This section includes MHCP coverage and billing policy for family planning services. Refer to the Reproductive Health/OB-GYN overview page for links to other related services and the Minnesota Family Planning Program (MFPP).
MHCP family planning services cover services and supplies for men and women of childbearing age, including minors. The following considerations apply:
Family planning services do not appear on any explanations of medical benefits (EMOBs) to the recipient or recipient’s family. Recipients may choose to receive notices at an address other than a home address.
The following MHCP-enrolled providers may provide some or all of the available family planning services and supplies:
Effective for dates of service on and after July 1, 2007, a registered nurse (RN) in a family planning agency may dispense oral contraceptives prescribed by a licensed practitioner, according to a dispensing protocol established by the agency’s medical director or under the direction of a physician. RNs may not dispense oral contraception to a recipient who is less than 12 years old. Follow state requirements for dispensing prescription drugs.
Refer to the applicable sections for information and requirements relevant to the various providers.
All MHCP recipients have free choice of family planning providers and may obtain covered family planning services from any qualified provider, including those outside of their provider network.
If a provider furnishes a family planning service to a managed care recipient and that provider is not part of the recipient’s health plan provider network, the provider must contact the health plan for payment.
All MHCP recipients, except Emergency Medical Assistance (EMA) recipients, of childbearing age, including minors, are eligible to receive family planning services.
The following are covered services for family planning:
Recipients enrolled in managed care organizations must seek treatment for HIV/AIDS or infertility treatment through their managed care network.
Refer to the HIV/AIDS web resources page for information about treatment for fee-for-service recipients.
Not all covered family planning services are directly provided by family planning providers. Recipients must be fully informed of, and consent freely to, all family planning services.
MHCP does not cover the following services:
Refer to the following when billing for family planning services:
Family Planning Service
A family planning service includes screening, testing, and counseling for sexually transmitted diseases, such as HIV, when provided in conjunction with the voluntary planning of conception and childbearing, and related to a recipient’s condition of fertility.
Family Planning Supply
A family planning supply is a prescribed drug or contraceptive device ordered by a physician or other eligible provider with prescribing authority for treatment of a condition related to a family planning service.
Family Planning Agency
A family planning agency is an entity having a medical director that provides family planning services under the direction of an MHCP-enrolled physician. The medical director must ensure that trained personnel perform the counseling and provide information about family planning according to accepted community standards.
Minnesota Session Laws 2007
Chapter 139 Article 1, section 21, subd., 311 Dispensing by protocol (registered nurse/family planning)
Minnesota Statutes 151.01, subd. 30 Definitions (Dispense)
Minnesota Statutes 151.212, subd. 1 Label of Prescription Drug Containers (Prescription drugs)
Minnesota Rules 9505.0280 Family planning services