Common use of Family Planning and Reproductive Health Services Clause in Contracts

Family Planning and Reproductive Health Services. a) Nothing in this Agreement shall restrict the right of Enrollees to receive Family Planning and Reproductive Health Services from any qualified Medicaid provider, regardless of whether the provider is a participating provider or a non-participating provider, without referral from the Enrollee's PCP and without approval from the Contractor. b) The Contractor agrees to permit Enrollees to exercise their right to obtain Family Planning and Reproductive Health Services as defined in Part C-l of Appendix C, which is hereby made a part of this contract as if set forth fully herein, from either the Contractor, if family planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating Family Planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. c) The Contractor agrees to permit Enrollees to obtain pre and post-test HIV counseling and blood testing when performed as part of a Family Planning encounter from the Contractor, if Family Planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating family planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. d) The Contractor will inform Enrollees about the availability of in-plan HIV counseling and testing services, out-of-plan HIV counseling and testing services when performed as part of a Family Planning encounter and anonymous counseling and testing services available from SDOH, Local Public Health Agency clinics and other county programs. Counseling and testing rendered outside of a Family Planning encounter, as well as services provided as the result of an HIV+ diagnosis, will be furnished by the Contractor in accordance with standards of care.

Family Planning and Reproductive Health Services. a) Nothing in this Agreement shall restrict the right of Enrollees to receive Family Planning and Reproductive Health Services Services, as defined in Appendix C of this Agreement, which is hereby made a part of this Agreement as if set forth fully herein. Enrollees may receive such services from any qualified Medicaid provider, regardless of whether the provider is a participating provider Participating or a nonNon-participating providerParticipating Provider, without referral from the Enrollee's ’s PCP and without approval from the Contractor. b) The Contractor agrees to permit Enrollees to exercise their right to obtain Family Planning and Reproductive Health Services as defined Services. The Contractor shall include Family Planning and Reproductive Health services in its Benefit Package and shall comply with the requirements in Part C-l C.2 of Appendix C, which is hereby made a part C of this contract as if set forth Agreement, including assuring that Enrollees are fully herein, from either the Contractor, if family planning is a part informed of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating Family Planning Provider without a referral from the Enrollee's PCP and without approval by the Contractortheir rights. c) The Contractor agrees to permit Enrollees to obtain pre and post-test HIV counseling and blood testing when performed as part of a Family Planning encounter from the Contractor, if Family Planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating family planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. d) The Contractor will inform Enrollees about the availability of in-plan HIV counseling counseling, testing, referral, and testing partner notification services, out-of-plan HIV counseling testing, referral, and testing partner notification services when performed as part of a Family Planning encounter and anonymous counseling HIV counseling, testing, referral, and testing partner notification services available from SDOH, Local Public Health Agency clinics and other county programs. Counseling HIV counseling, testing, referral, and testing partner notification services rendered outside of a Family Planning encounter, as well as services provided as the result of an HIV+ diagnosisa diagnosis of HIV infection, will be furnished by the Contractor in accordance with standards of care. e) Contractor must comply with federal, state, and local laws, regulations and policies regarding informed consent and confidentiality. Providers who are employed by the Contractor may share patient information with appropriate Contractor personnel for the purposes of claims payment, utilization review and quality assurance. Providers who have a contract with the Contractor, with an appropriate enrollee consent, may share patient information with the Contractor for purposes of claims payment, utilization review and quality assurance. Contractor must ensure that an individual's use of family planning services remains confidential and is not disclosed to family members or other unauthorized parties. f) Contractor must inform its practitioners and administrative personnel about policies concerning free access to family planning services, HIV counseling, testing, referral, and partner notification services, reimbursement, enrollee education and confidentiality. Contractor must inform its providers that they must comply with professional medical standards of practice, the Contractor’s practice guidelines, and all applicable federal, state, and local laws. These include but are not limited to, standards established by the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the U.S. Task Force on Preventive Services, the New York State Child/Teen Health Program, and the AIDS Institute. These standards and laws indicate that family planning counseling is an integral part of primary and preventive care. g) The Contractor agrees that the Contractor will be charged for the services of out-of-network providers at the applicable Medicaid rate or fee. In such instances, out of network providers will bill Medicaid and the SDOH will issue a confidential charge back to the Contractor. Such a charge back mechanism will comply with all applicable patient confidentiality requirements. h) The Contractor shall comply with the requirements for informing Enrollees about family planning and reproductive health services set forth in Part C-2 of Appendix C, which is hereby made a part of this Agreement as if set forth herein. i) SDOH with DHHS approval may issue modifications to Appendix (C) consistent with relevant provisions of federal and state statutes and regulations. Once issued and upon sixty (60) days notice to the LDSS and Contractor, such modifications shall be deemed incorporated into this Agreement without further action by the parties.

