Family Planning Services. Members may receive Covered Services for Family Planning from any OHA Provider as specified in the Social Security Act, Section 1905 [42 U.S.C. 1396d], 42 CFR 431.51 and defined in OAR 000-000-0000. To the extent the Member chooses to receive such services without Contractor’s authorization from a Provider other than Contractor or its Subcontractors, Contractor is not responsible for payment, Case Management, or Record Keeping.
Family Planning Services a. The Health Plan shall provide family planning services for the purpose of enabling Enrollees to make comprehensive and informed decisions about family size and/or spacing of births. The Health Plan shall provide the following services: planning and referral, education and counseling, initial examination, diagnostic procedures and routine laboratory studies, contraceptive drugs and supplies, and follow-up care in accordance with the Medicaid Physicians Services Coverage and Limitations Handbook. Policy requirements include:
(1) The Health Plan shall furnish services on a voluntary and confidential basis.
(2) The Health Plan shall allow Enrollees freedom of choice of family planning methods covered under the Medicaid program, including Medicaid covered implants, where there are no medical contra-indications.
(3) The Health Plan shall render the services to Enrollees under the age of eighteen (18) provided the Enrollee is married, a parent, pregnant, has written consent by a parent or legal guardian, or in the opinion of a physician, the Enrollee may suffer health hazards if the services are not provided. See Section 390.01114, F.S.
(4) The Health Plan shall allow each Enrollee to obtain family planning services from any Provider and require no prior authorization for such services. If the Enrollee receives services from a non-network Medicaid provider, then the Plan must reimburse at the Medicaid reimbursement rate, unless another payment rate is negotiated.
(5) The Health Plan shall make available and encourage all pregnant women and mothers with infants to receive postpartum visits for the purpose of voluntary family planning, including discussion of all appropriate methods of contraception, counseling and services for family planning to all women and their partners. The Health Plan shall direct Providers to maintain documentation in the Enrollee's Medical Records to reflect this provision. See Section 409.912, F.
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 1.3F.
Family Planning Services. Subject to Section 5.3 hereof, Contractor shall cover family planning services for all Enrollees whether the family planning services are provided by an Affiliated or non-Affiliated Provider.
Family Planning Services. Covered Services include: • Family planning counseling and education (see “Health Education” and “Preventive Care” later in this section) • Over the counter FDA approved contraceptive methods as prescribed by a health care Provider (see “Preventive Care” later in thissection) • Women’s contraceptives and sterilization procedures (see “Preventive Care” later in this section) • Abortions
Family Planning Services. 4.6.4.1 The Contractor shall provide access to Family Planning Services within the network to Members and P4HB Participants. In meeting this obligation, the Contractor shall make a reasonable effort to contract with all family planning clinics, including those funded by Title X of the Public Health Services Act, for the provision of Family Planning Services. The Contractor shall verify its efforts to contract with Title X Clinics by maintaining records of communication. The Contractor shall not limit Members' or P4HB Participants freedom of choice for family planning services to In-Network Providers and the Contractor shall cover services provided by any qualified Provider regardless of whether the Provider is In-Network. The Contractor shall not require a Referral if a Member or P4HB Participant chooses to receive Family Planning services and supplies from outside of the network.
4.6.4.2 The Contractor shall inform Members and P4HB Participants of the availability of family planning services and must provide services to Members and P4HB Participants wishing to prevent pregnancies, plan the number of pregnancies, plan the spacing between pregnancies, or obtain confirmation of pregnancy.
4.6.4.3 Family Planning Services and supplies for Members and P4HB Participants include at a minimum: • Education and counseling necessary to make informed choices and understand contraceptive methods; • Initial and annual complete physical examinations including a pelvic examination and Pap test; • Follow-up, brief and comprehensive visits. P4HB Participants are allowed up to four (4) such visits per year of participation in the Demonstration; • Pregnancy testing; • Contraceptive supplies and follow-up care; • Diagnosis of sexually transmitted infections; • Treatment of sexually transmitted infections with the following exception – P4HB Participants are excluded from receiving drugs for the treatment of HIV/AIDS and hepatitis under the Demonstration; • For P4HB Participants – Drugs, supplies, or devices related to the women’s health services described above that are prescribed by a health care provider who meets the State’s provider enrollment requirement; (subject to the national drug rebate program requirements). • Infertility assessments with the following exception – P4HB Participants are excluded from receiving this benefit.
