{"data":{"id":"us-ky/krs-205.556","jurisdiction":"us-ky","citation":"KRS 205.556","heading":"Coverage for lactation consultation, breastfeeding equipment, in -home","body":"programs for pregnant and postpartum women, and telehealth or digital\nhealth services related to maternity care.\n(1) As used in this section:\n(a) \"Breast pump kit\" means a collection of tubing, valves, flanges, bottles, and\nother parts required to extract human milk using a breast pump;\n(b) \"In-home program\" means a program offered by a health care facility or\nhealth care professional for the treatment of substance use disor der which the\ninsured accesses through telehealth or digital health service;\n(c) \"Lactation consultation\" means the clinical application of scientific principles\nand a multidisciplinary body of evidence for evaluation, problem\nidentification, treatment, education, and consultation to families regarding the\ncourse of lactation and feeding by a qualified clinical lactation care\npractitioner, including but not be limited to:\n1. Clinical maternal, child, and feeding history and assessment related to\nbreastfeeding and human lactation through the systematic collection of\nsubjective and objective information;\n2. Analysis of data;\n3. Development of a lactation management and child feeding plan with\ndemonstration and instruction to parents;\n4. Provision of lactation and feeding education;\n5. The recommendation and use of assistive devices;\n6. Communication to the primary health care practitioner or practitioners\nand referral to other health care practitioners, as needed;\n7. Appropriate follow-up with evaluation of outcomes; and\n8. Documentation of the encounter in a patient record;\n(d) \"Qualified clinical lactation care practitioner\" means a licensed health care\npractitioner wherein lactation consultation is within their legal scope of\npractice; and\n(e) \"Telehealth\" or \"digital health\" has the same meaning as in KRS 211.332.\n(2) The Department f or Medicaid Services and any managed care organization with\nwhich the department contracts for the delivery of Medicaid services shall provide\ncoverage:\n(a) For lactation consultation;\n(b) For breastfeeding equipment;\n(c) To pregnant and postpartum women for an in-home program; and\n(d) For telehealth or digital health services that are related to maternity care\nassociated with pregnancy, childbirth, and postpartum care.\n(3) The coverage required by this section shall:\n(a) Not be subject to:\n1. Any cost-sharing requirements, including but not limited to copayments,\nunless otherwise required under federal law; or\n2. Utilization management requirements, including but not limited to prior\nauthorization, prescription, or referral, except as permitted in paragraph\n(d) of this subsection;\n(b) Be provided in conjunction with each birth for the duration of breastfeeding,\nas defined by the beneficiary;\n(c) For lactation consultation, include:\n1. In-person, one-on-one consultation, including home visits, regardless of\nlocation of service provision;\n2. The delivery of consultation via telehealth, as defined in KRS 205.510,\nif the beneficiary requests telehealth consultation in lieu of in -person,\none-on-one consultation; or\n3. Group consultation, if the beneficiary requests group consultation in lieu\nof in-person, one-on-one consultation; and\n(d) For breastfeeding equipment, include:\n1. Purchase of a single -user, double electric breast pump, or a manual\npump in lieu of a double electric breast pump, if requested by the\nbeneficiary;\n2. Rental of a multi-user breast pump on the recommendation of a licensed\nhealth care provider; and\n3. Two (2) breast pump kits as well as appropriately sized breast pump\nflanges and other lactation accessories recommended by a health care\nprovider.\n(4) (a) The breastfeeding equipment described in subsection (3)(d) of this section\nshall be furnished within forty -eight (48) hours of notification of need, if\nrequested after the birth of the child, or by the later of two (2) weeks before\nthe beneficia ry's expected due date or seventy -two (72) hours after\nnotification of need, if requested prior to the birth of the child.\n(b) If the department cannot ensure delivery of breastfeeding equipment in\naccordance with paragraph (a) of this subsection, an individual may purchase\nequipment and the department or a managed care organization with whom the\ndepartment contracts for the delivery of Medicaid services shall reimburse the\nindividual for all out-of-pocket expenses incurred by the individual, including\nany balance billing amounts.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57023","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"d4e2f964019c2a6b1468608772bfed4ca91bb80e151e5c4f6183b6bb56ad4181","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.553","next":"us-ky/krs-205.557"},"notice":"GroundRules: Original legal text. Not legal advice."}