Provider Notice issued 06/26/14

Family Planning and Reproductive Health Services

​To: Participating Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments, Enrolled Encounter Rate Clinics, Federally Qualified Health Centers, Rural Health Clinics, Enrolled Hospitals, and Managed Care Entities 
​Date: ​June 26, 2014
​Re: Family Planning and Reproductive Health Services

The purpose of this notice is to provide further guidance regarding family planning and reproductive health services. Consistent with requirements of the Affordable Care Act, all Healthcare and Family Services (HFS) enrolled providers shall ensure that the full spectrum of family planning options and reproductive health services are appropriately provided with no cost sharing. Family planning and reproductive health services are defined as those services offered, arranged or furnished for the purpose of preventing an unintended pregnancy, and to improve health and birth outcomes. Family planning and reproductive health services shall be provided by, or administered under the supervision/collaboration of a physician (MD or DO), advanced practice nurse or physician assistant, and must follow the most current nationally recognized evidence-based standards of care and guidelines for sexual and reproductive health, such as those established by the Centers for Disease Control and Prevention (CDC) (pdf)  or the American Congress of Obstetricians and Gynecologists.

Medicaid’s free choice of provider’s statute (pdf) allows clients to see any Medicaid provider of their choice when seeking family planning and reproductive healthcare services.  Thus, clients can access contraceptive services and supplies without managed care network restrictions.  Additionally, provider policies/protocols shall not present barriers that delay or prevent access, such as prior authorizations or step-therapy failure requirements. Clients should receive education and counseling on all FDA-approved birth control methods (pdf) from most effective to least effective, and have the option to choose the preferred birth control method that is most appropriate for them – CDC Guidance (pdf).

The following services are covered under HFS’ comprehensive medical programs* and, at a minimum, must be offered to patients through direct services or timely referral:

  • A reproductive life plan (pdf) which may include a preconception care risk assessment notice and preconception and interconception care discussions.

  • Education and counseling on all contraceptive methods with emphasis on presenting the most effective methods first, specifically long acting reversible contraceptives (LARC) such as intrauterine devices (IUD) (pdf)  and the implantable rod.

  • Contraceptive methods must also include over-the-counter and prescription emergency contraception, including the provision of the copper IUD for emergency contraception.

  • Permanent methods of birth control: tubal ligation, transcervical sterilization and vasectomy

  • Basic infertility counseling, consisting of medical/sexual history review and fertility awareness education. Infertility medications and procedures are NOT covered.

  • Reproductive health exam, with pelvic exam decoupled from the provision of contraception

  • Age and risk appropriate Sexually Transmitted Infection (STI) screening and treatment (pdf)

  • Universal HIV testing and counseling

  • Testing and treatment for genital and related infections and other pathological conditions

  • Lab test or screening necessary for family planning and reproductive health services 

  • Cervical cancer screening, management, and  early treatment

  • Vaccines for preventable reproductive health related conditions (i.e., HPV, Hepatitis B)

  • Mammography referral and BRCA genetic counseling and testing

*Note, not all services are covered by Illinois Healthy Woman, please refer to http://www.illinoishealthywomen.com/covered.html

Please refer to the Handbook for Practitioners Rendering Medical Services (pdf) for policy and procedures for medical services.

Theresa A. Eagleson, Administrator, Division of Medical Programs