AZ
"SECTION D:
PROGRAM REQUIREMENTS
1. SCOPE OF
SERVICES…
Health Risk
Assessment and Screening: The Contractor shall provide these services for
non-hospitalized members 21 years of age and older. These services
include, but are not limited to...sexually transmitted diseases..."
Arizona Contract, pages 10, 12.
CA
"ARTICLE - DEFINITIONS...
F2. Sensitive
Services means those services related to...
2. Sexually
transmitted diseases (STDs)…" California Contract, pages 2, 13.
"6.7.4.7
Family Planning: Out-Of-Network Reimbursement
Contractor
shall reimburse out-of-plan family planning providers for the following
services provided to Members of childbearing age to temporarily or permanently
prevent or delay pregnancy...
D. Diagnosis and treatment of STD disease episode, as defined by DHS for each STD, if medically indicated.
6.7.4.9
Sexually Transmitted Diseases (STDs)
Contractor
shall provide access to STD services without Prior Authorization to all
Members both within and outside its provider network. Members may
access out-of-plan STD services through local health department (LHD) clinics,
family planning clinics, or through other community STD service providers.
LHD and family planning providers shall be reimbursed for STD services
pursuant to Sections 6.7.8.1, Subcontract, and 6.7.4.7, Family Planning:
Out-Of-Network Reimbursement. For community providers other than
LHD and family planning providers, the reimbursement of out-of-plan STD
services is limited to one office visit per disease episode for the purposes
of:
(1) diagnosis
and treatment of vaginal discharge and urethral discharge,
(2) those STDs
that are amenable to immediate diagnosis and treatment, and this includes
syphilis, gonorrhea, chlamydia, herpes simplex, chancroid, Trichomoniasis,
human papilloma virus, non-gonococcal urethritis, lymphogranuloma venereum
and granuloma inguinale and
(3) evaluation
and treatment of Pelvic Inflammatory Disease (PID). Contractor shall
provide follow-up care…" California Contract, pages 121-122.
DE
"6.2.4.1 Definition of Family Planning Services for Purposes of Out-of-Network Reimbursement This applies only to the Diamond State Health Plan, Medicaid members
For the purpose
of out-of-network reimbursement, family planning services are defined as
those services provided to individuals of childbearing age to temporarily
or permanently prevent or delay pregnancy These services include: ...
(d) Diagnosis
and treatment of STDs if medically indicated…" Delaware RFP, pages
II.31-II.32.
DC
"H. COVERAGE
AND BENEFITS
1.
Covered Services
This
contract provides for coverage and provision by Provider of all medical
assistance benefits and services that are listed in Attachment I, which
is incorporated herein as part of this contract…" District of Columbia
Contract, page 21.
"Attachment
I
Covered Services
A. General
Classes of Covered Benefits
Coverage of
all benefits by Provide shall conform to the definition of the benefit
set forth in federal statute and regulation. The following
general categories of benefits are included in the state plan and are not
otherwise exempt under this contract...
B. Family
Planning Services and Supplies
The following
family planning services and supplies shall be covered by Provider whether
furnished by a member of Provider's network or by a Qualified Family Planning
Provider...
5.
Treatment for sexually transmitted diseased including gonorrhea, herpes,
syphilis, chlamydia and other diseases classified as sexually transmitted
diseases by the CDC." District of Columbia Contract, Attachment I,
pages 1, 3.
FL
"8. Case
Management/Continuity of Care. The plan shall be for the management
of medical care and continuity of care for all enrolled Medicaid recipients.
The plan shall maintain written case management continuity of care protocol(s)
that include the following minimal functions: ...
n. In
accordance with Sections 381.0407(4), F.S. and 409.9122(2)(a)3., F.S.,
without prior authorization, the plan shall pay claims initiated by the
public provider for:
(1)
The diagnosis and treatment of sexually transmitted diseases and other
communicable diseases..." Florida Contract, pages 18-21.
HI
"For Adults:
The following
are services for which payment will be made by health plans as separate
medical services, as components of separate medical services, or as components
of the 'evaluation and management' services rendered by the health plans
providers. The services and periodicity are adapted from the 1996
U.S. Preventive Services Task force...
For the high risk population the required preventive interventions are an Adult Health Regimen which includes the prior listed preventive interventions in addition to the following:
Risk Factor/Intervention
9) high
risk sexual behavior/ 9) STD screens…" Hawaii RFP, Appendix
C, pages 1-3.
"Age appropriate Health Education of child and/or parent including ... STD, HIV... Provisions for children aged 12 years and older to be able to discuss sensitive issues alone with the provider or designated staff" Hawaii RFP, Appendix E, page 6.
