(pursuant to §1902(a)(13) of the Act (U.S.C. 1396a(a)(13))

 

THE VIRGINIA FAMILY PLANNING DEMONSTRATION WAIVER (PLAN FIRST)

 

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to continue and expand Medicaid coverage of family planning waiver services through the program known as Plan First.   The Plan First family planning program is authorized by the Centers for Medicare and Medicaid Services (CMS) under an 1115 demonstration waiver that expires September 30, 2010.  DMAS may request continuation and expansion of the demonstration beyond this date.  One requirement for continuation is to obtain input from all interested parties regarding the possibility of continuation of the demonstration program.  

 

The Plan First family planning demonstration waiver provides access to medical family planning services to low-income women and men who would normally not have public or private health coverage. Plan First provides these families the means for obtaining medical family planning services to prevent unintended pregnancies and space intended pregnancies for healthier mothers and children.  Family planning services do not cover abortion services or referrals for abortions. Plan First is not available to individuals under 19 years of age; they can be enrolled for full Medicaid or FAMIS benefits.

 

In addition to continuing this project, DMAS plans to modify the waiver in the areas of eligibility, eligibility renewal, and services codes. The proposed modifications reflect changes authorized through the Appropriations Act and CMS policy revisions.

 

 

·        DMAS intends to expand eligibility for Medicaid coverage of family planning services to individuals with a family income up to 200 percent of the federal poverty level in accordance with item 306.JJ. of the 2009 Appropriations Act.  Current, eligibility is limited to individuals with family income up to 133 percent of the federal poverty level.

 

·        In 2007, CMS mandated that DMAS change eligibility policy not to allow for individuals to be eligible if they have other creditable health care coverage. DMAS has requested to remove this requirement. DMAS will enforce that Medicaid is payer of last resort. This policy is already in place and is monitored and edited through the Medical Management Information System.

 

·        DMAS currently does not allow retroactive coverage due to a prior CMS mandate. This mandate required DMAS to remove retroactive coverage of individuals in the waiver, up to three months from the date the application is received. DMAS has requested approval to allow retroactive coverage for up to three months again. Retroactive coverage is consistent with Medicaid eligibility policy. 

 

 

·        DMAS does not allow ex parte renewal for the waiver due to a prior CMS mandate. DMAS has requested approval of the ex parte renewal process. An ex parte renewal is an internal review of eligibility based on available information. By relying on information already available, the eligibility worker can avoid unnecessary and repetitive requests for information from individuals that can add to administrative burdens, make it difficult for individuals to retain coverage, and cause eligible individuals to lose coverage. The enrollee is not required to complete and sign a renewal form when all information necessary to redetermine eligibility can be obtained through an ex parte renewal process. This is identical to the Medicaid renewal process utilizing ex parte reviews.

 

 

·        In addition to changing the eligibility requirements, DMAS has requested the addition of service codes to the current benefit package to include a more comprehensive service package of direct family planning services. 

 

 

This notice is intended to satisfy the State Notice Procedures set forth in Vol. 59, No. 186 of the Federal Register (September 27, 1994). A copy of this notice is available for public review from Ashley Barton at Department of Medical Assistance Services, 600 East Broad Street, Richmond, Virginia 23219, telephone:  (804) 371-7824, fax:  (804) 225-3961, email: ashley.barton@dmas.virginia.gov and this notice is available for public review on the Regulatory Town Hall (www.townhall.com).  Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Ms. Barton and such comments are available for review at the same address.