D.C. Mun. Regs. tit. 29, r. 29-10002

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-10002 - BREAST PUMPS AND LACTATION SUPPLIES

10002.1

Breast pumps described under Subsection 10002.3 and lactation supplies described under Subsection 10002.4 are reimbursable for mothers with infants under "durable medical equipment," subject to any requirements set forth in the District of Columbia State Plan for Medical Assistance (State Plan), § 996 of Title 29 DCMR, and any subsequent amendments thereto.

10002.2

Breast pumps and lactation supplies described under Subsections 10002.3 and 10002.4 shall be reimbursable if:

(a) The criteria set forth under Subsection 10002.3 is met;

(b) Prescribed by one of the following providers that has been screened and enrolled pursuant to Chapter 94 (Medicaid Provider and Supplier Screening, Enrollment, and Termination) of Title 29 DCMR and has a treatment relationship with the beneficiary or infant:

(1) A physician licensed pursuant to HORA and corresponding rules;

(2) A nurse practitioner licensed as an advanced practice registered nurse pursuant to HORA and corresponding rules; or

(3) A certified nurse mid-wife licensed as an advanced practice registered nurse pursuant to HORA and corresponding rules; and

(c) The infant is between the age of zero (0) and twelve (12) months, unless DHCF or its agent grants prior authorization when an infant is older than twelve (12) months.

10002.3

The following breast pumps are available to beneficiaries in accordance with Subsection 10002.2, subject to the following additional requirements:

(a) Hospital grade, or multi-user, electric pump only available for rental through prior authorization under the following circumstances:

(1) A mother and infant are separated due to illness;

(2) A mother is unable to feed directly from the breast due to congenital anomalies;

(3) A mother is unable to feed directly from the breast due to the prematurity of the baby;

(4) A mother requires induced lactation;

(5) A mother requires re- lactation;

(6) An infant is adopted; or

(7) A mother or infant has other medical or psychological conditions that preclude effective feeding at the breast.

(b) Individual electric breast pump for a mother who needs to maintain lactation because of separation from the infant on a regular basis, such as being employed.

(c) Manual breast pump for a mother who needs to occasionally express milk.

10002.4

Subject to the requirements under Subsection 10002.2, the following lactation supplies shall be reimbursed by DHCF:

(a) A maximum of two (2) breast pump kits, including tubing, valves, flanges, and collection bottles;

(b) Nipple shields; and

(c) Supplemental feeding tubes/devices and syringes.

D.C. Mun. Regs. tit. 29, r. 29-10002

Final Rulemaking published at 64 DCR 791 (1/27/2017)