Services covered and limitations

Except for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed and certified nurse-midwife which conform to accepted methods of diagnosis and treatment, but shall not pay for any procedures or services of an unproven, educational, social, research, experimental, or cosmetic nature; for services in excess of those deemed medically necessary and medically appropriate by the department to treat the client’s condition; or for services not directly related to the client’s diagnosis, symptoms, or medical history. (a) The department shall pay for the following: (1) services provided in the provider’s office, client’s home, hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID), chronic disease hospital, boarding home, state-owned or -operated institution, or home for the aged; and (2) family planning services as described in the Regulations of Connecticut State Agencies. (b) Limitations on covered services shall be as follows: (1) services concerned with the care and management of the care of essentially normal mothers and newborns, only throughout the maternity cycle, and well-woman gynecological care, including family planning services; and (2) services covered shall be limited to these listed in the department’s applicable fee schedule.