IL
"c) Certified
Local Health Department Services...
(2) The
following services, at a minimum, shall be encompassed in the subcontracts
or linkage agreements entered into by the Contractor pursuant to section
(c)(1) to the extent these services are within the Certified Local Health
Department's scope of services as established by the appropriate board
of health or other governing body: ...
(C) testing,
screening and initial treatment for sexually transmitted infections…"
Illinois HMO Contract, pages 25-26.
KS
"C. MEDICAL
SERVICES INCLUDED IN THE CONTRACT…
• Screening,
diagnosis and treatment of sexually transmitted diseases, as medically
necessary…" Kansas Contract, pages 4, 9.
KY
"D. Services
to Be Provided
1.
Covered Services
The
Contractor shall provide Covered Services in accordance with Section 7.9.1
and Attachment VIII of the RFA." Kentucky Contract, page 21.
"7.9.3 Direct
Access Services
The
Partnership shall ensure direct access and may not restrict the choice
of a qualified provider by a Member for the following services within The
Partnership's Network: ...
•
Sexually transmitted disease screening, evaluation and treatment;"
Kentucky RFA, page 72.
"The Member
Services staff shall be responsible for the following services and tasks:
...
•
Facilitating direct access to...sexually transmitted disease screening,
evaluation and treatment..." Kentucky RFA, page 53.
ME
"II. DEFINITIONS.
A. The
following terms used in this Contract shall be interpreted as defined herein,
except to the extent that the context may clearly require otherwise: ...
28. Family
Planning Services include... (v) diagnosis and treatment of sexually transmitted
diseases (STDs)..." Maine Contract, pages 2, 6.
"B. COVERED
SERVICES...
Covered Services:
...
• VD Screening
Services." Maine Contract, pages 20-21.
"11. VD Screening Services. In the event an out-of-network provider bills the Contractor for VD Screening Services provided to an Enrollee in Contractor's Health Plan, the Contractor shall reimburse the provider at no lower than the prevailing Medicaid fee-for-service rate." Maine Contract, page 25.
MD
"Chapter 65
Maryland Medicaid Managed Care Program: Managed Care Organizations...
E. An
MCO shall enter a memorandum of understanding with each local health department
(LHD) in its service area addressing the method by which the MCO and the
LHD will collaborate and communicate on matters of mutual interest and
concern, including but not limited to the responsibility of the LHD for
contact tracing for sexually transmitted diseases…" Maryland COMAR
10.09.65.02.
MI
"II-I Special
Coverage Provision...
14. Communicable
Disease Services
The Contractor
agrees that Enrollees may receive treatment services for communicable diseases
from local health departments without prior authorization by the Contractor
For purposes of this section, communicable diseases are... STDs..."
Michigan Contract, pages 22, 29.
MN
"Section 2.18. Family Planning Service means a ... health service, including screening, testing, and counseling for sexually transmitted diseases, such as HIV, when provided in conjunction with the voluntary planning of the conception and bearing of children …" Minnesota Contract, page 12.
"Section 6.1.7.
Family Planning Services...
B. The
HEALTH PLAN may not restrict the choice of an Enrollee as to where the
Enrollee receives the following services, pursuant to Minnesota Statutes,
Section 62Q.14: ...
3) testing
and treatment of a sexually-transmitted disease…" Minnesota Contract,
page 52.
MO
"b. Covered
Services...
22) Services
provided by local health agencies (may be provided by the health plan or
through and arrangement between the local health agency and the health
plan);
* Screening,
diagnosis, and treatment of sexually transmitted diseases…"
Missouri RFP, page 9.
"2.1.5
Services shall include...
1) Screening,
diagnosis, and treatment of sexually transmitted diseases…" Missouri
RFP, page 19.
"a. Health
plans are responsible for ensuring the following core services are available
to their members and for reimbursing the Department of Health and local
health agencies according to the most current Medicaid fee schedule in
effect at the time of service unless otherwise negotiated.
1) All
sexually transmitted disease service including screening, diagnosis, and
treatment…" Missouri RFP, page 58.
MT
"FAMILY PLANNING
SERVICE- for purposes of self referral, family planning services are defined
as the following:…
5.
Screening, testing, and treatment of and pre-and post-test counseling for
sexuality transmitted diseases…" Montana Contract, page 28.
"2.5 PROVISION
OF SERVICES
2.5.1
COVERED SERVICES...
HMO COVERED
SERVICE/Description...
Family Planning
(all persons)/per Social Security Act 1905(a)(2)(C); Medicaid beneficiaries
are given the freedom to self refer for family planning services.
Family Planning Service for purposes of self referral are as defined as
the following: …
2.
Patient counseling and education for the following:…sexually transmitted
disease, HIV/AIDS…
5.
