Family Planning Benefit Program Audio Conference November 16, 2004

1. Family Planning Benefit Program Audio Conference November 16, 2004

2. This audio conference is presented by the New York State Department of Health Bureau of Women’s Health and Office of Medicaid Management in conjunction with the School of Public Health University at Albany

3. For Additional Information • Contact University at Albany School of Public Health at: 518-402-0330 or • Log on to our website: www.albany.edu/sph/coned/fpbp.html

4. This Broadcast Part I • Overview of the Family Planning Benefit Program (FPBP) and its importance • Services covered by FPBP • Eligibility Part II • Developing a Memorandum of Understanding (MOU) with the Local Department of Social Services to assist patients in enrolling in FPBP • Implementing FPBP – including billing • FPBP enrollment process

5. Presenters for Part I • Dr. Angela Diaz – Professor of Pediatrics, Mt. Sinai School of Medicine and Director of the Mt. Sinai Adolescent Health Center • Dr. Marc Heller – Medical Director, Planned Parenthood Mohawk - Hudson • Dr. Carolyn Westhoff – Medical Director, Family Planning Clinics, New York Presbyterian Hospital

6. Staff from NYS DOH Office of Medicaid Management (OMM) • David Bacheldor, Medicaid Specialist, Division of Consumer and Local District Relations, Office of Medicaid Management • Ron Bass, Assistant Bureau Director, Bureau of Policy Development and Agency Relations, Office of Medicaid Management

7. Presenters for Part II • Cheryl Bequer – Income Maintenance Supervisor, Onondaga County Department of Social Services • Joanne Scanlon – Regional Manager, Financial Assessment and Reimbursement Options, Planned Parenthood of the Rochester/Syracuse Region Inc. • Staff from the NYS DOH Office of Medicaid Management

8. To ask a question: • Fax: 518-869-1969 • Emails: fpbp8123@yahoo.com • Phone: Press the pound symbol (#) followed by number 1 on your phone and an operator will assist you. Questions will be answered at the end of Part I.

9. Family Planning Benefit Program (FPBP) The FPBP provides Medicaid coverage for family planning services to women and men of childbearing age with net incomes at or below 200% of the federal poverty level.

10. Family Planning Benefit Program = Valuable Resource • Provides increased access to family planning services • Enables individuals of childbearing age to prevent or reduce the incidence of unintended pregnancies • Simplifies documentation for minors

11. Why Reduce Unintended Pregnancies? • To lower the pregnancy rates for adolescents ages 15 – 19 • To decrease the percentage of births to women of all ages receiving late or no prenatal care due to unplanned pregnancies

12. Other Important Benefits • To improve birth spacing and outcomes • To facilitate early detection of breast and cervical cancer and to curb the spread of STIs and HIV through health screening done during the family planning visit

13. FPBP and Confidentiality • Confidentiality applies to all Medicaid eligibility information and services • FPBP application asks “Do you need confidential services?” • Patient can be contacted by the provider privately - a different mailing address can be used

14. FPBP Compared to Other Medicaid Programs • Higher income eligibility levels (same as PCAP) • Easy application process • No resource test • Services available fee-for-service only (no managed care enrollment)

15. Who Qualifies? • People who meet income requirements (at or below 200% of Federal Poverty Level) • Minors who cannot provide proof of parents’ income can apply based on their own income • Those not otherwise eligible for Medicaid or Family Health Plus or who choose to only apply for FPBP

16. Eligibility Levels for 2004(200% of FPL)

17. Who Qualifies? (cont.) • New York State Residents • Citizens (includes the 50 states, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands and Samoa or Swain’s Island for purposes of Medicaid) nationals, Native Americans or persons in satisfactory immigration status • Females and males of childbearing age who are still fertile (includes minors)

18. Eligibility • Coverage lasts for two years unless eligibility circumstances change, such as income increasing above 200% of the federal poverty level • Can recertify after 2 years • Can recertify by mail • One page application/recertification form • Documentation needed of any changes

19. Covered Services • Preconception counseling and preventive screening and family planning options • All FDA approved forms of birth control devices, pharmaceuticals, and supplies • Emergency contraception (morning-after pill) and follow-up

