23 Miss. Code. R. 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.
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