D.C. Mun. Regs. tit. 29, r. 29-10001

Current through Register 71, No. 45, November 7, 2024

Rule 29-10001 - LACTATION CONSULTATION, EDUCATION, AND SUPPORT

10001.1

Lactation consultation, education, and support shall mean evaluation of the mother and infant's overall breastfeeding readiness, education on proper breastfeeding techniques, education on the proper use of a breast pump, and delivery of other necessary information and assistance to enhance breastfeeding.

10001.2

Lactation consultation, education, and support shall be reimbursed by the Department of Health Care Finance (DHCF) under the "pregnancy-related services" benefit, subject to any requirements set forth in the State Plan, implementing rules, and any subsequent amendments thereto.

10001.3

Lactation consultation, education, and support shall be covered for Medicaid-eligible pregnant women, as defined at 29 DCMR 9599, as follows:

(a) One (1) prenatal visit; and

(b) Up to six (6) visits during the twelve (12) month postpartum period. The twelve (12) month postpartum period shall begin on the last day of pregnancy and extend through the end of the calendar month in which the last day of the twelfth (12th) month after the end of the pregnancy falls.

10001.4

Reimbursable lactation consultation, education, and support may be provided in a clinic, physician's office, freestanding birth center, or in the home, by practitioners set forth under Subsection 10001.5.

10001.5

The following practitioners shall deliver lactation consultation, education, and support services in the settings described in Subsection 10001.4:

(a) A certified nurse mid-wife, licensed pursuant to the District of Columbia Health Occupations Revision Act of 1985 (HORA), effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201et seq. (2012 Repl. & 2015 Supp.)), Chapter 58 (Nurse-Midwives) of Title 17 of the District of Columbia Municipal Regulations (DCMR), and who demonstrates current certification by the International Board of Lactation Consultant Examiners (IBLCE) to deliver lactation consultation, education, and support; or

(b) A registered lactation consultant, who demonstrates current certification by the IBLCE to deliver lactation consultation, education, and support.

10001.6

In order for a provider under Subsection 10001.5 to receive Medicaid reimbursement, each provider shall comply with all provider screening and enrollment requirements set forth under Chapter 94 (Medicaid Provider and Supplier Screening, Enrollment, and Termination) of Title 29 DCMR. Additionally, a registered lactation consultant shall meet the following requirements, unless Subsection 10001.7 applies:

(a) Deliver lactation consultation, education, and support only when the services are ordered and/or prescribed by a physician, nurse practitioner, or certified nurse midwife who is licensed pursuant to HORA and corresponding rules, and is screened and enrolled in accordance with Chapter 94 of Title 29 DCMR;

(b) Submit a copy of the order or prescription for lactation consultation, education and support with each claim that is submitted for Medicaid reimbursement; and

(c) Complete an orientation session on billing provided by DHCF or its agent.

10001.7

If a registered lactation consultant who meets the qualifications in Section 10001.5(a) is employed by or has a contract with a Federally Qualified Health Center (FQHC) to deliver lactation consultation, education, and support, and the FQHC submits claims for reimbursement to DHCF for those services in accordance with Chapter 45 (Medicaid Reimbursement for Federally Qualified Health Centers) of Title 29 DCMR, the registered lactation consultants shall not bill DHCF separately for those services.

D.C. Mun. Regs. tit. 29, r. 29-10001

Final Rulemaking published at 64 DCR 791 (1/27/2017); amended by Final Rulemaking published at 69 DCR 10036 (8/5/2022)