Family Planning. Although family planning services are included within the MCO’s list of covered benefits, Medicaid enrollees are entitled to obtain all Medicaid covered family planning services without prior authorization through any Medicaid provider, who will bill the MCO and be paid on a fee- for-service basis.3 The MCO must give each enrollee, including adolescents, the opportunity to use his/her own primary care provider or go to any family planning center for family planning services without requiring a referral. The MCO must make a reasonable effort to Subcontract with all local family planning clinics and providers, including those funded by Title X of the Public Health Services Act, and must reimburse providers for all family planning services regardless of whether they are rendered by a participating or non-participating provider. Unless otherwise negotiated, the MCO must reimburse providers of family planning services at the Medicaid rate. The MCO may, however, at its discretion, impose a withhold on a contracted primary care provider for such family planning services. The MCO may require family planning providers to submit claims or reports in specified formats before reimbursing services. MCOs must provide their Medicaid enrollees with sufficient information to allow them to make an informed choice including: the types of family planning services available, the availability of long-acting reversible contraceptives (LARC), their right to access these services in a timely and confidential manner, and their freedom to choose a qualified family planning provider both within and outside the MCO’s network of providers. In addition, MCOs must ensure that network procedures for accessing family planning services are convenient and easily 3 Access to family planning services without prior notification is a federal law. Under OBRA 1987 Section 4113(c)(1)(B), “enrollment of an individual eligible for medical assistance in a primary case management system, a health maintenance organization or a similar entity shall not restrict the choice of the qualified person, from whom the individual may receive services under Section 1905(a)(4)(c).” Therefore, Medicaid recipients must be allowed freedom of choice of family planning providers and may receive such services from any family planning provider, including those outside the MCO’s provider network, without prior authorization. comprehensible to members. MCOs must also educate members regarding the positive impact of coordina...
Family Planning. The Contractor shall demonstrate that its network includes sufficient family planning providers to ensure timely access to covered services.
Family Planning family planning medical services, family planning counseling services, follow-up health care, outreach, and community education. Group Adult Xxxxxx Care - services ordered by a physician delivered to an Enrollee in a group housing residential setting such as assisted living, elderly, subsidized or supportive housing. Group Adult Xxxxxx Care services are based upon an individual plan of care and include: assistance with Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), and other personal care as needed, nursing services and oversight and care management. Assistance with ADLs, IADLs and other personal care is provided by a direct care worker that is employed or contracted by the Group Adult Xxxxxx Care Provider, Nursing services and oversight and care management are provided by a multidisciplinary team. Hearing Aid Services – including but not limited to diagnostic services, hearing aids or instruments, and services related to the care and maintenance of hearing aids or instruments. Home Health— all home health care services, including DME associated with such services; part-time or intermittent skilled nursing care and home health services; physical, occupational, and speech language therapy; and medical social services. Hospice – a package of services such as nursing; medical social services; physician; counseling, including bereavement, dietary, spiritual, or other types of counseling; physical, occupational, and speech language therapy; homemaker/home health aide; medical supplies, drugs, biological supplies; and short term inpatient care. Independent Nursing – continuous skilled nursing services to individuals living in the community Inpatient Hospital Services— all inpatient services, including but not limited to physician, surgery, radiology, nursing, laboratory, other diagnostic and treatment procedures, blood and blood derivatives, semi-private or private room and board, drugs and biologicals, medical supplies, durable medical equipment, and medical surgical/intensive care/coronary care unit, as necessary, at any of the following settings:
Family Planning. Family planning services include the following: • Prescription contraceptive drugs or devices; • Coverage for the insertion or removal of contraceptive devices; • Medically Necessary examination associated with the use of contraceptive drugs or devices; and • Voluntary female or male sterilization, including associated anesthesia.
Family Planning. Services Benefits will be provided for:
A. Non-Preventive Gynecological Care Benefits are available for Medically Necessary gynecological care. Benefits for preventive gynecological care are described in Section 1.3.F.
