Dear Friends:

Some information that may be of interest to you concerning U.S.
Federal-level coverage for breastfeeding services.  First is my letter
to the U.S. Health Care Financing Administration (the Feds who oversee
Medicaid and Medicare) and their response.  Comments to my email,
please.


>>>> <[log in to unmask]> 10/07/97 04:17am >>>
>To Whom it may Concern:
>I am working with my medical societies and our state health
>department to determine the extent to which breastfeeding-
>related services are covered under Medicaid at the State and
>Federal levels.  I am fairly well-versed on what Kentucky
>Medicaid currently covers, and want to make sure that these
>benefits are not lost or diluted as we change to a Managed
>Care format.  What I don't know is the extent to which HCFA
>provides guidance on appropriate standards of care, medical
>equipment, and supplies related to breastfeeding.
>
>In particular, I want to know if there are any regs or guide
>lines regarding the following as covered benefits:
>1)  Rented electric breast pump (automatically-cycling)
>2)  Lactation Consultant services (in-patient or out-patient)
>3)  Breastfeeding-related medial supplies (eg. breast-pump
>attachment kits, breast shells, nipple shields)
>
>Thank you for your time and efforts concerning this request.
>I look forward to hearing from you soon.  Please feel free
>to send your response to my email box.
>
>Sincerely,
>Doraine Bailey, MA
>Breastfeeding Support Services
>Lexington(KY)-Fayette County Health Department

 -------------------------REPLY-------------------------

>Date: Wed, 10 Dec 1997 14:22:04 -0500
>From: Jackie Sheridan <[log in to unmask]>
>>Subject: Breastfeeding-related services -Reply
>
>Dear Ms. Bailey,
>
>I am responding to your inquiry regarding HCFA guidelines relating to
>breastfeeding-related services.  HCFA does not have any specific
guidlines or
>regulations related to breast-feeding related services.
>
>A large portion of HCFA programs are administered on a day to day bases
by State
>agencies (Medicaid) or contractors (Medicare).  Therefore, we have
national
>policies on only a relatively small portion of services.  With regard
to
>Medicaid the States are responsible for determining the scope of
benefits under
>their program subject to broad Federal guidelines.  While the statute
does
>specify certain categories of services as mandatory under Medicaid,
these are
>broad general categories, such as hospital services, rather than
detailed
>benefits, such as equipment or types of counseling.
>
>With regard to Medicare, most coverage decisions are made under the
authority of
>section 1862(a)(1)(A) of the Social Security Act.  This section
provides that
>Medicare may cover only services that are reasonable and necessary for
the
>diagnosis or treatment of illness or injury. Medicare contractors are
authorized
>to make local policies related to services that meet this criteria.
>
>Similarly, HCFA has as one of its priorities encouraging high quality
care.
>Through contracts with Peer Review Organizations, End Stage Renal
Disease
>Networks and State survey agencies, we are working on various quality
>improvement projects to assure that beneficiaries are furnished high
quality
>care.  While some of these entities may have guidelines related to
specific
>quality improvement projects, there is local variation in the specific
types of
>services targeted.
>
>In summary, HCFA does not have national guidelines related to
breast-feeding
>services.  I regret that I could not be more helpful to you.  I wish
you good
>luck in your endeavors to assure that quality care is provided to
residents in
>need of these services.
>
>Jackie Sheridan
>Technical Advisor
>Coverage and Analysis Group
>Office of Clinical Standards and Quality
>
>

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