Ala. Admin. Code r. 560-X-14-.05
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-14-.05 - Non-Family Planning Services(1) Medically necessary procedures for the treatment of illness or injury which would inevitably have a secondary effect of rendering an individual incapable of reproducing are not classified as family planning procedures. Claims for such procedures are payable based on determination of medical necessity under the same procedures used by the fiscal agent in claims processing.(2) Sterilization by hysterectomy is not a family planning covered service.(3) Abortions are not covered as a family planning service. Refer to Chapter 6, Physician's Program.(4) Hospital charges resulting from recipient deciding not be sterilized after entering the hospital for sterilization purposes cannot be reimbursed as a family planning service.(5) Removal of IUD because the recipient has a uterine/pelvic infection is not considered a family planning service and is not reimbursable as such.(6) Colposcopy and biopsy of cervix/vagina performed to identify and treat medical conditions are not considered family planning services.(7) Medical complications requiring treatment (i.e., perforated bowel) caused by or following a family planning procedure cannot be a covered family planning service.(8) Any procedure/service provided to a woman who is known to be pregnant cannot be considered a family planning service.(9) Removal of contraceptive implants due to medical complications are not family planning services; however, the removal may be covered as a medical service through the Physician's Program. Authors: Delores Argo, Gail Ellerbrake, Deborah K. Crawford, Dee Lockridge
Ala. Admin. Code r. 560-X-14-.05
Rule effective October 1, 1982. Amended effective July 9, 1984; March 12, 1987; December 10, 1987; August 12, 1992. Amended: Filed August 6, 1993; effective September 10, 1993.Statutory Authority: State Plan; 42 C.F.R. §§401, etseq.; 441.250, 441.251, 441.252, 441.255; Title XIX, Social Security Act.