Statutes, codes, and regulations
Colorado Administrative Code
Department 2505 - Department of Health Care Policy and FinancingDivision 2505 - Medical Services Board (Volume 8; Medical Assistance, Children's Health Plan)
Rule 10 CCR 2505-10-8.700 - MEDICAL ASSISTANCE - SECTION 8.700 Federally Qualified Health Centers, Women's Health Services
Section 10 CCR 2505-10-8.732 - MATERNITY SERVICES

10 Colo. Code Regs. § 2505-10-8.732

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Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.732 - MATERNITY SERVICES
8.732.1DEFINITIONS

High-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 ELIGIBILITY
8.732.2.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 ELIGIBILITY
8.732.3.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 SERVICES
8.732.4.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 Visits
1. 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 Services
1. The following services are covered only when clinically indicated in accordance with nationally recognized standards of care for indications and frequency.
a. Amniocentesis
b. Fetal biophysical profile
c. Fetal non-stress test
d. Fetal echo cardiogram
e. Fetal fibronectin
f. Chorionic villus sampling
2. 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 SERVICES
8.732.5.A. The following services are not covered:
1. Home pregnancy tests
2. Three and four dimensional ultrasounds
3. Ultrasounds performed solely for the purpose of determining the sex of the fetus or to provide a keepsake picture
4. Paternity testing
5. Lamaze classes
6. Birthing classes
7. Parenting classes
8. Home tocolytic infusion therapy
8.732.6.PRIOR AUTHORIZATION
8.732.6.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.
8.732.7.LACTATION SUPPORT SERVICES
8.732.7.A.DEFINITIONS
1. Lactation Consultant means an International Board Certified Lactation Consultant (IBCLC) with current certification by the International Board of Lactation Consultant Examiners.
2. Certified Lactation Counselor (CLC) means a professional who has a current certification by the Academy of Lactation Policy and Practice, Inc. (ALPP).
3. Certified Lactation Educator (CLE) means a professional who has a current certification by the Childbirth and Postpartum Professional Association (CAPPA).
4. Lactation Support Services include training and counseling the breastfeeding (or lactating) member about breastfeeding and human lactation, and providing comprehensive, skilled care and evidence-based information for breastfeeding and human lactation, from pre-conception to weaning.
8.732.8MEMBER REQUIREMENTS
8.732.8.A. Members must be pregnant or postpartum, or a pediatric member who is breastfeeding, to be eligible for Lactation Support Services.
8.732.9PROVIDER REQUIREMENTS
8.732.9.A. Enrolled Medicaid providers who provide Lactation Support Services must be at least 18 years of age.
8.732.9.B. Lactation Support Services must be provided by individuals with training in advanced lactation support:
1. Lactation Consultants may provide Lactation Support Services without supervision.
2. Lactation Counselors and Lactation Educators may provide Lactation Support Services under the general supervision of enrolled Physicians (MDs/DOs), Physician Assistants (PAs), Advanced Practice Nurses (APNs), Certified Nurse Midwives (CNMs), or Lactation Consultants.
8.732.9.C. The following provider types may provide Lactation Support Services if within their scope of practice according to state licensing requirements and laws and the provider has training in advanced lactation support:
1. Certified Professional Midwife / Direct Entry Midwife (DEM);
2. Certified Midwife;
3. Certified Nurse Midwife (CNM);
4. Licensed Physician (MD/DO);
5. Licensed Physician Assistant (PA)
6. Licensed Advanced Practice Nurse (APN);
7. Licensed Registered Nurse (RN).
8.732.10COVERED SERVICES
8.732.10.A Lactation Support Services are recommended by a physician or other licensed practitioner of the healing arts to provide lactation support services to eligible members.
8.732.10.B. Lactation Support Services can be provided individually or in a group setting.

10 CCR 2505-10-8.732

47 CR 21, November 10, 2024, effective 11/30/2024