Screening, testing, and treatment of and pre-and post-test counseling for
sexuality transmitted diseases and HIV...ARM 46.12575 &576" Montana
Contract, page 41.
NE
"4.1.22 The term 'Family Planning Services' means services to prevent or delay pregnancy, including...Treatment for sexually transmitted diseases (STD) pursuant to this contract shall be reimbursed by the plans in the same manner as family planning services, without referral or authorizations by the Primary Care Physician(PCP)/plan…" Nebraska Contract, page 9.
"13.47.1 Family Planning Services Defined: ...Treatment for sexually transmitted diseases (STD) is to be reimbursed by the plans in the same manner as family planning services, without referral or authorizations by the PCP/plan. STD includes but is not limited to Chlamydia, Gonorrhea and Syphilis." Nebraska Contract, page 96.
NM
"2.C.10.c
Share Responsibility between MCO and Public Health Offices.
The
CONTRACTOR shall coordinate with the public health offices regarding the
following services:
(A) Sexually transmitted disease services including screening, diagnosis,
treatment, follow-up and contact investigations." New Mexico Contract,
page 31.
"Family planning
services are defined as the following: ...
Diagnosis and
treatment of sexually transmitted diseases (STDs) if medically indicated..."
New Mexico Contract, page 33.
"2.D.35.f The CONTRACTOR shall operate a Family Planning Program. This program shall ensure that members of the appropriate age of both sexes who seek Family Planning services shall be provided with counseling pertaining to the following: ... HIV and other sexually transmitted diseases and risk reduction practices..." New Mexico Contract, page 50.
NY
"10. BENEFIT
PACKAGE, COVERED AND NON-COVERED SERVICES…
10.19
Public Health Services...
c) Prevention
and Treatment of Sexually Transmitted Diseases
The Contractor
will be responsible for ensuring that its Participating Providers educate
their Enrollees about the risk and prevention of sexually transmitted disease
(STD). The Contractor also will be responsible for ensuring that its Participating
Providers screen and treat Enrollees for STDs and report cases of STD to
Local Public Health Agency and cooperate in contact investigation, in accordance
with existing state and local laws and regulations…" New York Contract,
pages 10-1-10-11.
ND
"2.4 Family
Planning Service Access and Confidentiality...
(3) For
purposes of self-referral, family planning services are covered and are
defined as defined as: ...
(f) Screening,
testing, and treatment of and pre and post test counseling for sexually
transmitted diseases…" North Dakota Contract, Attachment C, page
10.
OH
"APPENDIX M
COVERED FAMILY
PLANNING SERVICES
A. The
following specified family planning services are covered if the services
are provided
on-site by
a qualified family planning provider (QFPP) in accordance with the Program
Guidelines for Family Planning Services as issued by the U.S. Department
of Health and Human Services:
(2) History and physical assessments/examinations provided for family planning purposes or for the diagnosis and treatment of sexually transmitted diseases (STDs);
(3) Laboratory procedures provided for… the diagnosis of sexually transmitted diseases...
B. The
following specified family planning services are covered if the services
are prescribed by a qualified family planning provider but are not available
on-site, if the off site services are coordinated through the primary care
physician (PCP) and provide by an MCP panel provider, or are coordinated
through the PCP and provided in accordance with a pre-approved arrangement
between the MCP and the QFPP:
(1) Laboratory
procedures authorized for family planning purposes... the diagnosis of
sexually transmitted diseases...." Ohio RFP, Appendix M, pages 1-2.
RI
"EXTENDED FAMILY
PLANNING BENEFITS...
Referrals
Referral for
other medically necessary services as appropriate/indicated, including
but limited to:
- Referral
to State STD clinic for treatment if indicated
- Referral
to State confidential HIV testing and counseling sites, if indicated…"
Rhode Island RFP, Attachment F, pages 1-2.
SC
"4.10.2 Communicable
Disease Services
Communicable
disease services are available to help control and prevent diseases such
as... sexually transmitted diseases (STD)...
Medicaid HMO Program Members shall have the freedom to receive... STD…services outside the Contractor's provider network by the state public health agency without any restrictions. For members who elect to receive... STD...services outside the Contractor's provider network, the state public health agency will bill SCDHHS to be reimbursed by SCDHHS fee-for-service." South Carolina Contract, page 21.
"RECOMMENDATIONS
FOR THE PREVENTION AND MANAGEMENT OF CHLAMYDIA TRACHOMATIS INFECTIONS,
1993...
Chlamydia screening
at family planning and prenatal care clinics is particularly cost-effective
because of the large number of sexually active young women who undergo
pelvic examinations.