Family Planning and Reproductive Health Services. a) Nothing in this Agreement shall restrict the right of Enrollees to receive Family Planning and Reproductive Health Services from any qualified Medicaid provider, regardless of whether the provider is a participating provider or a non-participating provider, without referral from the Enrollee's PCP and without approval from the Contractor. b) The Contractor agrees to permit Enrollees to exercise their right to obtain Family Planning and Reproductive Health Services as defined in Part C-l C-1 of Appendix C, which is hereby made a part of this contract as if set forth fully herein, from either the Contractor, if family planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating Family Planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. c) The Contractor agrees to permit Enrollees to obtain pre and post-test HIV counseling and blood testing when performed as part of a Family Planning encounter from the Contractor, if Family Planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating family planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. d) The Contractor will inform Enrollees about the availability of in-plan HIV counseling and testing services, out-of-plan HIV counseling and testing services when performed as part of a Family Planning encounter and anonymous counseling and testing services available from SDOH, Local Public Health Agency clinics and other county programs. Counseling and testing rendered outside of a Family Planning encounter, as well as services provided as the result of an HIV+ diagnosis, will be furnished by the Contractor in accordance with standards of care.

Family Planning and Reproductive Health Services. a) Nothing in this Agreement shall restrict the right of Enrollees to receive Family Planning and Reproductive Health Services from any qualified Medicaid providerParticipating Provider of such services if the MCO provides Family Planning and Reproductive Services, regardless of whether or directly from a provider affiliated with the provider is a participating provider or a non-participating provider, Designated Third Party Contractor if such services are not provided directly by the MCO without referral from the Enrollee's PCP and without approval from the Contractor. b) The Contractor agrees to permit Enrollees to exercise their right to obtain Family Planning and Reproductive Health Services as defined in Part C-l C-1 of Appendix C, which is hereby made a part of this contract FHPlus - Section 10 (BENEFIT PACKAGE, COVERED AND NON-COVERED SERVICES) October 1, 2001 10-3 Agreement as if set forth fully herein, from either the Contractor, if family planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating Family Planning Provider the Designated Third Party Contractor, where applicable, without a referral from the Enrollee's PCP and without approval by the Contractor. c) The Contractor agrees to permit Enrollees to obtain pre and post-test HIV counseling and blood testing when performed as part of a Family Planning encounter from the Contractor, if Family Planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating family planning Provider the Designated Third Party Contractor, where applicable, without a referral from the Enrollee's PCP and without approval by the Contractor. d) The Contractor will inform Enrollees about the availability of in-plan HIV counseling and testing services, out-of-plan HIV counseling and testing services when performed as part of a Family Planning encounter and anonymous counseling and testing services available from SDOH, Local Public Health Agency clinics and other county programs. Counseling and testing rendered outside of a Family Planning encounter, as well as services provided as the result of an HIV+ diagnosis, will be furnished by the Contractor in accordance with standards of care. e) Contractor must comply with federal, state, and local laws, regulations and policies regarding informed consent and confidentiality. Providers who are employed by the Contractor and/or the Designated Third Party Contractor, where applicable, may share patient information with appropriate Contractor personnel for the purposes of claims payment, utilization review and quality assurance. Providers who have a contract with the Contractor, may share patient information with the Contractor and/or the Designated Third Party Contractor, where applicable, for purposes of claims payment, utilization review and quality assurance when the appropriate patient consent has been obtained. The Contractor and/or Designated Third Party Contractor, where applicable, must ensure that an individual's use of family planning services remains confidential and is not disclosed to family members or other unauthorized parties. f) Contractor must inform and educate its practitioners and administrative personnel about policies concerning direct access to family planning services, HIV counseling and testing, reimbursement, enrollee education and confidentiality. Contractor must inform its providers that they must comply with professional medical standards of practice, the Contractor's practice guidelines, and all applicable federal, state, and local laws. These include but are not limited to, standards established by this American College of Obstetricians and FHPlus - Section 10 (BENEFIT PACKAGE, COVERED AND NON-COVERED SERVICES) October 1, 2001 10-4 Gynecologists, the American Academy of Family Physicians, the U.S. Task Force on Preventive Services and the New York State Child/Teen Health Program. These standards and laws identify family planning counseling as an integral part of primary and preventive care. g) If Contractor includes family planning and reproductive health services in its benefits package, the Contractor shall comply with the requirements for informing Enrollees about family planning and reproductive health services set forth in Part C-2 of Appendix C, which is hereby made a part of this Agreement as if set forth herein. h) If Contractor does not include family planning and reproductive health services in its Benefit Package, Contractor must submit to the SDOH, within ninety (90) days of signing this Agreement, a statement of the policy and procedure that the Contractor will use to ensure that its Enrollees are fully informed of their rights to access a full range of family planning and reproductive health services. Refer to Part C-3 of Appendix C for the SDOH Guidelines for Plans That Do Not Provide Family Planning Services in their Capitation. Contractor shall ensure that prospective Enrollees and Enrollees are advised of the family planning services which are not provided by the Contractor and of their right of access to such services in accordance with the provisions of Part C-3 of Appendix C, which is hereby made a part of this Agreement as if set forth fully herein. i) SDOH with DHHS approval may issue modifications to Appendix (C) consistent with relevant provisions of federal and state statutes and regulations. Once issued and upon sixty (60) days notice to the Contractor, such modifications is shall be deemed incorporated into this Agreement without further action by the parties.

