Arizona Department of Health Services
Division of Behavioral Health Services
Policy and Procedures Manual
POLICY
XX
Effective Date: xx/xx/xxxx
Last Review Date: xx/xx/xxxx
Last Revision Effective Date: xx/xx/xxxx
FAMILY PLANNING SERVICES
DRAFT
____________________________________________________________________________
1. PURPOSE:
This policy outlines the responsibilities for providing, coordinating, and monitoring the Family
Planning services. The Family Planning services are covered when provided by physicians
or practitioners to members who voluntarily choose to delay or prevent pregnancy. Family
planning and Sixth Omnibus Budget Reconciliation Act (SOBRA) Family Planning Extension
Program (demonstration) services include covered medical, surgical, pharmacological, and
laboratory benefits specified in this policy. Covered services also include the provision of
accurate information and counseling to allow members to make informed decisions about
specific family planning methods available. Members may choose to obtain family planning
services and supplies from any appropriate provider within the RBHA health plan’s
networktheir RBHA provider network.
Female members whose SOBRA postpartum eligibility has expired (Arizona Revised
Statutes A.R.S. § 36-2907.04) and are enrolled with the RBHA health plan, are eligible for
the SOBRA Family Planning Extension Program for up to 24 months with redetermination of
eligibility, including income eligibility, at 12 months. SOBRA Family Planning Extension
services include only those services related to family planning and complications of family
planning services; other services are not covered.
2. TERMS:
Definitions for terms are located online at http://www.azdhs.gov/bhs/definitions/index.php
[RBHA to insert RBHA link]. The following terms are referenced in this section:
Sixth Omnibus Budget Reconciliation Act (SOBRA)
Iis an eligibility category for pregnant women and children up to the age of 19 years.
Eligibility is based on different Federal Poverty Income Levels. The SOBRA program
provides medical coverage to pregnant women and children up to the age of 19 years.
Family Planning Extension Program
provides This program provides comprehensive family planning services only to female
members who lost SOBRA eligibility; men are not eligible for these services. Postpartum
members are eligible for the SOBRA Family Planning Extension Program for up to 24
months with redetermination of eligibility, including income eligibility, at 12 months. SOBRA
Family Planning Extension services include only those services related to family planning
and complications of family planning services; other services are not covered. Women who
receive services through the SOBRA Family Planning Services Extension Program are not
eligible for full health care coverage, including treatment of any disease process.
____________________________________________________________________________
XX Family Planning Services
Page 1 of 5
Comment [JGC1]: New definition
Comment [JGC2]: New definition
Arizona Department of Health Services
Division of Behavioral Health Services
Policy and Procedures Manual
POLICY
XX
Effective Date: xx/xx/xxxx
Last Review Date: xx/xx/xxxx
Last Revision Effective Date: xx/xx/xxxx
FAMILY PLANNING SERVICES
DRAFT
____________________________________________________________________________
3. SCOPE:
The RBHA and its contracted providershealth plan coordinates the Family Planning services
program for enrolled eligible members.
Family Planning services are available to male and female members who are eligible to
receive full health care coverage and enrolled in the RBHA. health plan.
4. PROCEDURES:
The RBHA health plan contractorand its contracted providers must ensure that service
delivery, monitoring, and reporting requirements for family planning services are met.
a.
The RBHA health plan contractorand its contracted providers must:
ia. Plan and implement an outreach program to notify members of reproductive age of the
specific covered family planning services available and how to request them.
Notification must be in accordance with A.R.S. § 36.2904(L). The information provided
to members must include, but is not limited to:
Formatted: Indent: Left: 0.5", No bullets or
numbering
Formatted: Heading 2
Formatted: Heading 3, Indent: Left: 0.75"
(1)i A complete description of covered family planning services available
(2)ii
Information advising how to request/obtain these services
(3)iii Information that assistance with scheduling is available, and
(4)iv A statement that there is no charge for these services.
b. Have policies and procedures in place to notify SOBRA members who lose eligibility for
medical services (enrolled in the SOBRA Family Planning Extension Program) of nocost/low-cost primary care services. The notification must include the need for
redetermination for eligibility at 12 months.
c. The RBHA health plan must also have policies and procedures in place to inform
providers of no-cost/low-cost primary care services available to SOBRA Family Planning
Extension members.
d. Have policies and procedures in place to ensure that maternity care providers are
educated regarding covered and non-covered services, including family planning
services, available to AHCCCS members.
e. Have family planning services that are:
____________________________________________________________________________
XX Family Planning Services
Page 2 of 5
Formatted: Heading 3
Arizona Department of Health Services
Division of Behavioral Health Services
Policy and Procedures Manual
POLICY
XX
Effective Date: xx/xx/xxxx
Last Review Date: xx/xx/xxxx
Last Revision Effective Date: xx/xx/xxxx
FAMILY PLANNING SERVICES
DRAFT
____________________________________________________________________________
i
Provided in a manner free from coercion or mental pressure
ii
Available and easily accessible to members
iii Provided in a manner which assures continuity and confidentiality
iv Provided by, or under the direction of, a qualified physician or practitioner, and
v
f.
