23 Miss. Code. R. 222-1.1 - Maternity Services
A. The Division of
Medicaid covers maternity services which include:
1. Antepartum services defined by the
Division of Medicaid as the care of a pregnant woman during the time in the
maternity cycle that begins with conception and ends with labor.
2. Delivery services defined by the Division
of Medicaid as the care involved in labor and delivery.
3. Postpartum services defined by the
Division of Medicaid as the care of the mother inclusive of both hospital and
office visits following delivery for twelve (12) months including any remaining
days in the month in which the twelfth (12th) month
occurs.
B. The Division
of Medicaid covers inductions of labor or cesarean sections prior to one (1)
week before the treating physician's expected date of delivery when medically
necessary due to one (1) of the following medical and/or obstetric conditions
including, but not limited to:
1.
Non-reassuring fetal status or fetal compromise,
2. Fetal demise in prior pregnancy,
3. Fetal malformation,
4. Intrauterine Growth Restriction
(IUGR),
5. Preeclampsia,
6. Eclampsia,
7. Isoimmunization,
8. Placenta previa, accreta, or
abruption,
9. Thrombophilia or an
occurrence of maternal coagulation defects,
10. Complicated chronic or gestational
hypertension,
11.
Chorioamnionitis,
12. Premature
rupture of membranes,
13.
Oligohydramnios,
14.
Polyhydramnios,
15. Multiple
gestations,
16. Poorly controlled
diabetes mellitus (pregestational or gestational),
17. HIV infection,
18. Pulmonary disease,
19. Renal disease,
20. Liver disease,
21. Malignancy,
22. Cardiovascular diseases,
23. Classical or vertical uterine incision
from prior cesarean delivery, or
24. Prior myomectomy.
C. The Division of Medicaid does not cover
non-medically necessary early elective deliveries, prior to the expected due
date including, but not limited to, the following:
1. Maternal request,
2. Convenience of the beneficiary or
family,
3. Maternal exhaustion or
discomforts,
4. Availability of
effective pain management,
5.
Provider convenience,
6. Facility
scheduling,
7. Suspected macrosomia
with documented pulmonary maturity with no other medical indication,
8. Well-controlled diabetes,
9. History of rapid deliveries,
10. Long distance between beneficiary and
treating facility, or
11.
Adoption.
D. Medical
records will be subject to retrospective review. Reimbursement for hospital and
professional services related to the delivery will be recouped if determined
not to have met criteria for coverage.
E. Antepartum and postpartum office visits do
not apply to the physician services limit.
Notes
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