Section He-W 509.06 - Covered Services(a) The services in (b) and (c) below shall be covered as family planning services and family planning-related services, respectively, only if the services, supplies, and procedures are clearly provided or performed for family planning purposes.(b) The following services shall be covered as family planning services: (1) Those physician services in accordance with He-W 531, certified midwife services in accordance with He-W 538, and advanced registered nurse practitioner services in accordance with He-W 534, provided for family planning purposes;(2) Contraceptive devices or drugs, both prescription and non-prescription, in accordance with He-W 570;(3) Pregnancy tests and screening for a sexually transmitted disease (STD) only when performed routinely as part of an initial, regular, or follow-up family planning visit; and(4) Sterilization, in accordance with 42 CFR 441.253 and 42 CFR 441.254, as follows: a. The FPEC recipient shall be at least 21 years old at the time consent is obtained;b. The FPEC recipient shall not be a mentally incompetent individual;c. The FPEC recipient shall not be an institutionalized individual;d. The FPEC recipient shall voluntarily give informed consent in accordance with the requirements at 42 CFR 441.257 through 42 CFR 441.258;e. The provider shall submit a sterilization consent form meeting the requirements of 42 CFR 441, Subpart F, to the department prior to the department's payment for the sterilization claim;f. At least 30 days, but not more than 180 days, shall have passed between the date of informed consent and the date of sterilization, with the exception of cases of premature delivery or emergency abdominal surgery as described in g. below; g. A FPEC recipient may consent to be sterilized at the time of an emergency abdominal surgery if at least 72 hours have passed since he or she gave informed consent for the sterilization; and h. Treatment of surgical or anesthesia-related complications resulting from or during a covered sterilization procedure shall be covered; and(5) Family planning-related services that were provided as part of, or as follow-up to, a family planning visit in which a sterilization procedure took place.(c) The following services shall be covered as family planning-related services: (1) Services to treat adverse reactions to, or medical complications of, family planning procedures, services, treatments, or therapies including, but not limited to: a. Treatment of perforated uterus due to an intrauterine device insertion; andb. Treatment of severe menstrual bleeding caused by Depo-Provera injection;(2) Drugs, in accordance with the following: a. Drugs shall be for the treatment of STDs, except for HIV/AIDS and hepatitis, when the STD is identified or diagnosed during a routine or periodic family planning visit; andb. Title XIX providers shall comply with the provisions of He-W 570 regarding pharmaceutical services when prescribing or dispensing drugs covered in a. above;(3) A follow-up visit after prescribing drugs for the treatment of an STD, including a re-screen for the STD;(4) Drugs and other treatment for lower genital tract and genital skin infections/disorders, and urinary tract infections, when the infection/disorder is identified/diagnosed during a routine/periodic family planning visit;(5) A follow-up visit for drugs and other treatment of the lower genital tract and genital skin infections or disorders where the infections or disorder is identified during a family planning visit; and(6) Vaccinations to prevent cervical cancer that are routinely provided pursuant to a family planning service in a family planning setting.N.H. Admin. Code § He-W 509.06