Family Planning. The Orange County Health Care Agency is a FamilyPACT provider of family planning and pregnancy testing services. Services are provided in accordance with regulations specified by State Office of Family Planning (OFP) and Title X regulations and guidelines. The Standards of Care, promulgated by the State in cooperation with the American College of Obstetricians and Gynecologists (ACOG) and Title X, are the required level of care for all family planning providers and are used as a basis for evaluation of services. Eligibility/ Client Services County/Family Planning will provide family planning services to FamilyPACT eligible CalOptima Direct or CalOptima Health Network members choosing to seek such services outside of their Health Network or CalOptima. CalOptima recognizes that CalOptima Direct or CalOptima Health Network members have the right to choose to seek their family planning services outside of the Health Network/CalOptima. Upon request, CalOptima will provide Health Networks and providers information about low cost/free family planning services for members who lose eligibility. CalOptima, its Health Networks and providers will not require prior authorization for in-network or out- of-network family planning services. CalOptima, its Health Networks and providers will not require parental consent for family planning services for a member under 21 years. QUALITY ASSURANCE: CalOptima will respond to issues of Health Networks inappropriately requesting prior authorization for family planning services, and will take necessary corrective action. Follow-Up Services CalOptima beneficiaries receiving family planning services at County Family Planning clinics who require follow-up of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not covered by the DHS definition of family CalOptima Health Networks and Providers will provide family planning services and/or care of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not CATEGORY County Family Planning Clinic CalOptima/Health Networks planning services will be referred to their CalOptima Health Network provider for continuing care. covered by the DHS definition of family planning services to CalOptima members referred by County Family Planning clinics. Provider Network Education County Health Referral Line will provide CalOptima members upon request with communit...
Family Planning. All U.S. Food and Drug Administration (“FDA”) approved contraceptive methods are covered by this plan. FDA- approved contraceptive services provided in the office or outpatient setting, such as intrauterine devices (IUDs) and subdermal implants, including the insertion and removal, and voluntary sterilization procedures, including vasectomy and tubal ligation, are covered under the Family Planning benefit with no Cost-Sharing when provided by In-Network providers. Contraceptive methods that require a prescription, including oral contraceptives, transdermal patches, the vaginal ring, Medroxyprogesterone injections and emergency contraceptives, are covered under the Prescription Drug benefit and located in the Formulary. FDA-approved over-the-counter contraceptive products for women, such as sponges and spermicides, are covered under the Prescription Drug benefit only when prescribed by a qualified Provider. Voluntary termination of pregnancy is covered for female Members of this plan. Genetic testing, counseling, interventions, therapy and other genetic services are covered when determined to be Medically Necessary care or treatment of a covered condition, or a Medically Necessary precursor to obtaining prompt treatment of a covered condition. This benefit does not include genetic testing of a child’s father as a part of prenatal or newborn care.
Family Planning. Although family planning services are included within the MCO’s list of covered benefits, Medicaid enrollees are entitled to obtain all Medicaid covered family planning services without prior authorization through any Medicaid provider, who will bill the MCO and be paid on a fee-for-service basis.3 The MCO must give each enrollee, including adolescents, the opportunity to use his/her own primary care provider or go to any family planning center for family planning services without requiring a referral. The MCO must make a reasonable effort to Subcontract with all local family planning clinics and providers, including those funded by Title X of the Public Health Services Act, and must reimburse providers for all family planning services regardless of whether they are rendered by a participating or non-participating provider. Unless otherwise negotiated, the MCO must reimburse providers of family planning services at the Medicaid rate. The MCO may, however, at its discretion, impose a withhold on a contracted primary care provider for such family planning services. The MCO may require family planning providers to submit claims or reports in specified formats before reimbursing services. MCOs must provide their Medicaid enrollees with sufficient information to allow them to make an informed choice including: the types of family planning services available, their right to access these services in a timely and confidential manner, and their freedom to choose a qualified family planning provider both within and outside the MCO’s network of providers. In addition, MCOs must ensure that network procedures for accessing family planning services are convenient and easily comprehensible to members. MCOs must also educate members regarding the positive impact of coordinated care on their health outcomes, so members will prefer to access in-network services or, if they should decide to see out-of-network providers, they will agree to the exchange of medical information between providers for better coordination of care. In addition, MCOs are required to provide timely reimbursement for out-of-network family planning and related STD services consistent with services covered in their contracts. The reimbursement must be provided at least at the applicable West Virginia Medicaid fee-for- service rate appropriate to the provider type (current family planning services fee schedule available from BMS). The MCO, its staff, contracted providers and its contractors that are prov...
Family Planning. Family planning Services include:
Family Planning. SPECIFIC REQUIREMENTS ---------------------------------------
