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Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies

Published:September 30, 2021DOI:https://doi.org/10.1016/j.whi.2021.09.001

      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.