New York

Historically, the New York State Department of Health (DOH) has not permitted federally qualified health centers (FQHC) to bill outside their bundled reimbursement rate for the cost of LARC devices. This policy created a significant financial barrier to health centers’ ability to offer LARC devices to their patients. The Community Health Center Association of New York State (CHCANYS) worked with the DOH to “debundle” reimbursement of the LARC device from the FQHC rate and provide direct reimbursement for the costs of LARC devices in fee-for-service Medicaid. This advocacy was informed by research, conducted in partnership with Health Management Associates (HMA), into the steps other states took to achieve this policy change. In July 2016, CMS approved a state plan amendment to allow direct reimbursement to New York State FQHCs for the acquisition cost of the LARC device, retroactive to April 1. CHCANYS continued to partner with the National Institute and other stakeholders to support New York State FQHCs as DOH implemented the LARC reimbursement policy, including ensuring that FQHCs were aware of how to track and bill for LARC devices. The toolkit developed for this initiative served as a guide to advocates and health centers in other states seeking similar reimbursement policy changes for LARC devices.