OHCA Policies and Rules

OHCA Policies and Rules Main Page

317:30-5-232. Coverage

[Revised 09-11-23]

Lactation Consultant services are covered for pregnant women and women up to twelve (12) months postpartum.  SoonerCare members may self-refer or be referred by any provider.  Reasons for lactation services include but are not limited to the following:

(1) Prenatal education/training for first-time mothers;

(2) Women who have not previously breastfed, have a history of breastfeeding difficulty, have identified risk factors for breastfeeding difficulty or lactation insufficiency (e.g., history of breast surgery, infertility, hormonal imbalance, diabetes, obesity);

(3) Women expecting an infant with risk factors for ineffective breastfeeding (e.g., preterm, multiples, congenital birth defects);

(4) Latch-on difficulties;

(5) Low milk supply;

(6) Breastfeeding a premature baby (thirty-six (36) weeks or less gestation);

(7) Breastfeeding multiples; and

(8) A baby with special needs (e.g., Down Syndrome, cleft lip/or palate).

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.