23 Miss. Code. R. 209-1.15

Current through December 10, 2024

Rule 23-209-1.15 - Breast Pumps

A. The Division of Medicaid defines a breast pump as a device used to extract breast milk from a lactating mother.

B. The Division of Medicaid covers the following types of breast pumps for nursing mother beneficiaries when medically necessary, prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity.

1. The Division of Medicaid defines a manual breast pump as a single-user device manually operated to express breast milk from a lactating mother and is covered for purchase when:

a) Used to promote lactation when natural breastfeeding has been insufficient in maintaining adequate nutritional needs of the infant, or

b) Used to provide lactation support when natural breastfeeding is not possible.

2. The Division of Medicaid defines an electric breast pump as an electronic device used to express breast milk from a lactating mother and is covered for rental up to purchase amount, or for purchase when one (1) of the following is met:

a) The infant:

1) Is preterm or term and requires hospitalization longer than the mother,

2) Has a cleft palate or cleft lip,

3) Has cranial-facial abnormalities,

4) Is unable to suck adequately,

5) Has Failure to Thrive,

6) Has a low birth weight, or

7) Has other medical conditions that interfere with breastfeeding.

b) The mother:

1) Has a breast abscess,

2) Has mastitis,

3) Is hospitalized due to illness or surgery on short term basis,

4) Is unable to effectively use a manual pump to promote or maintain lactation due to a medical condition or physical limitation,

5) Is undergoing treatment with short-term medications which requires the pumping and discarding of breast milk, or

6) Has other medical conditions that interfere with breastfeeding.

C. All prior authorization requests must:

1. Be in the mother beneficiary's name,

2. Include the mother beneficiary's Medicaid ID number, and

3. Include an estimate of how many weeks or months the mother will require the electric breast pump.

23 Miss. Code. R. 209-1.15

42 U.S.C. §§ 1395m, 1396d; 42 CFR §§ 440.60, 440.166, 440.210, 440.220; PHSA § 2713; Miss. Code Ann. §§ 43-13-117, 43-13-121.

Revised eff. 05/01/2014.

Amended 9/1/2018