by a physician or other licensed practitioner of the healing arts acting within their scope of practice under state law. The recommending provider does not need to be enrolled in Medi-Cal or be a network provider with the member’s managed care plan (MCP).
4. 哪些助产士服务是经长期推荐授权的？ （更新于 8 月16日、 2024 ）
- 长期建议允许会员接受以下助产服务：
- 初次访问持续 90 分钟。
- Up to eight additional visits that may be provided in any combination of prenatal and postpartum visits, as determined by the birthing person and doula.
- 分娩、流产和流产期间的支持。
- 怀孕结束后，最多可进行两次延长三小时的产后访视。
- A second recommendation from a physician or other licensed practitioner of the healing arts acting within their scope of practice under state law is required for Medi-Cal members to receive up to nine additional visits during the postpartum period. See questions #5 and #6 below for more information.
5. 允许额外进行多少次产后访视？
- A second recommendation – either noted in the member’s medical record by a licensed provider or a signed Medi-Cal Doula Services Recommendation: Additional Postpartum Visits form – allows members to receive up to nine additional visits during the postpartum period. The standing recommendation does not authorize these additional postpartum visits.
6. 第二次产后服务推荐是否需要在怀孕之后进行？
- No. If the member has used or is likely to use all eight additional visits while they are pregnant, a licensed provider may recommend additional visits to be provided during the postpartum period.
7. 产后导乐服务的周期是多久？ （更新于 8 月16日、 2024 ）
- 对于助产师保险，产后期是指怀孕结束后最多一年的时间，这使得 Medi-Cal 会员可以在此期间接受助产师服务。
8. 会员只能在产后期间享受助产服务吗？
- 是的。产后一年内均可提供导乐服务。 如果会员在怀孕期间没有助产师，他们可以使用初次问诊和产后期间的所有八次问诊以及最多九次额外的产后问诊，并提供第二份书面建议。
9. DHCS 是否承保流产、死产或堕胎期间或之后提供的助产服务？
是的，助产士服务可为流产、死产或堕胎期间和怀孕后的个人提供支持。
10. Are there any requirements for reimbursement for doula support provided during or after a miscarriage or abortion? (added November 17, 2025)
Yes. To substantiate the medical necessity for services in case of a state or federaln audit and as an added protection for doulas, reimbursement for doula support for miscarriage is only available when a licensed provider (e.g., a physician, nurse practitioner, nurse midwife, or licensed midwife) has confirmed the pregnancy prior to the miscarriage. Confirmation can be documentation of a prenatal service by a licensed provider through either a claim, encounter data, or medical record.
Reimbursement for doula support for abortion is only available when there is documentation by claim, encounter data, or medical record of medication or surgical abortion.
Doulas are not required to provide supporting documentation when submitting claims and seeking reimbursement for support for miscarriage or abortion or for postpartum services provided after a miscarriage or abortion, but it is a best practice for doulas to confirm with the member that the pregnancy was confirmed by a licensed provider.
11.朵拉提供服务的地点有限制吗？（3 月添加11,2025)
- 不。助产士可以在社区、会员家中、医院等地点提供服务。
12.助产士可以通过远程医疗提供服务吗？(2025年3月11日更新)
- Yes. Doula may provide all services via telehealth, including by telephone. Services rendered via telehealth must be billed consistent with DHCS’ telehealth policy as outlined in the Medicine: Telehealth section of the Medi-Cal Provider Manual. This includes billing with modifier 93 for synchronous audio-only or modifier 95 for synchronous video. Services rendered via text, email, chat, or modalities other than audio-visual or audio-only are not reimbursable. Additionally, all doula services provided via telehealth must meet federal requirements for privacy, including the Health Insurance Portability and Accountability Act.
- Medi-Cal’s telehealth policy requires that any provider, including doulas, who are providing services via telehealth be able to provide a warm hand-off to an in-person doula, if requested by the Medi-Cal member.
13.会员可以从一个以上的朵拉那里获得朵拉服务吗？(8月更新16,2024)
- 是的，在会员怀孕和产后期间，可以有多名助产师提供服务。 但是，会员可接受的总访问次数是按每次怀孕计算的，而不是按每个助产士计算的。 此外，只有一名助产师可以为分娩、流产或堕胎期间提供的服务开具账单。
- DHCS recognizes that there may be various reasons why a Medi-Cal member may see one or more doulas during the course of their pregnancy, or even on the same day. For example, a Medi-Cal member may meet with one or more doulas as part of the process of initially identifying a doula who best meets their individual needs. Similarly, a Medi-Cal member may need to change doulas during the course of their pregnancy. For these reasons, Medi-Cal policy does not prohibit two doulas from providing medically necessary prenatal or postpartum visits during the course of a Medi-Cal member’s pregnancy or even on the same day.
14.专业朵拉 (例如，仅分娩/L&D、仅产前、仅产后等) 是否能够为其专业提供朵拉服务？(11月更新17,2025)
- DHCS has created a single enrollment pathway for doulas, so they must be able to provide all doula services listed in the Medi-Cal Provider Manual: Doula Services — prenatal, labor, and postpartum care. Doulas may have areas of specialties. These are listed in the Doula Directory.
- DHCS 与各利益相关方合作制定了朵拉福利，这些利益相关方认为，了解分娩经历对于提供优质产后护理至关重要。因此，DHCS 没有任何设立专业助产士的计划。
15.助产士可以协助在家分娩吗？（3 月添加11,2025)
- 是的，助产士可以协助有执照的提供者进行在家分娩。Medi-Cal 对于助产士提供服务的地点没有任何限制。
16. 从哪里可以获取更多信息或提供反馈？
- Information about the doula benefit is available on the DHCS Doula Services webpage.
- 如果您有任何反馈、问题或评论，请发送电子邮件至 DoulaBenefit@dhcs.ca.gov。{cph0