Providers such as family physicians, internists, obstetricians-gynecologists, and pediatricians who provide care for sexually active young women also should implement chlamydia screening programs - although a lower volume of such patients may increase the cost of testing.
Chlamydial Infection
in Adolescents and Adults...
To maximize
compliance with recommended therapies, medications for chlamydial infections
should be dispensed on site, and the first dose should be directly observed...
Management of
Sex Partners
Patients should
be instructed to refer their sex partners for evaluation, testing, and
treatment…Sex partners should be evaluated, tested, and treated if they
had sexual contact with patient during the 60 days preceding onset of symptoms
in the patient or diagnosis of chlamydia…" South Carolina Contract,
Appendix B, pages 10-12.
"COMMUNICABLE
DISEASE SERVICES...
B. Communicable
Disease
An array
of communicable disease services are available to help control and prevent
diseases such as…sexually transmitted diseases (STD's). Communicable
disease services include examinations, assessments, diagnostic procedures,
health education and counseling, treatment, and contact tracing, according
to the Centers for Disease Control (CDC) standards...
Eligible recipients should be encouraged to receive…STD…services through their primary care provider or b appropriate referral to promote the integration/coordination of these services with their total medial care…Legible recipients have the freedom to receive…STD…services from any public health agency without any restriction to services." South Carolina Contract, Appendix C, Tab, 1 pages 3-4.
TX
"6.7 FAMILY
PLANNING - SPECIFIC REQUIREMENTS…
The following
initial Member education content may vary according to the educator’s assessment
of the Member’s current knowledge: ...
6.7.4.7
information on HIV/STD infection and prevention and safer sex discussion."
Texas Contract, pages 40-41.
"6.15
SEXUALLY TRANSMITTED DISEASES (STDS) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV)
HMO must provide
STD services that include STD/HIV prevention, screening, counseling, diagnosis,
and treatment. HMO is responsible for implementing procedures to
ensure that Members have prompt access to appropriate services for STDs,
including HIV.
6.15.1
HMO must allow Members access to STD services...
6.15.2
HMO must provide all covered services required to form the basis for a
diagnosis and treatment plan for STD/HIV by the provider.
6.15.3
HMO must consult with TDH regional public health authority to ensure that
Members receiving clinical care of STDs, including HIV, are managed according
to a protocol which has been approved by TDH...
6.15.4
HMO must make education available to providers and Members on the prevention,
detection and effective treatment of STDs, including HIV.
6.15.5
HMO must require providers to report all confirmed cases of STDs, including
HIV, to the local or regional health authority according to 25 Texas Administrative
Code...
6.15.6
HMO must coordinate with the TDH regional health authority to ensure that
Members with confirmed cases of syphilis, chancroid, gonorrhea, chlamydia
and HIV receive risk reduction and partner elicitation/notification counseling...HMO
may contract with local or regional health authorities to perform any of
the covered services required...
6.15.8.2
Medical Records and Confidentiality. HMO must require that providers
have procedures in place to protect the confidentiality of Members provided
STD/HIV services...HMO must implement policies and procedures to monitor
provider compliance with confidentiality requirements...
6.15.8.3
Partner Referral and Treatment. Members who are named as contacts
to an STD, including HIV, should be evaluated and treated according to
HMO’s protocol...HMO’s providers must coordinate referral of non-Member
partners to local and regional health department STD staff." Texas
Contract, pages 51-52.
WA
"4.9 Self-Referral to Family Planning Clinics and Health Departments: … Members may self-refer to health departments for the following services: …sexually transmitted disease screening and follow-up… In addition, members may self-refer to family planning clinics for… sexually transmitted disease screening and treatment services." Washington Contract, pages 17-18.
WV
"3.9 Family
Planning Access and Confidentiality...
Family planning
services are defined as the following: ...
* diagnosis
and treatment of sexually transmitted diseases (STDs) if medically indicated…"
West Virginia Contract, page 13.
"3.6.2 . Local
Health Departments
Local governmental
departments administer certain public health programs which are critical
to the protection of the public's health and, therefore, must be available
to Medicaid managed care enrollees...
The MCP must
provide the following core services to Medicaid managed care members and
must reimburse the local health departments as specified:
a) All sexually
transmitted disease services including screening, diagnosis and treatment…"
West Virginia RFA, page 22.
"3.5.1
Definition of Family Planning Services for Purposes of Out-of-Network Reimbursement
For the purpose
of out-of network reimbursement, family planning services are defined as
those services provided to individuals of childbearing age to temporarily
or permanently prevent or delay pregnancy. These services include: ...
d) Diagnosis
and treatment of sexually transmitted diseases (STDs) if medically indicated…"
West Virginia RFA, page 20.