5101:3-21-02 Reproductive health services: pregnancy prevention/contraceptive management services.

(A) The following definitions apply for the purposes of medicaid:

(1) "Family planning"is the prevention or delay of pregnancy.

(2) "Pregnancy prevention/contraceptive management services" or "family planning services" are services and supplies provided for the primary purpose of preventing or delaying pregnancy. They include services provided for the temporary prevention of pregnancy in accordance with rule 5101:3-21-02.1 of the Administrative Code, services provided for the permanent prevention of pregnancy in accordance with rule 5101:3-21-02.2 of the Administrative Code, and related supplies.

(3) "Family planning visit" is a visit to a health professional for the primary purpose of obtaining pregnancy prevention/contraceptive management services.

(B) Medicaid providers of pregnancy prevention/contraceptive management services must offer three assurances:

(1) Medicaid-eligible individuals have access to pregnancy prevention/contraceptive management services without regard to religion, race, color, national origin, disability, age, sex, number of pregnancies, or marital status;

(2) Medicaid-eligible individuals are able to obtain pregnancy prevention/contraceptive management services voluntarily, free from coercion or pressure and free to choose the method of pregnancy prevention/contraceptive management to be used; and

(3) Provision of pregnancy prevention/contraceptive management services is not a prerequisite to eligibility for or receipt of any other services or assistance from or participation in any other programs of the medicaid provider.

(C) Medicaid-covered pregnancy prevention/contraception services include services provided for the temporary prevention of pregnancy, in accordance with rule 5101:3-21-02.1 of the Administrative Code and for the permanent prevention of pregnancy, in accordance with rule 5101:3-21-02.2 of the Administrative Code.

(D) Providers must include the following information on claims for pregnancy prevention/contraceptive management services:

(1) A valid current procedural terminology (CPT) or healthcare common procedure coding system (HCPCS) procedure code for each service provided; and

(2) An appropriate diagnosis code in the range from V 25.0 through V 25.9 to indicate an encounter for contraceptive management, as specified in the "International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)."

Replaces: 5101:3-21-02

Effective: 01/01/2012
R.C. 119.032 review dates: 01/01/2017
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 9/1/89, 5/25/91, 4/1/92 (Emer), 7/1/92, 12/31/92, (Emer), 4/1/93, 5/2/94 (Emer), 7/1/94, 3/20/95, 1/1/01, 10/1/03, 12/30/05 (Emer), 3/27/06, 7/1/09