205.556 Coverage for lactation consultation, breastfeeding equipment, in-home
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/ky/205-556A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
programs for pregnant and postpartum women, and telehealth or digital
health services related to maternity care.
(1)As used in this section:
(a)"Breast pump kit" means a collection of tubing, valves, flanges, bottles, and
other parts required to extract human milk using a breast pump;
(b)"In-home program" means a program offered by a health care facility or
health care professional for the treatment of substance use disorder which the
insured accesses through telehealth or digital health service;
(c)"Lactation consultation" means the clinical application of scientific principles
and a multidisciplinary body of evidence for evaluation, problem
identification, treatment, education, and consultation to families regarding the
course of lactation and feeding by a qualified clinical lactation care
practitioner, including but not be limited to:
1. Clinical maternal, child, and feeding history and assessment related to
breastfeeding and human lactation through the systematic collection of
subjective and objective information;
2. Analysis of data;
3. Development of a lactation management and child feeding plan with
demonstration and instruction to parents;
4. Provision of lactation and feeding education;
5. The recommendation and use of assistive devices;
6. Communication to the primary health care practitioner or practitioners
and referral to other health care practitioners, as needed;
7. Appropriate follow-up with evaluation of outcomes; and
8. Documentation of the encounter in a patient record;
(d)"Qualified clinical lactation care practitioner" means a licensed health care
practitioner wherein lactation consultation is within their legal scope of
practice; and
(e)"Telehealth" or "digital health" has the same meaning as in KRS 211.332.
(2)The Department for Medicaid Services and any managed care organization with
which the department contracts for the delivery of Medicaid services shall provide
coverage:
(a)For lactation consultation;
(b)For breastfeeding equipment;
(c)To pregnant and postpartum women for an in-home program; and
(d)For telehealth or digital health services that are related to maternity care
associated with pregnancy, childbirth, and postpartum care.
(3)The coverage required by this section shall:
(a)Not be subject to:
1. Any cost-sharing requirements, including but not limited to copayments;
or
2. Utilization management requirements, including but not limited to prior
authorization, prescription, or referral, except as permitted in paragraph
(d)of this subsection;
(b)Be provided in conjunction with each birth for the duration of breastfeeding,
as defined by the beneficiary;
(c)For lactation consultation, include:
1. In-person, one-on-one consultation, including home visits, regardless of
location of service provision;
2. The delivery of consultation via telehealth, as defined in KRS 205.510,
if the beneficiary requests telehealth consultation in lieu of in-person,
one-on-one consultation; or
3. Group consultation, if the beneficiary requests group consultation in lieu
of in-person, one-on-one consultation; and
(d)For breastfeeding equipment, include:
1. Purchase of a single-user, double electric breast pump, or a manual
pump in lieu of a double electric breast pump, if requested by the
beneficiary;
2. Rental of a multi-user breast pump on the recommendation of a licensed
health care provider; and
3. Two
(2)breast pump kits as well as appropriately sized breast pump
flanges and other lactation accessories recommended by a health care
provider.
(a)The breastfeeding equipment described in subsection (3)(d) of this section
shall be furnished within forty-eight
(48)hours of notification of need, if
requested after the birth of the child, or by the later of two
(2)weeks before
the beneficiary's expected due date or seventy-two
(72)hours after
notification of need, if requested prior to the birth of the child.
(b)If the department cannot ensure delivery of breastfeeding equipment in
accordance with paragraph
(a)of this subsection, an individual may purchase
equipment and the department or a managed care organization with whom the
department contracts for the delivery of Medicaid services shall reimburse the
individual for all out-of-pocket expenses incurred by the individual, including
any balance billing amounts.