Conn. Agencies Regs. § 17b-262-731

Current through November 7, 2024

Section 17b-262-731 - Need for service

(a) The department shall pay for medically necessary and medically appropriate home health care services only under orders of a licensed practitioner as part of a care plan.

(b) The department shall pay for pregnancy-related preventive prenatal or postpartum nursing care services only if the woman has one, or a combination of, high risk indicators including, but not limited to, the following, which, in the opinion of her licensed practitioner, places the woman at high risk for negative pregnancy outcomes:

(1) an age under 20;

(2) an age over 39;

(3) a late registration for prenatal care that starts after the sixteenth week of gestation;

(4) no prenatal care;

(5) a serious weight loss or inadequate weight gain of seven pounds or less;

(6) a prenatal weight of more than eighty percent above the standard for height and age;

(7) more than one abortion, or an abortion within three months before the current pregnancy;

(8) a previous neonatal or fetal death;

(9) a previous preterm birth;

(10) an infant with a significant congenital anomaly or central nervous system damage;

(11) violence or deprivation that was abusive or damaging to the woman or her children;

(12) active substance abuse or an addiction, or a history of substance abuse or addiction, such as alcohol, drugs or nicotine;

(13) an active sexually transmitted disease or a history of such a disease;

(14) diseases or conditions including, but not limited to:

(A) human immunodeficiency virus (HIV), including related conditions such as acquired immune deficiency syndrome (AIDS) or AIDS related complex (ARC);

(B) cancer;

(C) acute or chronic cardiac disease;

(D) chronic renal disease;

(E) a seizure disorder;

(F) hypertension, either pre-existing or gestational;

(G) mental disorder without social or psychiatric supervision;

(H) mental retardation without supervision or support;

(I) endocrine or metabolic disorder;

(J) hepatitis;

(K) multiple sclerosis; or

(L) nutritional deficiency; and

(15) an infant up to sixty days of age with one or a combination of diseases or conditions such as:

(A) HIV, including related conditions such as AIDS or ARC;

(B) a birth before thirty-six weeks of gestation or a birth weight under two thousand five hundred grams;

(C) central nervous system damage;

(D) a failure to thrive or a significant infant feeding problem;

(E) an admission to a neonatal intensive care unit;

(F) a sibling who required treatment for recurring apnea or had sudden infant death syndrome;

(G) mental retardation;

(H) neonatal asphyxia;

(I) a seizure disorder;

(J) a significant congenital anomaly; or

(K) a supervising relative under sixteen years of age.

Conn. Agencies Regs. § 17b-262-731

Adopted effective March 7, 2007