Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1249 - HOME HEALTH AGENCY SERVICES
PAYMENT FOR HOME HEALTH SERVICES
Section 1249.57 - Payment conditions for maternal/child services

Universal Citation: 55 PA Code ยง 1249.57

Current through Register Vol. 54, No. 12, March 23, 2024

(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.

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).

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

Disclaimer: These regulations may not be the most recent version. Pennsylvania may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.