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2019-15: LDH Issues HPA Regarding Breast Pump Coverage- Attestation and Equipment Requirements

Date: 03/06/19

Louisiana Department of Health released Health Plan Advisory (HPA) 19-4 on February 12, 2019 establishing guidelines to Durable Medical Equipment (DME) providers. Effective April 1, 2019, Louisiana Medicaid will require an attestation for breast pump coverage. All DME providers will be required to obtain a signed Electric Breast Pump Request form from patients at the time of sale.

The Breast Pump Request Form will be located on www.lamedicaid.com under Forms, Files and User Manuals and will also be included in the DME provider manual as Appendix I. DME providers should submit the completed form with the claim for medical review. 

HPA 19-4 also outlined minimum criteria that all Medicaid recipients must meet for an electric breast pump to be dispensed:

  • Have an adjustable suction pressure rate with either written instructions or an automatic mechanism to prevent a suction greater than 250 mm Hg;
  • Be adaptable for simultaneous pumping of both breasts (double-collection);
  • Automatically cycle with an adjustable variable cycling rate, typically 30 to 60 or more cycles per minute;
  • Include a battery option and adapter to be used as an alternate power source when electricity is not immediately available;
  • Breast shields (flanges) that are adjustable and flexible, or flanges that are available in several different sizes if rigid, including larger sizes;
  • All accessories necessary for pumping two breasts simultaneously for electric pumps;
  • At least two collection bottles with spill-proof standard size caps, that are bisphenol-A (BPA) and diethylhexyl phthalate (DEHP) free; and
  • Accessories and supplies must be compatible with the pump provided. Materials must be of durable quality for withstanding repeated boiling, washing and pumping use.

Click here to read the advisory.