20. Covered Services (cont.) • Male & female sterilization (in accordance with federally mandated age limits and informed consent requirements) • Recipient must be 21 years of age or older • Informed consent must be obtained from the patient at least 30 days prior to the sterilization

21. Additional Covered Services • Pregnancy testing and counseling • Counseling services related to: • Pregnancy • STI/HIV risk counseling • Comprehensive reproductive health history • Physical exam, including clinical breast exam Only when provided during a family planning visit and when the service is directly related to family planning

22. Additional Covered Services (cont.) • Screening for STIs, cervical cancer and genito-urinary infections • Screening & related diagnostic testing for conditions impacting contraceptive choice (e.g., glycosuria, proteinuria, hypertension) • HIV counseling and testing • Contraceptive follow up visits Only when provided during a family planning visit and when the service is directly related to family planning

23. Outside Pharmacy Coverage • Available for family planning • Use Medicaid card for family planning supplies • Take Medicaid card to pharmacy for • Prescription contraceptives not carried by provider • Prescription refills • OTC contraceptives (e.g., condoms, foam) • Emergency contraception

24. Services Not Covered • Colposcopy/Cryosurgery/LEEP • Mammography • Pregnancy-related services (prenatal care & pregnancy termination) • Primary care, other than screening and referral • Prescriptions for non-contraceptive drugs (e.g., STI medications) • Follow up services and treatment of non-family planning medical conditions

25. Follow-up Care for non-covered Services • Refer patient to “Federally Qualified Health Center” or other source of low-cost primary care centers: http://www.health.state.ny.us/nysdoh/ mancare/omm/2003/dec2003.htm • Refer patient directly to a provider • Refer patient to Healthy Women’s Partnership for further breast and cervical cancer screening and treatment http://www.health.state.ny.us/nysdoh/cancer/ center/partnerships.htm • Provide treatment and bill as if patient had no insurance

26. Required to Apply for FPBP • Proof of identity including date of birth* • Birth certificate • Driver’s license • Passport • School records • Proof of citizenship/immigration status* • Proof of income in most recent four weeks** • Social Security number • Proof of residency * Under 21 can self-declare if cannot obtain proper documentation ** If under 21 & cannot provide proof of household income, applicant will be judged based on own income

27. Encouraging Patient Enrollment in the FPBP program • Review the benefits of preventing an unintended pregnancy • Emphasize minimal application process – 20 minutes • Emphasize the word “Free” as in no co-payments or deductiblesfor eligible people • Outline the steps needed to secure the required documentation • Emphasize two-year enrollment period • Emphasize minimal recertification process • Direct marketing to men

28. How Do Patients Enroll? Apply at: • Local Department of Social Services (LDSS) • Family planning, private practitioners and other clinics that have a Memorandum of Understanding (MOU) with LDSS to assist patients in enrolling • Contact the Growing Up Healthy Hotline 1(800)522-5006 for a provider in your area

29. How Does a Provider Verify Recipient Eligibility for FPBP? • Health care providers verify a recipient’s eligibility via the Medicaid Eligibility Verification System (MEVS) • MEVS will return the following response for FPBP eligible recipients: “ELIGIBLE ONLY FAMILY PLANNING SERVICES”

30. For More Information About theFamily Planning Benefit Program Go to the NYS Department of Health’s website at: • http://www.health.state.ny.us/nysdoh/ mancare/omm/2003/feb2003.htm • http://www.health.state.ny.us/nysdoh/ mancare/omm/2003/may2003.htm • htpp://www.health.state.ny.us/nysdoh/ medicaid/familyplanbenprog.htm

31. For Additional Information • Clinic billing questions should be directed to Computer Sciences Corporation (518) 447-9810 or (800) 522-1892 • Practitioner billing questions should be directed to Computer Sciences Corporation (518) 447-9860 or (800) 522-5518 • Clinic/Practitioner policy questions should be directed to the Department of Health, Office of Medicaid Management Policy Unit (518) 473-2160

32. Question and Answer Period • Fax: 518-869-1969 • Emails: fpbp8123@yahoo.com • Phone: Press the pound symbol (#) followed by number 1 on your phone and an operator will assist you.