Documented in the medical record. In addition, documentation must be recorded
that each member of reproductive age was notified verbally or in writing of the
availability of family planning.
Provide translation/interpretation of information related to family planning in accordance
with requirements of the AHCCCS Division of Healthcare Management “Cultural
Competency” policy, available from the AHCCCS Contractor Operations Manual
(available online at www.azahcccs.gov). Additionally, Culturally and Linguistically
Appropriate Services must be provided pursuant to DBHS’ policies CO 1.2, Cultural
Competence, PM 3.23 Cultural Competence, PM 9.1 Training Requirements and Title VI
of the Civil Rights Act of 1964.
g. Incorporate medical audits for family planning services within quality management
activities to determine conformity with acceptable medical standards.
h. Establish quality/utilization management indicators to effectively measure/monitor the
utilization of family planning services.
i.
j.
Have written practice guidelines that detail specific procedures for the provision of longterm contraceptives. These guidelines shall be written in accordance with acceptable
medical standards.
Process for ensuring that prior to insertion of intrauterine and subdermal implantable
contraceptives, the family planning provider has provided proper counseling to the
eligible member to minimize the likelihood of a request for early removal. Counseling
information is to include a statement to the member indicating if the implant is removed
within two years of insertion, the member may not be an appropriate candidate for
reinsertion for at least one year after removal.
k. In addition, RHBA Contractors, as a part of the provision of SOBRA Family Planning
Extension Program services, must:
____________________________________________________________________________
XX Family Planning Services
Page 3 of 5
Formatted: Indent: Left: 0.5"
Formatted: Indent: Left: 0.5"
Arizona Department of Health Services
Division of Behavioral Health Services
Policy and Procedures Manual
POLICY
XX
Effective Date: xx/xx/xxxx
Last Review Date: xx/xx/xxxx
Last Revision Effective Date: xx/xx/xxxx
FAMILY PLANNING SERVICES
DRAFT
____________________________________________________________________________
i
Assist contracted providers in establishing procedures for referral of members, who
are screened and determined to have a sexually transmitted disease, to an agency
which provides low-cost/no-cost treatment for members receiving SOBRA Family
Planning Extension services.
ii
Assist contracted providers in establishing procedures for referral of those members
who lose AHCCCS eligibility to low-cost/no-cost agencies for family planning
services.
iii Assist contracted providers in establishing procedures for referral of those members
with medical needs to an agency that provides low-cost/no-cost primary care
services.
iv Develop a process for monitoring whether referrals for low-cost/no-cost primary care
services were made.
5. REFERENCES:
5. Title VI of the Civil Rights Act of 1964.
Social Security Act, Title V, Parts 1 and 4 [Maternal and Child
Health]
42 C.F.R. § 441.306
Arizona Revised Statutes (A.R.S.)A.R.S.§ 36-2907 [Covered Health and Medical Services]
AHCCCS Contractor Operations Manual, Chapter 400, Section 404, Attachment B (ACOM) ,
www.azahcccs.gov
AHCCCS Medical Policy Manual (AMPM) Chapter 400, Section 420
AHCCCS ADHS/DBHS Contract, Section D, Number 10, Scope of ServicesAHCCCS Acute
Care Contract, Section D
ADHS/DBHS CO 1.2 Cultural Competence
ADHS/DBHS PM 3.23 Cultural Competence
ADHS/DBHS PM 9.1 Training Requirements
____________________________________________________________________________
XX Family Planning Services
Page 4 of 5
Formatted: Normal
Formatted: Font: Not Bold
Arizona Department of Health Services
Division of Behavioral Health Services
Policy and Procedures Manual
POLICY
XX
Effective Date: xx/xx/xxxx
Last Review Date: xx/xx/xxxx
Last Revision Effective Date: xx/xx/xxxx
FAMILY PLANNING SERVICES
DRAFT
____________________________________________________________________________
6. APPROVED BY:
_________________________________________
Cory Nelson, MPA
Date
Deputy Director
Arizona Department of Health Services
Division of Behavioral Health Services
_________________________________________
Steven Dingle M.D.
Date
Medical Director
Arizona Department of Health Services
Division of Behavioral Health Services
____________________________________________________________________________
XX Family Planning Services
Page 5 of 5