Plan First Virginias Family Planning Program

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Plan FirstVirginias Family Planning Program

• CASE MANAGERS PRESENTATION

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Purpose

• To improve birth outcomes
• To help in birth spacing
• To reduce Medicaid expenditures for pregnancy and
  child birth by preventing unintended pregnancies.

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History

• Initially implemented on October 1, 2002
• AKA Family Planning Waiver or Family Planning
  Services (FPS)
• Eligible population Women who received a
  pregnancy-related service paid for by Medicaid
  and had countable income within 133 of the
  federal poverty level (FPL)
• Approved for 5 years

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History

• 2006 General Assembly Mandate
• Expanded eligible population to include men
• Removed pregnancy requirement for women
• September 28, 2007 Centers for Medicare and
  Medicaid Services (CMS) approved renewal request
• Regulation was effective January 1, 2008

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Plan First Eligibility

• Effective January 1, 2008
• Eligible population includes both uninsured men
  and women who have countable income within 133
  FPL and have not had a sterilization procedure.

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Plan First Eligibility

• Eliminates
• 24-month time limitation requirement
• Receipt of a Medicaid-paid pregnancy-related
  service by women requirement

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Plan First Eligibility

• Cannot choose Plan First if eligible for full-
  benefit Medicaid covered group
• No auto-eligibility
• No retroactive eligibility

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Plan First Eligibility

• Eligibility begins the first day of the month of
  application, provided all eligibility
  requirements are met
• No Ex Parte renewals
• New Application Requirement!
• Must use Plan First form at application and
  renewal

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How to enroll in Plan First

• Need to apply
• Complete Plan First application!
• Sign and date Plan First application
• Drop off, mail or fax Plan First application to
  the local DSS in city/county of residence
• Plan First applications are processed at the
  local Department of Social Services in which the
  applicant resides.

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Covered Services

• Annual family planning exams
• Cervical cancer screening for women (one per 6
  months)
• Standard of care is now every other year to three
  years
• Sexually transmitted infection (STI) testing
• Laboratory services for family planning and STI
  testing
• Family planning education and counseling

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Covered Services cont.

• Sterilization procedures
• Most Food and Drug Administration (FDA) approved
  prescription contraception
• Most FDA approved over-the-counter contraception,
  including emergency contraception and
• Referrals to a primary care provider who may
  provide care for free or on a sliding fee scale
  for services not covered through Plan First.

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Service Limits

• Only specific family planning services and
  supplies covered
• Additional codes have to be approved by CMS via
  amendment to waiver
• Services must be performed within the scope of a
  family planning office visit

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Service Limits

• Treatment for abnormal findings
• Follow up cervical cancer screenings
• Emergency services
• Complications
• Vaccinations

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Service Limits

• Performance of, counseling for, or
  recommendations of abortions
• Performance of a hysterectomy or partial
  hysterectomy
• Infertility treatments and
• Transportation to a family planning service

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Marketing

• Updated marketing approach
• First Marketing task force meeting
• Studying marketing trends for family planning
• Focus groups with local Family Planning Clinic
  and Planned Parenthood
• Coordinating efforts with VDH, Virginia Community
  Healthcare Association and Planned Parenthoods

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Need to Knows

• Link on DMAS website of Medicaid providers who
  are actively billing for family planning services
• New email PlanFirst_at_dmas.virginia.gov

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WebVISION

• Virginia Department of Health's system that
  manages the business functions associated with
  providing clinical services such as registration,
  tracking services received, billing, and
  scheduling appointments.

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WebVISION

• Purpose Generate Plan First application using
  data collected through WebVISION for potential
  eligible individuals ages 19 and older.
• Individual (age 19 and over) registers for
  service at a local health department and there
  would be a potential to receive a WebVISION
  generated Plan First application.

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In the near future

• 2007 General Assembly mandate
• Increase eligible populations income limit as
  high as possible without exceeding 200 FPL and
  remain budget neutral
• Requesting approval for additional family
  planning codes
• Maximizing outreach efforts
• Plan First Provider Manual

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Plan First Materials

• Commonwealth Martin
• (Telephone) 1-804-780-0076
• (Fax) 1-804-780-0198
• DMAS-65E Plan First Application
• DMAS-65S Plan First Application (Spanish)
• DMAS-66E Plan First Brochure
• DMAS-66S Plan First Brochure (Spanish)
• Provider and/or Recipient Fact Sheets

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Ashley Barton, Maternal Child Health
Coordinator 804-371-7824
PLANFIRST_at_DMAS.VIRGINIA.GOV
Remember to take Folic Acid!