Abstract
Background
Previous assessment of statewide policies on long-acting reversible contraception
(LARC) indicate that an increasing number of states are implementing policies specifically
for provision immediately postpartum, supported by current clinical guidelines. Less
is known about how state policies describe payment methodologies for the insertion
procedure and device costs.
Methods
We conducted a systematic, web-based review of publicly available statewide policy
language on immediate postpartum LARC among all 50 states. We examined the payor/s
identified in the policy and policy type, if the policy included language on the global
obstetric fee, whether providers and/or facilities were authorized to bill for procedure
or device costs, and if the billing mechanism was identified as inpatient and/or outpatient
services.
Results
Three-fourths of states (76%; n = 38) had statewide policies on immediate postpartum LARC. All policies identified
Medicaid as the payor, although two also included non-Medicaid plans. Language allowing
for reimbursement separate from the global obstetric fee for insertion procedures
was present in 76% of states; 23 states permit it and 6 do not. Device cost reimbursement
separate from the fee was identified in more state policies (92%); 31 states allow
it and 4 do not. More policies included inpatient or outpatient billing mechanisms
for device costs (82%; n = 31) than insertion procedures (50%; n = 19).
Conclusions
Medicaid reimbursement policies for immediate postpartum LARC services vary by state
reimbursement process, type, and mechanism. Observed differences indicate payment
methodologies more often include the cost of the device than provider reimbursement
(31 states vs. 23 states). Fewer than one-half of states offer reimbursement for provider
insertion fees, a significant systems barrier to contraceptive access for women who
choose LARC immediately postpartum.
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Biography
Charlan D. Kroelinger, PhD, is Chief, Maternal & Infant Health Branch, Division of Reproductive Health, the Centers for Disease Control and Prevention. Her research interests are primarily in health services research reviewing state policies on issues related to maternal and child health.
Biography
Ekwutosi M. Okoroh, MD, is Lead, Maternal and Child Health Epidemiology Program, Field Support Branch, Division of Reproductive Health at the Centers for Disease Control and Prevention. Her research interests include studying capacity-building efforts in applied science in maternal and child health.
Biography
Keriann Uesugi, PhD, is a Research Faculty member in the Division of Epidemiology and Biostatistics within the School of Public Health at the University of Illinois at Chicago. Her research interests include capacity-building efforts in maternal and child health.
Biography
Lisa Romero, DrPH, is a Senior Health Scientist in the Office of the Director within the Division of Reproductive Health at the Centers for Disease Control and Prevention. Her research interests are focused on prevention of adolescent pregnancy, contraception, and family planning.
Biography
Olivia R. Sappenfield, MPH, PhD, is a student in the Division of Epidemiology and Biostatistics within the School of Public Health at the University of Illinois at Chicago. Her research interests include capacity-building efforts in maternal and child health.
Biography
Julia F. Howland, MPH, is a doctoral student in the Division of Epidemiology and Biostatistics within the School of Public Health at the University of Illinois at Chicago. Her research interests include capacity-building efforts in maternal and child health.
Biography
Shanna Cox, MSPH, is Associate Director for Science in the Office of the Director, Division of Reproductive Health at the Centers for Disease Control and Prevention. Her research interests include ensuring the scientific integrity of all science conducted within the Division.
Article info
Publication history
Published online: September 30, 2021
Accepted:
September 2,
2021
Received in revised form:
August 31,
2021
Received:
December 14,
2020
Footnotes
Disclosure: The authors report no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
