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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJune 2017

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Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance initiated proceedings to amend the Title XIX Medicaid State Plan regarding services provided to pregnant and postpartum individuals, specifically, to provide lactation counseling services as separately reimbursed pregnancy-related services. The Department’s proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the April Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by May 1, 2017 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
42 CFR §440.60, Medical or other remedial care provided by licensed practitioners
42 CFR §440.170, Any other medical care or remedial care recognized under State law and specified by the Secretary
42 CFR §440.210, Required services for the categorically needy
42 CFR §440.225, Optional services for the categorically needy
42 CFR §447, Payments for services
§1902(a) of the Social Security Act, State plans for medical assistance, service requirements
In accordance with the federal public notice requirements established at Section 1902(a)(13)(A) of the Social Security Act and 42 CFR 447.205 and the state public notice requirements of Title 29, Chapter 101 of the Delaware Code, Delaware Health and Social Services (DHSS)/Division of Medicaid and Medical Assistance (DMMA) gives public notice and provides an open comment period for thirty (30) days to allow all stakeholders an opportunity to provide input on proposed regulations. Comments were to have been received by 4:30 p.m. on May 1, 2017.
THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Title XIX Medicaid State Plan regarding services provided to pregnant and postpartum individuals, specifically, to provide lactation counseling services as separately reimbursed pregnancy-related services, is adopted and shall be final effective June 11, 2017.
Provided With limitations*
Not Provided
Provided With limitations*
Not Provided
Additional coverage ++
Additional coverage ++
Those services normally covered by Medicaid for all eligibles Medicaid beneficiaries are available to pregnant women.
Lactation counseling services for pregnant and postpartum individuals when such services are ordered by a licensed practitioner, [opportuning operating] within the scope of their license, and provided by a certified lactation consultant; and
Provided: No limitations With limitations* None licensed or approved
Please describe any limitations: See ATTACHMENT 3.1-A Page 11 Addendum
Provided: No limitations With limitations* (please describe below)
Not Applicable (there are no licensed or State approved Freestanding Birth Centers)
Please describe any limitations: See ATTACHMENT 3.1-A Page 11 Addendum
(a) Practitioners furnishing mandatory services described in another benefit category and otherwise covered under the State plan (i.e., physicians and certified nurse midwives).
(b) Other licensed practitioners furnishing prenatal, labor and delivery, or postpartum care in a freestanding birth center within the scope of practice under State law whose services are otherwise covered under 42 CFR 440.60 (e.g., lay midwives, certified professional midwives (CPMs), and any other type of licensed midwife). *
(c) Other health care professionals licensed or otherwise recognized by the State to provide these birth attendant services (e.g., doulas, lactation consultant, etc.).**
25. (i) Limitations on Licensed or Otherwise State-Approved Freestanding Birth Center Services
(b) Birth center facility services are those services determined by the attending physician (MD or DO), or certified nurse-midwife (CNM), or licensed midwife to be reasonable and necessary for the care of the mother and newborn child following the mother's pregnancy. The center and attending physician, or CNM certified nurse-midwife, or licensed midwife must be licensed at the time and place the services are provided. Reimbursable services are limited to services provided by the birthing center during the labor, delivery, and postpartum periods.
25. (ii) Limitations on Licensed or Otherwise State-Recognized covered professionals in the Freestanding Birthing Center Services
(a) Services provided by a physician, or CNM certified nurse-midwife, or licensed midwife, or certified lactation consultant, which are described in another benefit category and otherwise covered under the State plan, are not considered to be birth center services by the Delaware Medical Assistance Program.
Entire State
Only in the following geographic areas (authority of section 1915(g)(1) of the Act is invoked to provide services less than Statewide):
Services are provided in accordance with section 1902(a)(10)(B) of the Act.
Services are not comparable in amount, duration, and scope. Authority of section 1915(g)(1) of the Act is invoked to provide services without regard to the requirements of section l902(a)(10)(B) of the Act.
Case management of high risk pregnant women individuals must include at least the following components:
1. NUTRITION
2. SOCIAL WORK
3. NURSING
a. Weekly/monthly health assessment by RN Registered Nurse with report of suspected problems to attending physician; and
b. Education on appropriate pregnancy topics, such as childbirth, newborn care (anticipating guidance), lactation counseling, etc.
4. OUTREACH
5. POST PARTUM
a. Continue services and resolve problems in 60 day postpartum period including pregnancy prevention, infant care, lactation counseling, assisting clients to plan for self-sufficiency through referral to appropriate employment and training counseling services.
Qualified providers of case management services for high risk pregnant women individuals will be those that can provide all of the service components described in item D, on page 1a Definition of Services, above, and who have staff or contractual arrangements to make up a case management team as defined below:
Shall be a Registered Nurse licensed in the State of Delaware. Lactation counseling services for pregnant and postpartum individuals shall be provided by a certified lactation consultant.
Last Updated: December 31 1969 19:00:00.
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