Review of Publicly Available State Policies for Long-Acting Reversible Contraception Device Reimbursement

Romero, Lisa; Sappenfield, Olivia; Uesugi, Keriann; Howland, Julia; Kroelinger, Charlan D.; Okoroh, Ekwutosi M.; Erondu, Chioma; Cox, Shanna

doi:10.1089/jwh.2021.0361

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…23 Addressing Medicaid reimbursement policy for contraceptive implants may be a high-yield first step to impact family medicine implant training in states using the buy and bill system, which requires health centers to pay for devices upfront in bulk and get reimbursed (sometimes months or years later). 25 This disproportionately impacts primary care systems, which provide LARC at much lower numbers than specialty providers. This is illustrated by the low-volume program that successfully provided IUDs, because the inability to use insurance coverage up front for implants was insurmountable.…”

Section: Discussionmentioning

confidence: 99%

Barriers to and Facilitators of Contraceptive Implant Training in New Jersey Family Medicine Residencies: A Qualitative Study

Mischell

Cabrera

Acosta

et al. 2023

Fam Med

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Background and Objectives: The aim of this study was to examine experiences of New Jersey family medicine residents and preceptors with the etonogestrel subdermal contraceptive implant and to explore barriers to and facilitators of training. Methods: In this qualitative study, we conducted semistructured individual interviews to explore residents’ and preceptors’ experiences with contraceptive implant procedural training. We invited residents and preceptors from programs with high (5.2–10.9) and low (0.0–0.1) implant procedures per resident to participate. Participants discussed factors that supported or inhibited implant training and provision. We transcribed, coded, and analyzed interviews on a rolling basis. We used memoing to reflect on the data and identify saturation. We developed and refined our codebook using a collaborative, iterative process. We analyzed interviews using deductive and inductive techniques to identify themes. Results: We interviewed 25 subjects: 14 residents and 11 preceptors from four family medicine residency programs with the highest and lowest implant training numbers. Common barriers included lack of hands-on experience with the procedure, lack of teaching with the procedure, and difficulty scheduling patients. Facilitators included formal training and inclusion of contraception in residency curricula, preceptors’ comfort with the procedure, office sessions dedicated to procedures or gynecology visits, and patient familiarity with the implant. Conclusions: Family medicine residencies provide unique opportunities to impact provision of long-acting reversible contraception (LARC). We identified potential interventions, including formal implant training sessions, dedicated procedure office sessions, stocking of devices in the office, and staff focused on reproductive health that can aid in scheduling, obtaining devices, and setup.

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Section: Discussionmentioning

confidence: 99%

Barriers to and Facilitators of Contraceptive Implant Training in New Jersey Family Medicine Residencies: A Qualitative Study

Mischell

Cabrera

Acosta

et al. 2023

Fam Med

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“…We then excluded states (IL, MD, MA) that carved out the cost of outpatient LARC from the federally qualified health center (FQHC) prospective payment system (PPS) rate. The Medicaid PPS base rate is based on the average cost per encounter making it difficult to recover costs from providing costly LARC devices 23,57 . Similar to unbundling postpartum LARC, some states allow separate payments for the acquisition cost of LARCs, enabling more providers to offer outpatient LARC services.…”

Section: Methodsmentioning

confidence: 99%

“…The Medicaid PPS base rate is based on the average cost per encounter making it difficult to recover costs from providing costly LARC devices. 23 , 57 Similar to unbundling postpartum LARC, some states allow separate payments for the acquisition cost of LARCs, enabling more providers to offer outpatient LARC services. Next, we excluded states with abortion‐related restrictions on Title X family planning funding (AZ) to avoid other confounding shocks impacting access to family planning services that could influence postpartum LARC use.…”

Section: Methodsmentioning

confidence: 99%

“…This was a particular challenge in settings where Medicaid pays providers a comprehensive payment per episode of care with no way to account for the high cost of LARC device and insertion procedure within a bundled rate 19 . One common approach by state Medicaid agencies has been to separate the cost of the immediately postpartum (IPP) LARC device and insertion procedure from bundled payments in inpatient hospital the maternity care bundled payment for postpartum insertion 22,23 . This carve out approach allows providers to bill separately for the device and procedure.…”

Section: Introductionmentioning

confidence: 99%

“… 19 One common approach by state Medicaid agencies has been to separate the cost of the immediately postpartum (IPP) LARC device and insertion procedure from bundled payments in inpatient hospital the maternity care bundled payment for postpartum insertion. 22 , 23 This carve out approach allows providers to bill separately for the device and procedure.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Examining the impact of Medicaid payments for immediate postpartum long‐acting reversible contraception on the mental health of low‐income mothers

Marthey,

Rochford,

Andreyeva

2024

Health Services Research

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ObjectiveTo examine the effect of Medicaid immediate postpartum long‐acting reversible contraception (IPP LARC) reforms on self‐reported mental health among low‐income mothers aged 18–44 years.Data Sources and Study SettingWe used national secondary data on self‐reported mental health status in the past 30 days from the core component (2014–2019) of the Behavioral Risk Factor Surveillance System (BRFSS).Study DesignWe estimated linear probability models for reporting any days of not good mental health in the past 30 days. We adjusted for individual‐level factors, state‐level factors, and state and year fixed effects. Our primary independent variable was an indicator for IPP LARC payment reform. We examined the effect of the Medicaid payment reforms on self‐reported mental health status in the past 30 days using difference‐in‐differences and event‐study designs.Data Collection/Extraction MethodsNot applicable.Principal FindingsState adoption of Medicaid IPP LARC reforms was associated with significant reductions (between 5.7% and 11.5%) in the predicted probability of reporting any days of not good mental health among low‐income mothers. Treatment effects appeared to be driven by respondents reporting two or more children (less than 18 years of age) in the household (ATT = ‐0.028, p = 0.04). Results are robust to a series of sensitivity tests and alternative estimation strategies.ConclusionsOur findings suggest that contemporary efforts to improve access to contraceptive methods may have important benefits beyond reproductive autonomy. These findings have implications for policymakers as the landscape related to family planning services continues to shift.

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Association of Medicaid Reimbursement Policies with Provision of Long-Acting Reversible Contraception in the Postpartum Period, 2012–2018

Moon,

Chang,

Bryant

et al. 2024

Journal of Women's Health

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Review of Publicly Available State Policies for Long-Acting Reversible Contraception Device Reimbursement

Cited by 4 publications

References 25 publications

Barriers to and Facilitators of Contraceptive Implant Training in New Jersey Family Medicine Residencies: A Qualitative Study

Barriers to and Facilitators of Contraceptive Implant Training in New Jersey Family Medicine Residencies: A Qualitative Study

Examining the impact of Medicaid payments for immediate postpartum long‐acting reversible contraception on the mental health of low‐income mothers

Association of Medicaid Reimbursement Policies with Provision of Long-Acting Reversible Contraception in the Postpartum Period, 2012–2018

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