Current through Register Vol. 49, No. 9, September, 2024
217.220
Other Contraceptive Methods
12-01-21
Additional contraceptive methods covered by Medicaid
are:
A. Contraceptive implant systems,
their implantations and removal,
B.
Intrauterine devices (IUD) and
C.
Depo-Provera injections
214.333
Contraception 12-01-21
A. Prescription and Non-Prescription
Contraceptives
1. Medicaid covers birth
control pills and other prescription contraceptives as a family planning
prescription benefit.
2. Medicaid
covers non-prescription contraceptives as a family planning benefit when a
physician writes a prescription for them.
B Contraceptive Implant Systems.
1. Medicaid covers the contraceptive implant
systems, including implants and supplies.
2. Medicaid covers insertion, removal and
removal with reinsertion.
C. Intrauterine Device (IUD)
1. Medicaid pays for IUDs as a family
planning benefit.
2. Alternatively,
Medicaid reimburses physicians that supply the IUD at the time of
insertion.
3. Medicaid pays
physicians for IUD insertion and removal.
D. Medroxyprogesterone Acetate
Medicaid covers medroxyprogesterone acetate injections for
birth control.
E.
Sterilization
1. All adult (21 or older) male
or female Medicaid beneficiaries who are mentally competent are eligible for
sterilization procedures as long as they remain Medicaid-eligible.
2. Medicaid covers Occlusion by Placement of
Permanent Implants. Coverage includes the procedure, the implant device and
follow-up procedures as specified in Section 252.430.
3. Refer to Sections 252.430 through 252.431
of this manual for family planning procedure codes and billing instructions for
family planning services.
215.250
Contraception 12-01-21
A. Prescription and Non-Prescription
Contraceptives
1. Medicaid pays for birth
control pills and other prescription contraceptives as a family planning
prescription benefit.
2. Medicaid
pays for non-prescription contraceptives as a family planning benefit, when a
certified nurse-midwife writes a prescription for them.
B. Contraceptive Implant Systems
1. Medicaid covers the contraceptive implant
systems, including implants and supplies.
2. Medicaid covers insertion, removal and
removal with reinsertion.
C. Intrauterine Devices (IUDs)
1. Medicaid pays for IUDs as a family
planning benefit.
2. Alternatively,
Medicaid reimburses physicians, nurse practitioners, certified nursemidwives
and clinics who supply the IUD at the time of insertion.
3. Medicaid pays physicians, nurse
practitioners, certified nurse-midwives and clinics for IUD insertion and
removal.
D.
Medroxyprogesterone Acetate
1. Medicaid covers
medroxyprogesterone acetate injections for birth control.
216.513
Contraception
12-01-21
A. Prescription and
Non-Prescription Contraceptives
1. Medicaid
covers birth control pills and other prescription contraceptives as a family
planning prescription benefit.
2.
Medicaid covers non-prescription contraceptives as a family planning benefit
when a physician writes a prescription for them.
B Contraceptive Implant Systems
1. Medicaid covers the contraceptive implant
systems, including implants and supplies.
However, the Arkansas Medicaid family planning Aid Category 69
(FP-W) does not cover this device. However, Medicaid covers the removal of this
device.
2. Medicaid covers
insertion, removal and removal with reinsertion.
C. Intrauterine Device (IUD)
1. Medicaid pays for IUDs as a family
planning benefit.
2. Alternatively,
Medicaid reimburses hospitals that supply the IUD at the time of
insertion.
3. Medicaid pays
hospitals for IUD insertion and removal.
4. Outpatient Global Surgery rules apply. See
Section 272.160.
D.
Medroxyprogesterone Acetate
Medicaid covers medroxyprogesterone acetate injections for
birth control.
E.
Sterilization
1. All adult (21 or older) male
or female Medicaid beneficiaries who are mentally competent are eligible for
sterilization procedures as long as they remain Medicaid-eligible.
