Current through Register Vol. 54, No. 24, June 15, 2024
Section 1249.57 - Payment conditions for maternal/child services(a)Maternal/child services. Home health agencies are reimbursed for maternal/child services if the following conditions are met: (1) The service is prescribed by the recipient's attending physician.(2) The services are reasonable and necessary to the treatment of the pregnancy, illness or injury. To be considered reasonable and necessary, the services furnished must be consistent with: (i) The recipient's particular medical needs as ordered by the recipient's attending physician.(ii) Accepted standards of medical practice.(b)Postpartum and child services. When the mother no longer requires postpartum visits for medical reasons, but the child continues to need medical services, payment will be made for the additional visits for care of the child only if the services are ordered by the attending physician and are part of a written plan of care written specifically for the child.The provisions of this § 1249.57 adopted August 12, 1988, effective 9/1/1988, 18 Pa.B. 3571; amended May 11, 2007, effective 5/12/2007, 37 Pa.B. 2185.The provisions of this § 1249.57 issued under sections 403(a) and (b), 443.2(2) and 509 of the Public Welfare Code (62 P. S. §§ 403(a) and (b), 443.2(2) and 509).
This section cited in 55 Pa. Code § 1249.51 (relating to general payment policy).