Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 8238 (December 30, 2023).

55 Pa. Code § 1249.57. Payment conditions for maternal/child services.

§ 1249.57. Payment conditions for maternal/child services.

 (a)  Maternal/child services. Home health agencies are reimbursed for maternal/child services if the following conditions are met:

   (1)  The service is prescribed by the recipient’s attending physician.

   (2)  The services are reasonable and necessary to the treatment of the pregnancy, illness or injury. To be considered reasonable and necessary, the services furnished must be consistent with:

     (i)   The recipient’s particular medical needs as ordered by the recipient’s attending physician.

     (ii)   Accepted standards of medical practice.

 (b)  Postpartum and child services. When the mother no longer requires postpartum visits for medical reasons, but the child continues to need medical services, payment will be made for the additional visits for care of the child only if the services are ordered by the attending physician and are part of a written plan of care written specifically for the child.

Authority

   The provisions of this §  1249.57 issued under sections 403(a) and (b), 443.2(2) and 509 of the Public Welfare Code (62 P. S. § §  403(a) and (b), 443.2(2) and 509).

Source

   The provisions of this §  1249.57 adopted August 12, 1988, effective September 1, 1988, 18 Pa.B. 3571; amended May 11, 2007, effective May 12, 2007, 37 Pa.B. 2185. Immediately preceding text appears at serial pages (251267) to (251268).

Cross References

   This section cited in 55 Pa. Code §  1249.51 (relating to general payment policy).



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