20305 Services

A. Covered Services. Recipients shall receive coverage of pregnancy-related health care services and associated medically necessary services for conditions that, if not treated, would complicate the pregnancy. Pregnancy-related health care services which may be covered include:

1. inpatient and outpatient health care services;

2. physician services;

3. surgical services;

4. clinic and other ambulatory health care services;

5. prescription and over-the-counter medications;

6. laboratory and radiological services;

7. pre-natal care and pre-pregnancy family services and supplies;

8. inpatient and outpatient mental health services other than those services relative to substance abuse treatment;

9. durable medical equipment and other medically-related or remedial devices;

10. disposable medical supplies;

11. nursing care services;

12. case management services;

13. physical therapy, occupational therapy and services for individuals with speech, hearing and language disorders;

14. medical transportation services; and

15. any other medically necessary medical, diagnostic, screening, preventive, restorative, remedial, therapeutic or rehabilitative services.

B. Service Exclusion. Sterilization procedures are not a covered service in this program.

C. Service Limits and Prior Authorization. Other Medicaid-specific benefit limits, age limits and prior authorization requirements may be applicable to the services covered in this program.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XXI of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 35:72 (January 2009), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 40:545 (March 2014).