4.6.4.4 The Contractor shall furnish all services on a voluntary and confidential basis, even if the Member is less than eighteen (18) years of a...
Family Planning Services. 4.6.4.1 The Contractor shall provide access to family planning services within the network. In meeting this obligation, the Contractor shall make a reasonable effort to contract with all family planning clinics, including those funded by Title X of the Public Health Services Act, for the provision of family planning services. The Contractor shall verify its efforts to contract with Title X Clinics by maintaining records of communication. The Contractor shall not limit Members’ freedom of choice for family planning services to In-Network Providers and the Contractor shall cover services provided by any qualified provider regardless of whether the provider is In-Network. The Contractor shall not require a Referral if a Member chooses to receive family planning services and supplies from outside of the network.
4.6.4.2 The Contractor shall inform Members of the availability of family planning services and must provide services to Members wishing to prevent pregnancies, plan the number of pregnancies, plan the spacing between pregnancies, or obtain confirmation of pregnancy.
4.6.4.3 Family planning services and supplies include at a minimum:
4.6.4.3.1 Education and counseling necessary to make informed choices and understand contraceptive methods;
4.6.4.3.2 Initial and annual complete physical examinations;
4.6.4.3.3 Follow-up, brief and comprehensive visits;
4.6.4.3.4 Pregnancy testing;
4.6.4.3.5 Contraceptive supplies and follow-up care;
4.6.4.3.6 Diagnosis and treatment of sexually transmitted diseases; and
Family Planning Services. (A) The MCO must comply with the sterilization consent procedures required by the federal government, and must ensure open access to Family Planning Services pursuant to 42 CFR § 431.51, and the Family Planning Services prescribed by Minnesota Statutes, § 62Q.14.
(B) The MCO may not restrict where the Enrollee receives the following services, pursuant to Minnesota Statutes, § 62Q.14:
(1) Voluntary planning of the conception and bearing of Children, not including abortion services;
(2) Diagnosis of infertility, including counseling and services related to the diagnosis (i.e., Provider visit(s) and test(s) necessary to make a diagnosis of infertility and to inform the Enrollee of the results);
(3) Testing and treatment of a sexually-transmitted disease; and
(4) Testing for AIDS and other HIV-related conditions.
(C) The MCO may require family planning agencies and other Providers to refer patients back to the MCO under the following circumstances for other services, diagnosis, treatment and follow-up:
(1) Abnormal pap smear/colposcopy;
(2) Infertility treatment;
(3) Medical care other than Family Planning Services;
(4) Genetic testing; and
(5) HIV treatment.
(D) Pursuant to 42 CFR § 433.116(f)(2), the MCO shall not specify confidential services, as defined by the STATE, in Notices about claims sent to the Enrollee, including the Explanation of Benefit and/or Explanation of Medical Benefit Notices.
Family Planning Services. Total served: The unduplicated number of individuals receiving family planning services. *The ’Total Served’ cell will provide you with the sum of Medicaid, CHIP, Private, Other, and Unknown cells. Total infants served: the unduplicated number of infants less than 1 year of age who received services. *The ’Total Served’ cell will provide you with the sum of Medicaid, CHIP, Private, Other, and Unknown cells.
Family Planning Services. 4.5.8.1 Federal law prohibits restricting access to family planning services for Medicaid recipients. The CONTRACTOR shall implement written policies and procedures, previously approved by HSD, that define how Members are educated about their right to family planning services, freedom of choice (including access to Non-Contract Providers) and methods for accessing family planning services. The family planning policy shall ensure that Members of the appropriate age of both sexes who seek family planning services shall be provided with counseling pertaining to the following:
4.5.8.1.1 HIV and other sexually transmitted diseases and risk reduction practices;
4.5.8.1.2 Birth control pills and devices (including Plan B);and
4.5.8.1.3 That Members can self-refer to Non-Contracted family planning providers.