Family Planning and Reproductive Health Services. a) Nothing in this Agreement shall restrict the right of Enrollees to receive Family Planning and Reproductive Health Services from any qualified Medicaid provider, regardless of whether the provider is a participating provider or a non-participating provider, without referral from the Enrollee's PCP and without approval from the Contractor. b) The Contractor agrees to permit Enrollees to exercise their right to obtain Family Planning and Reproductive Health Services as defined in Part C-l C-1 of Appendix C, which is hereby made a part of this contract as if set s et forth fully herein, from either the Contractor, if family planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating Family Planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. c) The Contractor agrees to permit Enrollees to obtain pre and post-test HIV counseling and blood testing when performed as part of a Family Planning encounter from the Contractor, if Family Planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating family planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. d) The Contractor will inform Enrollees about the availability of in-plan HIV counseling and testing services, out-of-plan HIV counseling and testing services when performed as part of a Family Planning encounter and anonymous counseling and testing services available from SDOH, Local Public Health Agency clinics and other county programs. Counseling and testing rendered outside of a Family Planning encounter, as well as services provided as the result of an HIV+ diagnosis, will be furnished by the Contractor in accordance with standards of care.

Family Planning and Reproductive Health Services. a) Nothing in this Agreement shall restrict the right of Enrollees to receive Family Planning and Reproductive Health Services from any qualified Medicaid provider, regardless of whether the provider is a participating provider or a non-participating participating. provider, without referral from the Enrollee's PCP and without approval from the Contractor. b) . The Contractor agrees to permit Enrollees to exercise their right to obtain Family Planning and Reproductive Health Services as defined in Part C-l C-1 of Appendix C, which is hereby made a part of this contract as if set forth fully herein, from either the Contractor, if family planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid Medicaid. enrolled Non-Participating Family Planning Provider without a referral from the Enrollee's PCP and without approval by the Contractor. c) . The Contractor agrees to permit Enrollees to obtain pre and post-test HIV counseling and blood testing when performed as part of a Family Planning encounter from the Contractor, if Family Planning is a part of the Contractor's Benefit Package, or from any appropriate Medicaid enrolled Non-Participating family planning Provider without a referral from the Enrollee's PCP and AND. without approval by the Contractor. d) . The Contractor will inform Enrollees about the availability of in-plan HIV counseling and testing services, out-of-plan HIV counseling and testing services when performed as part of a Family Planning encounter and anonymous counseling and testing services available from SDOH, Local Public Health Agency Agency, clinics and other county programs. Counseling and testing rendered outside of a Family Planning encounter, as well as services provided as the result of an HIV+ diagnosis, will be furnished by the Contractor in accordance with standards of care.