1. 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. 1. inpatient and outpatient health care services;
   2. 2. physician services;
   3. 3. surgical services;
   4. 4. clinic and other ambulatory health care services;
   5. 5. prescription and over-the-counter medications;
   6. 6. laboratory and radiological services;
   7. 7. pre-natal care and pre-pregnancy family services and supplies;
   8. 8. inpatient and outpatient mental health services other than those services relative to substance abuse treatment;
   9. 9. durable medical equipment and other medically-related or remedial devices;
   10. 10. disposable medical supplies;
   11. 11. nursing care services;
   12. 12. case management services;
   13. 13. physical therapy, occupational therapy and services for individuals with speech, hearing and language disorders;
   14. 14. medical transportation services; and
   15. 15. any other medically necessary medical, diagnostic, screening, preventive, restorative, remedial, therapeutic or rehabilitative services.
2. B. Service Exclusion. Sterilization procedures are not a covered service in this program.
3. 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

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

Historical Note

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).