10 Colo. Code Regs. § 2505-10-8.732
Current through Register Vol. 47, No. 11, June 10, 2024
Section 10 CCR 2505-10-8.732 - MATERNITY SERVICES8.732.1DEFINITIONSHigh-Risk Pregnancy means pregnancy that threatens the health or the life of the mother or her fetus. Risk factors can include existing health conditions, weight and obesity, multiple births, older maternal age, and other factors.
8.732.2.CLIENT ELIGIBILITY8.732.2.A. Medicaid-enrolled pregnant or postpartum clients are eligible for maternity services. Women remain eligible throughout their pregnancy and maintain eligibility until the end of the month in which 60 days have passed post-pregnancy.8.732.3.PROVIDER ELIGIBILITY8.732.3.A. All Colorado Medicaid-enrolled providers are eligible to provide maternity services when it is within the scope of the providers' practice.8.732.4.COVERED SERVICES8.732.4.A. Maternity services are covered when medically necessary and within the limitations described in this section 8.732 and under 10 CCR 2505-10 as applicable.8.732.4.B. Prenatal and Post-Partum Office Visits1. One initial, comprehensive, prenatal visit including history and physical exam is covered.2. Subsequent prenatal visits are covered at a frequency that follows nationally recognized standards of care based on client risk factors and complicating diagnoses.3. Postpartum visits are covered at a frequency that follows nationally recognized standards of care. Generally, one to two postpartum visits are considered routine for uncomplicated pregnancies and deliveries. Guidelines for screening, diagnostic, and monitoring services are located at 8.732.4.D and 8.732.4.E, of this rule.8.732.4.C. Ultrasounds 1. A maximum of two routine ultrasounds are covered per low-risk pregnancy.2. Clients with High-Risk Pregnancies may receive more than two ultrasounds when clinically indicated in accordance with nationally recognized standards of care for indication and frequency. Clinical indication must be clearly documented in the client record.8.732.4.D. Additional Screening, Diagnostic, and Monitoring Services1. The following services are covered only when clinically indicated in accordance with nationally recognized standards of care for indications and frequency. b. Fetal biophysical profilef. Chorionic villus sampling2. The clinical indication must be clearly documented in the medical record.8.732.4.E. Effective July 1, 2022, Genetic Screening, including but not limited to Non-Invasive Prenatal Testing (NIPT), and Genetic Counseling are covered in accordance with nationally recognized standards of care. Screening coverage is available for women carrying a singleton gestation who meet national standard guidelines.8.732.4.F. Diabetic supplies are covered for clients diagnosed with gestational diabetes mellitus (GDM), in accordance with nationally recognized standards of care for GDM. 8.732.4.G. Labor and Delivery services including admission to the hospital, the admission history and physical examination, and management of labor and delivery services.8.732.4.H. Home births may be performed by physicians and certified nurse-midwives carrying malpractice insurance that covers home births.8.732.5NON-COVERED SERVICES8.732.5.A. The following services are not covered:2. Three and four dimensional ultrasounds3. Ultrasounds performed solely for the purpose of determining the sex of the fetus or to provide a keepsake picture8. Home tocolytic infusion therapy8.732.6.PRIOR AUTHORIZATION8.732.6.A. Prior Authorization is not required for services under § 8.732, with the following exception: 1. Services under Section 8.732.4.E may require prior authorization.