An Extension of the Family Planning Program for Select Recipients Alabama Medicaid Agency July 2007

1. An Extension of the Family Planning Program for Select Recipients Alabama Medicaid Agency July 2007

2. Plan First • A Research and Demonstration Waiver for family planning services – federally approved • A collaboration – Dept. of Public Health and Medicaid • Extends family planning and birth control services • Used to prevent or delay pregnancy

3. Overview • Eligibles • Age of Consent • Types of Providers • Goals of Program • Covered Services • Sterilization Rules • Contraceptive Supplies • Care Coordination • PT + 3 Educational Method

4. Who Is Eligible? A woman who: • Has not previously been sterilized • Meets citizenship and alienage requirements • Meets poverty level guidelines • Is between ages of 19-54 • Has one or more SOBRA eligible children • Is a SOBRA pregnant woman • Not postpartum or applying for a child

5. Eligibility Process Automatic enrollment for: • Women with SOBRA eligible children • Women who are SOBRA eligible who lose coverage at end of 60 days postpartum Applications needed for: • Women who are not pregnant and do not have children

6. Provider Types • Physicians • Clinics • Nurse Midwives • Nurse Practitioners • Physician Assistants

7. Covered Services • Doctor/clinic visits for family planning only • Birth control methods such as pills, injections, patch and vaginal ring • Outpatient tubal ligations • Plan First care coordination services for high risk women

8. Covered Services • Initial Visit (99205-FP) • Annual Visit (99214-FP) • Periodic Revisit (99213-FP) • STD/HIV Risk Screening and Pre-HIV test Counseling (99401 with Dx code V259) • STD/HIV Post test counseling (99402 with Dx code V259) • Clinical Protocols

9. Sterilization Rules - Tubal Ligation • Requires a 30 day time span • Consent must be under 180 days between date of signature and procedure • Medicaid eligible at time of procedure • 21 years of age at the time the consent is signed • Mentally competent • Exceptions: premature delivery or emergency abdominal surgery • At least 72 hours must have passed since he/she gave informed consent for sterilization

10. Contraceptive Supplies • Plan First recipients using oral contraceptives, patch or vaginal ring will obtain supplies from the county health department upon referral and a new order form from Plan First provider – good for one year from DOS of an initial/annual visit • Plan First providers will use new “Plan First Patient Contraceptive Order Form” from Agency website after depleting current supplies. • Providers keep inventory log of pills and file claims accordingly until supply is depleted • New form is available at the sites below: www.medicaid.alabama.gov www.adph.org (on-line)

11. Contraceptive Supplies • The Health Department will provide oral contraceptives, patch and vaginal ring as follows: • First time users will initially receive a 3-month supply • Current/previous users will receive a 1-year supply • All contraceptive patch and vaginal ring users will receive a 3-month supply on a quarterly basis

12. Care Coordination Services • Provides for risk assessment • Provides special assistance to women who: • Are at high risk for unintended pregnancy • Need enhanced contraceptive education • Need assistance with removing barriers to successful pregnancy planning • Provided by licensed social workers and nurses at Department of Public Health

13. Plan First Variation • Care coordination services available • PT+3 Method for education • Age (19-44) • Gender (females only) • Aid category (50) • Begins after 60 days postpartum

14. Plan First Variation • Different from “regular” family planning (eligibles do not have full Medicaid benefits) • Have to use enrolled providers (must enroll separately) • List of enrolled providers are located on website • Women will have to recertify each year

15. What is ? PT+3 is a standardized educational method that uses prescribed educational aids designed specifically for a population high risk for unintended pregnancy

16. P – Personalize the Problem = Tackle It! • T – set a therapeutic Tone • A – Assess (learning needs & knowledge) • K – provide with Knowledge • L – Listen for feedback • E – Educate again if needed • +3 - Summarize

17. To Find Out More Information About Plan First: TOLL FREE HOTLINE 1-888-737-2083 or using Agency website for a list of Plan First providers or by contacting the local health department for a list of providers

18. Contact Information • Health Department(supplies) Annie Vosel 334-206-2959 • Medicaid (policy issues) Leigh Ann Payne 334-353-5263 • Provider Assistance Center 800-688-7989 • Recipient Call Center 800-362-1504 • Recipient Call Center Fax 334-215-4140 • Website www.medicaid.alabama.gov • For additional information, select the Programs tab from the top menu bar