杜拉服務常見問題
Doula Providers – Hospitals
衞生護理服務部（DHCS）涵蓋懷孕和產後個人的管理護理和服務費交付系統的杜拉服務。 服務包括對產前和產後檢查以及分產期間、流產和流產期間的非醫療支持。
1.醫院病人是否有權接受自己選擇的訪客，是否有例外情況？ （添加了 6，2024 的 9 月）
- 是的 根據適用 州 和 聯邦 指導，患者有權接待他們指定的訪客。 有關聯邦要求的更多信息，請參閱下面的問題 #4。
- 然而，醫院可能需要對該等權利建立任何臨床必要或合理的限制或限制。 例如：
- 醫院根本不允許任何訪客，儘管這不是標準的做法，僅在有限的情況下允許。
- 醫院根據個別個案的評估合理決定是否存在 特定 訪客會危及病人、工作人員或其他訪客的健康及/或安全，或會顯著干擾該設施的運作。 這裡的一些例子可能包括如果訪客生病或生病（例如感染控制），訪客/或會顯著干擾醫院的運作（例如，小型手術室），或患者表示他們不希望訪客在場。
- 醫院訪問政策可能因單位類型而有所不同，例如重症病房或新生兒托兒所的單獨政策。
2. What constitutes “patient visitation” under federal Centers for Medicare and Medicaid Services (CMS) regulations for hospitals? (Added September 6, 2024)
- 患者有權接待患者指定的訪客。這些訪客可以包括但不限於配偶或家庭伴侶（包括同性配偶或家庭伴侶），另一位家庭成員或朋友。其他例子可能包括神職人員、牧師、牧師或信仰領袖。受 CMS 病人訪問規定的設施必須確保其政策不會根據種族、顏色、國籍、宗教、性別、性別身份、性取向或殘疾進行歧視。患者還有權隨時撤回或拒絕對任何此類訪客的同意。這些權利受《聯邦規例》第 42 章《聯邦法規守則》第 482.13 (h) 條所載的 CMS 法規保護，詳情請參閱下面的問題 #4。
- 聯邦和州法律允許醫院由於各種原因限制訪問。 《CMS 醫院解釋指南》[標籤 A-0215 至 A-0217] 和 CMS 嚴重接入醫院解釋指南 [標籤 C-0154 到 C-0158] 中找到許可限限制和/或原因的範例。
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.醫院是否必須寫上 P & Ps，其中包含有關病人訪問權的信息，包括支持人員？（添加了 6，2024 的 9 月）
- 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.
- 這些要求在 CFR 第 42 條 482.13 (h) 條中概述了，其中包括接受聯邦 Medicaid 美金的醫院，如下：
「(h) 醫院必須有關患者訪問權利的書面政策和程序，包括規定醫院可能需要對該等權利施加的任何臨床必要或合理限制的政策和程序以及臨床限制或限制的原因。 醫院必須符合以下要求：
(1) 在通知每位患者（或支援人士（如適用）他或她的訪問權利，包括對該權利的臨床限制或限制，當他或她獲知他或她根據本條所提出的其他權利時。
(2) 通知每位患者（或適當的情況下），在獲得他或她的同意下，接受其指定的訪客的權利，包括但不限於配偶、家庭伴侶（包括同性家庭伴侶）、其他家庭成員或朋友，以及他或她隨時撤回或拒絕該同意的權利。
(3) 不根據種族、顏色、國籍、宗教、性別身份、性別身份、性取向或殘疾而限制、限制或以其他方式拒絕訪問特權。
（四）E nsure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.”
5.鑑於患者對自己選擇的個人有訪問權，醫院是否可以阻止 Medi-Cal 成員在醫院接觸他們的杜拉？ （添加了 6，2024 的 9 月）
- 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).
六.如果杜拉對其客戶/患者提供支持遇到困難或被拒絕訪問，該怎麼辦？ （添加了 6，2024 的 9 月）
- 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.
- 如果您與特定醫院遇到挑戰，請通過電子郵件至 DoulaBenefit@dhcs.ca.gov 與 DHCS 聯繫，並提供以下信息：
- 醫院名稱；
- 您就該問題與任何醫院代表聯絡的姓名；
- 問題的簡要描述；
- 與發行相關的日期；及
- 跟進的聯繫信息（電子郵件和電話優先）。
- DHCS 已成立一個經常性的醫院-杜拉工作小組，進行公開對話，以解決這種問題，並找出減少訪問障礙的機會。
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.
八.我可以在哪裡獲得更多信息或提供有關醫院接入問題的意見？ （添加了 6，2024 的 9 月）
- 有關朵拉（ doula） 福利的資訊可在 DHCS 朵拉（doula）服務網頁 上獲得。
- 如有任何其他問題，請發送電子郵件至DoulaBenefit@dhcs.ca.gov。