33. Please Complete the Evaluation You can: • Complete your evaluation online at:http://www.informz.net/survistapro/s.asp?id=465 or • Fax your completed evaluation form to (518) 402-1137 or • Mail your completed evaluation to: School of Public Health University at Albany Continuing Education Program One University Place Rensselaer, NY 12144-3456 Your feedback is invaluable. Thank You!

34. To Obtain FreeEducational Materials • Please complete and return the order form which is included in your conference materials.

35. Why Become a FPBP Provider? • To expand services to a previously unserved or underserved population • To receive reimbursement for additional services • Services previously provided for free or at a loss

36. How to Assist with FPBP Applications • Whether you are a clinic or a private provider, consider contacting your Local Department of Social Services (LDSS) to inquire about developing a Memorandum of Understanding (MOU).

37. What is an MOU? • A formal written agreement between an enrolled Article 28 clinic and/or a private practitioner with the LDSS to assist patients in applying for FPBP • Allows a provider or clinic to complete necessary paperwork for determining eligibilityand satisfiesMedicaid requirement for face-to-face interview • Negotiated on a county by county basis (A sample MOU is included in the conference materials packet)

38. Typical LDSS Activities Under an MOU: • Supplies necessary application forms • Provides agency staff with training onthe information or documents the applicant needs • Identifies contact person • Sets timeframe for application processing • Notifies applicants & provider of FPBP eligibility decision • Advises providers of relevant Medicaid changes

39. Typical Provider Activities Under an MOU: • Designate interviewer(s) • Assist applicant by: • Obtaining a signed Applicant Release Agreement • Providing applicant with application package • Conducting a face-to-face interview • Gathering necessary documentation and informing client of information due date

40. Provider Activities (cont.) • Explain all health care programs for which applicant may be eligible • Ensure applicant makes an informed choice • Provide patient with list of Federally Qualified Health Centers (FQHC) or other affordable sites for obtaining primary care • Ensure confidentiality of all information

41. Billing for the FPBP • Medicaid claims need to indicate that the visit is for family planning services • “Y” must be checked in the “Family Planning” field on the Medicaid claim • Diagnosis code in the V25.0 series must be indicated on the claim

42. Billing for the FPBP (cont.) • Timely submission of claims • Must be submitted within 90 days of the date of service, unless the claim is delayed due to circumstances outside of the control of the provider.

43. Billing for HIV Counseling/Testing under FPBP • Dually certified Family Planning Clinics/HIV Primary Care Centers • May bill for 2 distinct clinic visits when providing FP and HIV/Counseling and Testing • One clinic claim for the FP encounter • A second clinic claim for HIV counseling/testing • Family Planning Clinics that are not dually certified may only bill for 1 clinic visit on a given date • HIV Counseling/Testing is included in the clinic threshold rate

44. Ordering Family Planning Related Laboratory Tests Under FPBP • Ordering provider must indicate on lab test requisition that test is for family planning • Diagnosis code in V25.0 series must be indicated on lab test requisition

45. Getting People to Enroll in FPBP • Review benefits of preventing unintended pregnancies • Emphasize minimal application process – 20 minutes • Emphasize the word “Free for eligible people” • Review how to get needed documentation • Emphasize two year enrollment period • Emphasize minimal recertification process • Direct market to women and men

46. Where Do Patients Enroll? Apply at: • Local Department of Social Services (LDSS) • Family planning providers and other clinics that have an MOU with their LDSS to assist patients in enrolling

47. To find a participating provider of services you can call • The New York State Growing Up Healthy Hotline: 1-800-522-5006 (24 hours a day) • Local LDSS: If you can’t locate the phone number call the NY Medicaid Helpline 1-800-541-2831 (M–F, 8am – 4:45pm) • In NYC call: Medicaid Helpline 1-888-692-6116 or General NYC Services Directory Dial 311

48. Timeframe for Processing Application Completed application should be processed in 30 to 45 days from date of completing the application

49. Question and Answer Period • Fax: 518-869-1969 • Emails to: fpbp8123@yahoo.com • Phone: Press the pound symbol (#) followed by the number 1 on your phone and an operator will assist you.

50. Marketing Ideas • Patient Information Sheet • Shortened version of Documentation Checklist • FPBP Wallet Cards • Posters of various sizes • FPBP buttons worn by all staff - encouraging patients to ask about free birth control • Contact local media for free ad time