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AN ACT relating to Medicaid coverage for lactation support services and 1
breastfeeding equipment. 2
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 3
SECTION 1. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 4
READ AS FOLLOWS: 5
(1) The Department for Medicaid Services and any managed care organization with 6
which the department contracts for the delivery of Medicaid services shall provide 7
coverage for comprehensive lactation counseling, lactation consultation, and 8
breastfeeding equipment. 9
(2) The coverage required by this section shall: 10
(a) Not be subject to: 11
1. Any cost-sharing requirements, including but not limited to 12
copayments; or 13
2. Utilization management requirements, including but not limited to 14
prior authorization, prescription, or referral, except as permitted in 15
paragraph (d) of this subsection; 16
(b) Be provided in conjunction with each birth for the duration of 17
breastfeeding, as defined by the beneficiary; 18
(c) For lactation counseling and lactation consultation, include: 19
1. In-person, one-on-one counseling or consultation, including home 20
visits, regardless of location of service provision; 21
2. The delivery of counseling or consultation via telehealth, as defined in 22
KRS 205.510, if the beneficiary requests telehealth counseling or 23
consultation in lieu of in-person, one-on-one counseling or 24
consultation; and 25
3. Group counseling, if the beneficiary requests group counseling in lieu 26
of in-person, one-on-one counseling or consultation; and 27 UNOFFICIAL COPY 22 RS BR 257
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(d) For breastfeeding equipment, include: 1
1. Purchase of a single-user, double electric breast pump, or a manual 2
pump in lieu of a double electric breast pump, if requested by the 3
beneficiary; 4
2. Rental of a multi-user breast pump on the recommendation of a 5
licensed health care provider; and 6
3. Two (2) breast pump kits as well as appropriately sized breast pump 7
flanges and other lactation accessories recommended by a health care 8
provider. 9
(3) (a) The breastfeeding equipment described in subsection (2)(d) of this section 10
shall be furnished within forty-eight (48) hours of notification of need, if 11
requested after the birth of the child, or by the later of two (2) weeks before 12
the beneficiary's expected due date or seventy-two (72) hours after 13
notification of need, if requested prior to the birth of the child. 14
(b) If the department cannot ensure delivery of breastfeeding equipment in 15
accordance with paragraph (a) of this subsection, an individual may 16
purchase equipment and the department or a managed care provider with 17
whom the department contracts for the delivery of Medicaid services shall 18
reimburse the individual for all out-of-pocket expenses incurred by the 19
individual, including any balance billing amounts. 20
(4) As used in this section: 21
(a) "Breast pump kit" means a collection of tubing, valves, flanges, bottles, and 22
other parts required to extract human milk using a breast pump; 23
(b) "Lactation consultation" means the provision of lactation care and services 24
by an International Board Certified Lactation Consultant or other licensed 25
health care provider, including: 26
1. Lactation assessment; 27 UNOFFICIAL COPY 22 RS BR 257
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2. Creation of a lactation care plan; 1
3. Lactation education; and 2
4. Recommendations for an instruction in the use of assistive devices; 3
and 4
(c) "Lactation counseling" means the provision of breastfeeding education and 5
support services by an International Board Certified Lactation Consultant 6
or other licensed health care provider, including: 7
1. Educating women and families on the health impacts of breastfeeding 8
and human lactation; 9
2. Advocating for breastfeeding as the norm for feeding infants and 10
young children; 11
3. Providing breastfeeding support, encouragement, and care to help 12
women and families meet their breastfeeding goals; and 13
4. Identifying and, when appropriate, referring high-risk mothers for 14
clinical treatment. 15
Section 2. If the Cabinet for Health and Family Services or the Department for 16
Medicaid Services determines that a waiver or any other authorization from a federal 17
agency is necessary prior to the implementation of any provision of Section 1 of this Act, 18
the cabinet or department shall, within 90 days after the effective date of this Act, request 19
the waiver or authorization and shall only delay full implementation of those provisions 20
for which a waiver or authorization was deemed necessary until the waiver or 21
authorization is granted. 22