The Massachusetts Medical Society (MMS) wishes to be
recorded in support of S.507, An Act Relative to Women’s Health (Chang-Diaz). S.507 would require public and private
insurance coverage for Long-Acting Reversible Contraception (LARC) separate, or
“unbundled” from other services. The mandate would include inpatient and
outpatient services. The bill would also direct the Department of Public Health
to develop a program to expand the number of health care providers that offer
LARC.
Two types of LARC are intrauterine devices (IUDs) and
subcutaneous hormone-releasing implants.
These birth control options have gained popularity, potentially due to
their low rates of side effects, greater effectiveness, and broader
acceptability among different populations of women.
As LARC methods often have higher upfront costs than other
contraceptives, LARC coverage policies play a large role in determining their
accessibility. Research shows that LARC
methods save money over time. One study estimates a savings of $2.3 million
over two years for every 1,000 Medicaid-eligible women.
More can be done to increase the use of LARC contraception.
Two reasons cited for the low utilization of LARCs in the U.S. are (1)
administrative and reimbursement barriers that result in high upfront costs for
devices and (2) payment policies that reduce (or do not provide) reimbursement
for devices or their placement. Coverage of LARC methods does exist under both
private insurance plans and public coverage models, but there is a lack of
uniformity within and across policies. S.507 would standardize reimbursement
and ensure fair coverage across all carriers.
Reimbursement for LARC devices provided immediately
postpartum is particularly complicated due to the payment structure of obstetric services under both
Medicaid and private insurance plans. Usually, hospitals and clinicians receive reimbursement for
obstetric care through a “bundled” payment that may not include the costs of
LARC insertion or even the device itself.
In such situations, providers may not offer postpartum LARC methods
because they or their health system lose money in the process. Again, S.507
would rectify this situation by allowing for separate reimbursement for
postpartum LARC insertion.
Reimbursement for LARC separately from other services is
supported by the U.S. Centers for Medicare and Medicaid Services (CMS). In June
2016, CMS wrote to state health officials offering recommendations for how to
ensure Medicaid coverage of LARC. The letter states “CMS strongly recommends
that states establish payment policies that, when a woman chooses, permit and
encourage insertion of LARCs immediately following a vaginal delivery or
surgical procedure as a separately identified service that is eligible for the
90 percent FFP.”
The MMS urges the Committee on Financial Services to report
S.507 out of Committee favorably.
