Los Angeles Regional Family Planning Council, Inc.
Background
The Consolidated Omnibus Reconciliation Act of 1985 (COBRA '86) contained a provision guaranteeing the right of Medicaid patients to receive family planning services from providers of their choice. This federal "Freedom of Choice" waiver was created to ensure Medicaid managed care enrollees confidential access to family planning services in an environment in which they feel most comfortable seeking these sensitive services. Due to family circumstances, cultural factors, domestic violence or other personal considerations, women and teens may be reluctant to seek family planning care where other family members receive health care services. Further, some primary care providers may not be comfortable addressing sexuality and family planning issues. Ultimately this results in higher rates of unintended pregnancy and sexually transmitted diseases and increased costs for the health care delivery system.
The Freedom of Choice Waiver in California
As California's Medi-Cal managed care enrollment increases, the Freedom of Change Waiver is being implemented. The Los Angeles Regional Family Planing Council has worked in collaboration with State Department of Health Services Office of Family Planning and the Medi-Cal Managed Care Division to develop mechanisms whereby out-of-plan providers are reimbursed from managed care plans for services provided to Medi-Cal managed care enrollees. Requiring prior authorization for family planning services is prohibited by law; however, out-of-plan providers and managed care plans are working together to ensure coordination of services and quality care.
Out-of Plan Services in Los Angeles County
Since managed care plans are capitated for family planning services, each plan is contractually responsible for reimbursement for services provided to its members. The Los Angeles Regional Family Planning Council is the intermediary for many of the out-of-plan family planning providers with Medi-Cal managed care plans in Los Angeles County. Family planning agencies submit their bills through the Council which in turn bills the plans and disperses reimbursement. In order to facilitate the billing process, the Council works with plans to establish procedures ensuring coordination of care and timely reimbursement.
Services Covered by the Waiver
Clients may exercise their freedom of choice when seeking the following services:
About the Los Angeles Regional Family Planning Council
Incorporated in 1968, the Los Angeles Regional Family Planning Council is a not-for-profit health management organization. The Council distributes government and private family planning funding to a network of diverse family planning providers throughout Los Angeles County. The Council conducts fiscal and quality improvement monitoring of grantee agencies, reporting funding sources as appropriate. The Council also provides extensive training and technical assistance to medical and non-medical clinic staff and conducts contraceptive research.
Based on nearly three decades of experience, the Council and its agencies have developed unique expertise in the delivery of high quality reproductive health care services to hard-to-reach clients and those with special needs. Special training and service programs exist to meet the needs of clients of various cultural backgrounds, teens, disabled women, and other traditionally hard-to-reach populations.
Family Planning Agencies
Agencies under the Family Planning Council umbrella are independent corporations: hospitals, public health entities or licensed community clinics which represent approximately 90 service sites countywide. While all have comprehensive family planning programs, agencies also provide a range of other health and social services as well. All facilities have bilingual (English, Spanish) staff; several agencies have numerous other language and cultural capabilities as well.
The Following agencies are grantees of the Family Planning Council:
For More Information
Please contact your managed care plan representative or the Los Angeles Regional Family Planning Council if you have questions regarding the freedom of choice waiver.
Los Angeles Regional Family Planning Council
3600 Wilshire Blvd., Suite 600
Los Angeles, CA 90010
Phone: (213) 386-5614
TDD: (213) 487-4193