States Have Considerable Disparity in High-Quality LARC Service Delivery

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There are gaps in reimbursement and training, along with issues regarding the clarity of the Medicaid LARC payment policy.
There are gaps in reimbursement and training, along with issues regarding the clarity of the Medicaid LARC payment policy.

Medicaid policy encourages the use of long-acting reversible contraception (LARC), but state-level payment policies are inconsistent and often do not include critical aspects of care, according to an article published in Women's Health Issues.

Veronica X. Vela, MS, DrPH(C), from George Washington University, Washington, DC, and colleagues researched Medicaid programs across a diverse group of 9 states.

They analyzed Medicaid policies to determine whether state fee-for-service Medicaid coverage and payment policies covered the essential components of effective LARC service delivery, including provider training, family planning counseling, and LARC insertion, removal, and follow-up.

In the United States, nearly 50% of all pregnancies are unintended, and 1 in 5 of these result in abortion. LARC is the most effective form of contraception to reduce those numbers. Approximately 19.4 million low-income women of child-bearing age are insured through Medicaid, which entitles them to coverage for family planning services. However, the Centers for Medicare & Medicaid Services (CMS) never explicitly state that all contraceptive methods approved by the US Food and Drug Administration should be covered for those receiving Medicaid services.

The authors note that there is considerable disparity in coverage of family planning services. California is the only state to cover all components of quality LARC care, and California, Illinois, and Pennsylvania are the only states that covered family planning counseling services as a separately covered service.

The investigators found specific gaps in reimbursement and training, along with issues regarding the clarity of the Medicaid LARC payment policy. Some states provided extensive LARC training programs, whereas others provided none. The researchers also discovered confusing policy language that may be a barrier to implementation of existing LARC payment policies.

The authors argue that state-level fee-for-service and managed care policies should address all elements of quality family planning care, including access to the full range of LARC methods. States should consider developing educational and evaluation programs for family planning, potentially in partnership with academic institutions, foundations, and medical societies.

At the federal level, CMS should consider requiring state fee-for-service payment policies to include coverage for LARC follow-up and removal, eliminating restrictions on those services. CMS has indicated interest in developing payment models that will enhance access to LARC and offers a $4 million Health Care Innovation Award that may encourage states to pursue new LARC payment models to help manage payment policy discrepancies.

The authors note that Medicaid policy continues to shift rapidly and change across states, and add that important changes could have occurred after October 2015, when data collection ended.

Reference

Vela VX, Patton EQ, Sanghavi D, Wood SF, Shin P, Rosenbaum S. Rethinking Medicaid coverage and payment policy to promote high value care: the case of long-acting reversible contraception [published online January 10, 2018]. Womens Health Issues. doi.org/10.1016/jwhi.2017.10.013

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