1. A. For the purpose of this Subpart 1, Infants or Toddlers are defined as young children, up to age 3, who have not learned to ambulate without assistance.

2. B. Home health services are considered to be medically necessary for an infant or toddler when the primary care physician has advised against removing the infant or toddler from the home because it would:

   1. 1. place the infant or toddler at serious risk of infection;
   2. 2. greatly delay or hamper the recovery process;
   3. 3. cause significant further debilitation of an existing medical condition or physical infirmity;
   4. 4. seriously threaten to cause or aggravate a handicap or a physical deformity or malfunction;
   5. 5. cause great suffering or pain;
   6. 6. seriously endanger the well-being of the infant or toddler; or
   7. 7. otherwise be considered medically contraindicated.

3. C. The following circumstances are not considered when determining the medical necessity of home health services for infants and toddlers:

   1. 1. the provision of services in the home is solely a matter of convenience;
   2. 2. a lack of personal transportation; or
   3. 3. failure or lack of cooperation by the child’s legal guardian(s) to obtain the required medical services in an outpatient setting.

NOTE: The fact that an infant or toddler cannot ambulate or travel without assistance from another is not a factor in determining medical necessity for services.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX 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 30:432 (March 2004), amended by the Department of Health, Bureau of Health Services Financing, LR 44:59 (January 2018).