导乐服务常见问题
Doula Providers – Hospitals
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. 医院里的病人是否有权选择自己的访客？有哪些例外情况？ （添加于6年 9 月、 2024 ）
- 是的。 根据适用 状态 和 联邦 指导意见，病人有权接待自己指定的访客。 有关联邦要求的更多信息，请参阅下面的问题4。
- 但是，医院可能需要对此类权利建立任何临床上必要或合理的限制或限制。 例如：
- 医院根本不允许任何访客，尽管这不是标准做法，并且只在有限的情况下允许。
- 医院根据个案评估合理地确定， 特别的 访客会危害患者、工作人员或其他访客的健康和/或安全，或会严重扰乱设施的运营。 这里的一些例子可能包括：访客是否生病或患病（例如，感染控制），访客是否/将会严重扰乱医院的运营（例如，小型手术室），或者患者表示他们不希望访客出现。
- 医院探视政策可能因病房类型而异，例如重症监护病房或新生儿托儿所有单独的政策。
2. What constitutes “patient visitation” under federal Centers for Medicare and Medicaid Services (CMS) regulations for hospitals? (Added September 6, 2024)
- 病人有权接待其指定的探访者。这些访客可以包括但不限于配偶或同居伴侣（包括同性配偶或同居伴侣）、其他家庭成员或朋友。其他例子可能包括神职人员、牧师、传教士或宗教领袖。受 CMS 患者探视规定约束的机构必须确保其政策不会基于种族、肤色、国籍、宗教、性别、性别认同、性取向或残疾而歧视。患者也有权随时撤回或拒绝同意任何此类访客。这些权利受到《联邦法规》（CFR）第 42 篇第482.13(h)节的 CMS 法规的保护，这些权利将在下面的问题 4 中得到更详细的说明。
- 联邦和州法律允许医院以各种理由限制探视。 权限限制和/或原因的示例可在 CMS 医院解释指南 [标签 A-0215 至 A-0217] 和 CMS 关键通道医院解释指南 [标签 C-0154 至 C-0158] 中找到。
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. 医院是否必须有书面的 P&P，其中包含有关患者探视权利的信息，包括陪护人员的权利？（于 9 月6 、 2024添加）
- 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.
- 这些要求在第 42 篇 CFR第 482.13(h) 节中有概述，其中包括接受联邦医疗补助资金的医院，如下所示：
“(h) 医院必须有关于患者探视权利的书面政策和程序，包括列明医院可能需要对此类权利施加的任何临床必要或合理限制或限制的政策和程序，以及临床限制或限制的原因。 医院必须满足以下要求：
(1) 在告知每位患者（或适当情况下的支持人员）其探视权利时，包括对此类权利的任何临床限制或限制。
(2) 告知每位患者（或适当情况下的支持者），在征得患者同意的情况下，患者有权接待其指定的访客，包括但不限于配偶、同居伴侣（包括同性同居伴侣）、其他家庭成员或朋友，并且患者有权随时撤回或拒绝此类同意。
(3) 不得基于种族、肤色、国籍、宗教、性别、性别认同、性取向或残疾而限制、限制或以其他方式拒绝探视权。
（4）E nsure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.”
5. 鉴于患者有探视自己选择的个人的权利，医院可以阻止 Medi-Cal 会员在医院内探视助产士吗？ （添加于6年 9 月、 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. 如果助产士在为其客户/患者提供支持时遇到困难或被拒绝，该怎么办？ （添加于6年 9 月、 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.
- 如果您在某家特定医院遇到问题，请通过电子邮件 DoulaBenefit@dhcs.ca.gov 联系 DHCS，并提供以下信息：
- 医院名称；
- 就该问题与您交谈过的任何医院代表的姓名；
- 问题简要描述；
- 与问题相关的日期；以及
- 后续联系信息（最好是电子邮件和电话）。
- DHCS 已建立定期的医院-助产士工作组，进行公开对话来解决这一问题，并寻找减少获取服务障碍的机会。
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.我可以在哪里获取更多信息或提供有关医院准入问题的信息？ （添加于6年 9 月、 2024 ）
- 有关朵拉福利的信息，请访问DHCS 朵拉服务网页。
- 如有任何其他问题，请发送电子邮件至DoulaBenefit@dhcs.ca.gov。