New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 509 - FAMILY PLANNING EXPANSION CATEGORY (FPEC)
Section He-W 509.06 - Covered Services
Universal Citation: NH Admin Rules He-W 509.06
Current through Register No. 40, October 3, 2024
(a) The services in (b) and (c) below shall be covered as family planning services and family planning-related services, respectively, only if the services, supplies, and procedures are clearly provided or performed for family planning purposes.
(b) The following services shall be covered as family planning services:
(1) Those
physician services in accordance with He-W 531, certified midwife services in
accordance with He-W 538, and advanced registered nurse practitioner services
in accordance with He-W 534, provided for family planning purposes;
(2) Contraceptive devices or drugs, both
prescription and non-prescription, in accordance with He-W 570;
(3) Pregnancy tests and screening for a
sexually transmitted disease (STD) only when performed routinely as part of an
initial, regular, or follow-up family planning visit; and
(4) Sterilization, in accordance with
42 CFR
441.253 and
42 CFR
441.254, as follows:
a. The FPEC recipient shall be at least 21
years old at the time consent is obtained;
b. The FPEC recipient shall not be a mentally
incompetent individual;
c. The FPEC
recipient shall not be an institutionalized individual;
d. The FPEC recipient shall voluntarily give
informed consent in accordance with the requirements at
42 CFR
441.257 through
42 CFR
441.258;
e. The provider shall submit a sterilization
consent form meeting the requirements of 42 CFR 441, Subpart F, to the
department prior to the department's payment for the sterilization
claim;
f. At least 30 days, but not
more than 180 days, shall have passed between the date of informed consent and
the date of sterilization, with the exception of cases of premature delivery or
emergency abdominal surgery as described in g. below;
g. A FPEC recipient may consent to be
sterilized at the time of an emergency abdominal surgery if at least 72 hours
have passed since he or she gave informed consent for the sterilization; and
h. Treatment of surgical or
anesthesia-related complications resulting from or during a covered
sterilization procedure shall be covered; and
(5) Family planning-related services that
were provided as part of, or as follow-up to, a family planning visit in which
a sterilization procedure took place.
(c) The following services shall be covered as family planning-related services:
(1)
Services to treat adverse reactions to, or medical complications of, family
planning procedures, services, treatments, or therapies including, but not
limited to:
a. Treatment of perforated uterus
due to an intrauterine device insertion; and
b. Treatment of severe menstrual bleeding
caused by Depo-Provera injection;
(2) Drugs, in accordance with the following:
a. Drugs shall be for the treatment of STDs,
except for HIV/AIDS and hepatitis, when the STD is identified or diagnosed
during a routine or periodic family planning visit; and
b. Title XIX providers shall comply with the
provisions of He-W 570 regarding pharmaceutical services when prescribing or
dispensing drugs covered in a. above;
(3) A follow-up visit after prescribing drugs
for the treatment of an STD, including a re-screen for the STD;
(4) Drugs and other treatment for lower
genital tract and genital skin infections/disorders, and urinary tract
infections, when the infection/disorder is identified/diagnosed during a
routine/periodic family planning visit;
(5) A follow-up visit for drugs and other
treatment of the lower genital tract and genital skin infections or disorders
where the infections or disorder is identified during a family planning visit;
and
(6) Vaccinations to prevent
cervical cancer that are routinely provided pursuant to a family planning
service in a family planning setting.
#10357, eff 7-1-13
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