SECTION 317:30-5-233. Limitations

(a)   Services billed by a contracted IBCLC are only covered when performed in the IBCLC's office setting, patient's home, or other confidential outpatient setting. Payment for inpatient services provided by a Lactation Consultant is included in the hospital's per diem rate.

(b)   No separate reimbursement will be made to a facility.

(c)   Services are not to duplicate any basic breastfeeding education/training a member may have received through another program such as WIC or the Children's First Program and services must be problem focused.

(d)   Services provided by a contracted IBCLC must be provided face-to-face and in an individual setting.

(e)   Reimbursement is limited to not more than 6 sessions per pregnancy and must be objectively documented as medically necessary.

[Source: Added at 25 Ok Reg 429, eff 12-1-07 through 7-14-08 (emergency); Added at 25 Ok Reg 2639, eff 7-25-08]

Note

EDITOR’S NOTE: This emergency action expired before being superseded by a permanent action. Upon expiration of an emergency action enacting a new Section, the Section is no longer effective. Therefore, on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section 317:30-5-233 was no longer effective, and remained as such until added again by permanent action on 7-25-08.