Thank you for sending this.  Love this work.

What is missing from this tool kit:

1.  How to help mothers access E0604 breast pumps for medical necessity.  Even in California, we cannot always access these breast pumps from the state Medicaid program.

I note on page 69 it says "Hospital staff should be trained in acquiring pumps for women.”

I am pretty well trained, and even work directly with the state agency yet we have NO DME providers who will provide these pumps to our Medi-Cal mothers.

One reason is that there are very limited clinical guidelines which utilization managers can rely on for these type of issues.  For example when I approached Apollo Managed Care (a frequently use vendor for health plans when deciding if they will pay for something) their Chief Medical Officer responded with:

"Lactation and breast feeding are not medical conditions (neither covered nor noncovered). Therefore, Apollo does not have a clinical guideline. Formula to feed an infant is also not covered unless a medical indication requires a special infant formula.
Breast pumps may be covered by some health plans such as Anthem. The contact may find the Anthem policy for Medi-Cal members of interest and helpful:   https://www.anthem.com/wps/portal/ca/culdesac?content_path=provider%2Ff3%2Fs1%2Ft3%2Fpw_a112604.htm&label=Prenatal%20Program&rootLevel=2&name=ssb&  <https://www.anthem.com/wps/portal/ca/culdesac?content_path=provider%2Ff3%2Fs1%2Ft3%2Fpw_a112604.htm&label=Prenatal%20Program&rootLevel=2&name=ssb&> "

When you look at anthems uM guidance on breast pumps - the E0604 pump is only available under the three strict criteria here:  https://www11.anthem.com/ca/medicalpolicies/guidelines/gl_pw_c164437.htm

And look at Aetna’s RIDICULOUS policy!  http://www.aetna.com/cpb/medical/data/400_499/0421.html

You can have the pump while the baby’s in the NICU, but once they discharge the baby - Magically they can breastfeed and the mom won’t need a pump?

If we had better clinical guidelines not just for the baby - BUT for the mother and building a supply and when to issue these pumps, then health plans would be more apt to change their practices.  



> On Oct 9, 2018, at 9:00 PM, LACTNET automatic digest system <[log in to unmask]> wrote:
> 
> Date:    Tue, 9 Oct 2018 06:05:52 -0400
> From:    Elizabeth Brooks <[log in to unmask] <mailto:[log in to unmask]>>
> Subject: NEW edition (Sept 2018) of CPQCC Toolkit for VLBW Infant now out
> 
> Fire up your downloader! Sept 2018 revision of the excellent Toolkit for
> Nutritional Support of the VLBW Infant now available from the CA Perinatal
> Quality Care Collaborative. It is full of photos, and beautifully
> designed.  Kudos to Lactnet's own Nancy Wight MD IBCLC FABM FAAP and the
> writing team!
> https://www.cpqcc.org/resources/nutritional-support-vlbw-infant <https://www.cpqcc.org/resources/nutritional-support-vlbw-infant>
> 
> -- 
> Liz Brooks, JD, IBCLC, FILCA
> Wyndmoor, PA, USA
> Director, Human Milk Banking Assn of North America (2015-19)
> "IBCLCs empower women and save babies' lives!"-Ursuline Singleton


             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome