Family Planning Services: Coverage And Limitations

Family planning includes counseling and medical services prescribed or performed by a provider. Specific items covered are diagnosis, treatment, contraceptive supplies, related counseling, and restricted sterilization. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 223 Page 68 01. Contraceptive Supplies. (7-1-26) a. Contraceptive supplies include condoms, foams, creams and jellies, prescription diaphragms, intrauterine devices, or oral contraceptives. (7-1-26) b. Payment for oral contraceptives is limited to purchase of a six (6) month supply. (7-1-26) 02. Sterilization. (7-1-26) a. No sterilizations for individuals institutionalized in correctional facilities, mental hospitals, or other rehabilitative facilities are payable unless such sterilizations are ordered by a court of law. (7-1-26) b. Hysterectomies are subject to these rules. (7-1-26) c. All requirements of state or local law for obtaining consent, except for spousal consent, must be followed. (7-1-26) 03. Exceptions to Sterilization Time Requirements. If premature delivery occurs or emergency abdominal surgery is required, the physician must certify that the sterilization was performed because of the premature delivery or emergency abdominal surgery less than thirty (30) days, but no less than seventy-two (72) hours after the date of the participant's signature on the consent form; and (7-1-26) a. In the case of premature delivery, the provider must also state the expected date of delivery and describe the emergency in detail; and (7-1-26) b. Describe, in writing to the Department, the nature of any emergency necessitating emergency abdominal surgery; and (7-1-26) c. Under no circumstance can the period between consent and sterilization exceed one hundred eighty (180) days. (7-1-26) 04. Requirements for Sterilization Performed Due to a Court Order. The performing provider must have been provided with a copy of the court order prior to the performance of the sterilization, and: (7-1-26) a. Certify that all requirements have been met concerning sterilizations; and (7-1-26) b. Submit a copy of the court order together with the “Consent Form” and claim. (7-1-26)