2. Medicaid covers Occlusion by Placement of
Permanent Implants. Coverage includes the procedure, the implant device and
follow-up procedures as specified in Section 216.515.
3. Refer to Section 216.514 of this manual
for Medicaid policy regarding sterilization.
4. Refer to Sections 216.100,
216.130-216.132, 216.510-216.515, and 216.540
216.550 of this manual for family planning
procedure codes and billing instructions for family planning
services.
243.500
Contraception 12-01-21
A. Prescription
and Non-Prescription Contraceptives
1.
Medicaid covers birth control pills and other prescription contraceptives as a
family planning prescription benefit.
2. Medicaid covers non-prescription
contraceptives as a family planning benefit when a physician writes a
prescription for them.
B
Contraceptive Implant Systems
1. Medicaid
covers the contraceptive implant systems, including implants and
supplies.
2. Medicaid covers
insertion, removal and removal with reinsertion.
C. Intrauterine Device (IUD)
1. Medicaid pays for IUDs as a family
planning benefit.
2. Alternatively,
Medicaid reimburses physicians that supply the IUD at the time of
insertion.
3. Medicaid pays
physicians for IUD insertion and removal.
D. Medroxyprogesterone Acetate
Medicaid covers medroxyprogesterone acetate injections for
birth control.
E.
Sterilization
1. All adult (21 or older) male
or female Medicaid beneficiaries who are mentally competent are eligible for
sterilization procedures as long as they remain Medicaid-eligible.
2. Medicaid covers Occlusion by Placement of
Permanent Implants. Coverage includes the procedure, the implant device and
follow-up procedures as specified in Section 292.553.
3. Refer to Section 251.290 of this manual
for Medicaid policy regarding sterilization.
4. Refer to Sections 292.550 through 292.553
of this manual for family planning procedure codes and billing instructions for
family planning services.
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
MEDICAL ASSISTANCE PROGRAM STATE ARKANSAS
ATTACHMENT 4.19-B
4.
c.
Family Planning Services
Reimbursement is based on the lesser of the amount billed or
the maximum Title XIX (Medicaid) charge allowed. State developed fee schedule
rates are the same for both public and private providers.
1. The Title XIX (Medicaid) maximum for
Family Planning services is one hundred percent (100%) of the current physician
Medicaid maximum.
At the beginning of each calendar year, the State Agency will
negotiate with the affected provider group representatives to arrive at a
mutually acceptable increase or decrease from the maximum rate. Market forces,
such as private insurance rates, medical and general inflation figures, changes
in practice costs and changes in program requirements, will be considered
during the negotiation process. Any agreed upon increase or decrease will be
implemented at the beginning of the following State Fiscal Year, July 1, with
any appropriate State Plan changes.
2.
Long-Acting Reversible
Contraceptives (LARCs)
Effective for claims with dates of service January 1, 2014 and
after, the intrauterine device (IUD) is reimbursed based on one hundred percent
(100%) of the manufacturer's list price as of April 15, 2011. Effective for
claims with dates of service October 1, 2014 and after, the fifty-two
milligrams (52) mg Levonorgestrel-Releasing Intrauterine Contraceptive System
is reimbursed based on one hundred percent (100%) of the manufacturer's list
price as of November 18, 2013. Effective for claims with dates of service
October 1, 2014 and after, the 13.5 mg Levonorgestrel-Releasing Intrauterine
Contraceptive System is reimbursed based on one hundred percent (100%) of the
manufacturer's list price as of January 1, 2013.
Effective for claims with dates of service December 1, 2021,
and after, the reimbursement of Food and Drug Administration approved
Long-Acting Reversible Contraceptives (LARCs) to include the IUD and
contraceptive implants, will be based on Wholesale Acquisition Cost as of
December 1, 2021. Reimbursement will also apply to replacement of LARCs per
manufacturer recommendations, or sooner if medically necessary. Reimbursement
information can be found at the following Physician Fee Schedule.
