5160-21-02.3 Limited family planning benefit.

 

 

 

TO BE RESCINDED

 

5160-21-02.3               Limited family planning benefit.

 

 

 

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

 

(1)   "Pregnancy prevention/contraceptive management services" or "family planning services" are defined in rule 5160-21-02 of the Administrative Code.

 

(2)   "Family planning-related services" are medically necessary services identified during a routine or periodic family planning visit that satisfy two criteria:

 

(a)   They belong to one of four specific types:

 

(i)   Diagnosis of sexually-transmitted diseases or infections (STIs);

 

(ii)   Treatment of STIs other than human immunodeficiency virus (HIV) and hepatitis;

 

(iii)   Mammography when indicated by a breast examination; or

 

(iv)    Vaccinations against human papillomavirus (HPV) or hepatitis B provided in accordance with rule 5160-4-12 of the Administrative Code; and

 

(b)   They are provided as part of a family planning visit or within sixty days of the family planning visit where their need was determined.

 

(B)   Individuals who meet the eligibility criteria in rule 5160:1-5-40 of the Administrative Code have a limited medicaid benefit that only includes the following:

 

(1)   Family planning and family planning-related services listed in the appendix to this rule;

 

(2)   Hospital services covered in Chapter 5160-2 of the Administrative Code when provided as a family planning-related service as defined in this rule; and

 

(3)     Medicaid-covered, FDA-approved drugs covered in Chapter 5160-9 of the Administrative Code when provided as a family planning-related service as defined in this rule.

 

(C)    When submitting claims for services available under the limited family planning

 

 

benefit, providers must include the information specified in rule 5160-21-02 of the Administrative Code. All claims, including pharmacy claims, for family planning and family planning-related services must be submitted with a family planning diagnosis code in the V25 series.

Effective:                                                             01/01/2016

Five Year Review (FYR) Dates:                         Exempt

CERTIFIED ELECTRONICALLY

Certification

12/21/2015

Date

Promulgated Under:                           119.03

Statutory Authority:                           5164.02

Rule Amplifies:                                  5162.03, 5164.02, 5163.06

Prior Effective Dates:                         01/01/2012, 12/30/2012 (Emer), 03/28/2013,

12/18/2013 (Emer), 03/27/2014 , 12/31/2014 (Emer)