THOMAS J. VILSACK, GOVERNOR DEPARTMENT OF HUMAN SERVICES

SALLY J. PEDERSON, LT. GOVERNOR KEVIN W. CONCANNON, DIRECTOR

- 2 -

INFORMATION RELEASE NO. 485 February 10, 2006

TO: All Iowa Medicaid Participating FQHC and RHC Providers

ISSUED BY: Iowa Department of Human Services, Iowa Medicaid Enterprise

RE: Billing for Family Planning Waiver Members

EFFECTIVE DATE: February 1, 2006

The Iowa Medicaid Enterprise (IME) has received federal approval to implement a waiver to provide family planning services to a selected member group. This new coverage group is called the Iowa Family Planning Network (IFPN). Women who are eligible for the Iowa Family Planning Network will have an aid type of 906, which will be seen on the member’s medical assistance card. However, this new program ONLY covers family planning services. Please refer to informational release 483 for details, including the list of covered services.

If providers need to make eligibility inquiries concerning a given individual’s IFPN eligibility, such can be made in the same manner as for any Iowa Medicaid member. This information is available through the automated Eligibility Verification System (ELVS), or via the Iowa Medicaid Enterprise Eligibility Web Portal.

Special Payment Method for FQHCs and RHCs

FQHCs and RHCs may provide these Family Planning Waiver services to eligible members. However, please note: Payment for these family planning services will be based on the physician fee schedule for the CPT codes eligible for reimbursement. RHCs and FQHCs may NOT bill an encounter (procedure code T1015) for these services. To receive payment:

·  The claim submitted by the FQHC or RHC must have the eligible CPT code (i.e. for the covered Family Planning Waiver service) and the supporting eligible (i.e. family planning) diagnosis code.

·  See informational release 483 for a list of covered CPT codes and covered prescription and over the counter drugs.

·  When the claim is submitted, the payment system will verify that the member is eligible for this limited benefit package.

·  The payment will then be made according to the physician fee schedule, for the appropriate Family Planning Waiver service CPT code.

These IFPN visits and payments may not be used in calculations in establishing the FQHC’s or RHC’s encounter rate for subsequent payment years. These visits may not be counted as Medicaid visits and the revenue must be treated as any other private/commercial insurance payment.

If you have any questions, please contact the IME Provider Services at 1-800-338-7909 or locally at 515-725-1004.

.