This section includes MHCP coverage and billing policy for the Minnesota Family Planning Program (MFPP) providers.
MHCP offers MFPP as a separate set of Family Planning services. Provider, recipient, and service delivery requirements are not the same for MFPP and non-MFPP MHCP family planning services. Refer to the Reproductive Health/OB/GYN overview page for links to other related services.
The Minnesota Family Planning Program (MFPP) provides family planning services and supplies for women and men ages 15 years to 50 years, (eligibility begins the first day of the month of the 15th birthday through the end of the month of the 50th birthday), who are not eligible for other MHCP programs, and meet certain income guidelines. The main goal of MFPP is to reduce the number of unintended births, thereby reducing costs to Minnesota’s publicly funded health care programs.
The following enrolled MHCP providers are eligible to provide services to MFPP recipients:
A registered nurse (RN) in a family planning agency may dispense oral contraceptives prescribed by a licensed practitioner, according to a dispensing protocol established by the agency’s medical director or under the direction of a physician. RNs may not dispense oral contraception to a recipient who is less than twelve years of age. Follow state requirements for dispensing prescription drugs.
Presumptive eligibility is a short-term period of eligibility determined at the point of service by a certified MFPP provider. At the time a presumptive eligibility determination is made, the certified MFPP provider gives the applicant a MFPP Short-Term Approval Notice, available online through the MN–ITS site. Other providers, including pharmacies and labs, must accept this form as proof of eligibility for the dates indicated.
Before you determine PE you must verify eligibility on MN–ITS, IVR or X12 270/271. Recipients currently eligible for any Minnesota Health Care Program (MHCP) (including MinnesotaCare) are not eligible for PE. Give current MHCP recipients a denial notice, and forward the application to DHS for a formal denial.
Certified MFPP providers are individuals and clinics providing primary family planning services that are certified by DHS to determine presumptive (short-term) eligibility for MFPP. Individual providers working in a certified clinic do not need separate certification when the clinic itself is certified.
To become certified, a provider must have participated in a past MFPP training or complete the current online MFPP Training Guide (PDF), and submit the completed Certified Family Planning Provider Application Packet (DHS-4773) (PDF) to:
PO Box 64987
St Paul MN 55164-0987
Fax forms to: 651-431-7462
For questions, please call the Provider Call Center at 651-431-2700 or 800-366-5411.
When recipients require access to primary care services, direct them to the MHCP Provider Directory. Refer recipients who want other health care coverage to the MNsure website.
Additional MFPP forms are also available from the MFPP office at 651-431-3480 or 888-702-9968.
Certified MFPP providers will determine MFPP eligibility at the point of service. MFPP applicants may apply on their own behalf without the consent of anyone else. Eligibility for individuals under age 21 is not based on parental income. An eligible recipient for MFPP must meet the following criteria:
Recipients have initial presumptive (short-term) eligibility for the month the MFPP provider determines them eligible, through the last day of the following month. MHCP will determine the recipient’s continued MFPP eligibility. If found eligible, the recipient has MFPP coverage for an additional twelve months. MFPP eligibility ends before the annual renewal if the recipient has one of the following occur:
All partner agencies of the Minnesota Department of Human Services (DHS) are required to comply with federal and state laws that protect the privacy and security of individually identifiable client information.
Responsibility to Protect Private Data
You are responsible to protect individually identifiable information about applicants for, or enrollees in, DHS services and program benefits.
Responsibility to Protect Privacy of Minors
Remember that minors may apply for the MFPP without parental consent.
In addition to MHCP confidentiality protection, MFPP applicants and recipients also have the following protections:
All MFPP procedure codes are available on the Minnesota Family Planning Program (MFPP) Procedure Codes list. Refer to Family Planning Codes with Increased Rates for a list of the codes that receive the legislative rate increases.
Use an MFPP recipient’s approval notice as proof of MFPP presumptive eligibility. After the initial three business days, verify eligibility and obtain the recipient’s ID number using MN–ITS. The system will denote MFPP eligibility with major program code FP. If the recipient is ineligible or you cannot obtain the ID number, contact an MFPP Eligibility Specialist at 651-431-3480 or 888-702-9968.
MFPP covers only family planning related services and supplies, and treatment of sexually transmitted infections (STIs) diagnosed in conjunction with a family planning service listed below:
Mammograms are not a covered MFPP service. For women who require a mammogram, the Minnesota Department of Health (MDH) SAGE Program may be an option if they meet program requirements. Recipients may be eligible for both the SAGE Program and MFPP.
Report all primary MFPP services with a primary ICD diagnosis code in the applicable range.
Refer to Sterilization for service, consent, and timeline requirements.
Contact the pharmacy before you fax both sides of the MFPP Rx Form available in MN–ITS, (do not give to the recipient) and a copy of the recipients short term approval letter to the pharmacy. Pharmacies need to be prepared to accept prescriptions and immediately dispense medications and supplies listed on the MFPP Rx Form during a recipient’s MFPP presumptive eligibility period.
MHCP asks pharmacies to work with the MFPP provider and dispense the medications and supplies indicated on the MFPP Rx Form during a recipient’s MFPP presumptive eligibility period.
Certified MFPP providers prescribing medication or supplies must:
MHCP asks pharmacies to wait three business days to bill for the initial dispense of MFPP medication and supplies, to allow the recipient’s eligibility status to appear in the MHCP system
MHCP reimburses pharmacies for MFPP related medications and supplies during the presumptive eligibility period, even if it is later determined the recipient was not eligible for more than the initial two months of MFPP.
Refer to the MFPP Contraceptive and Medication Supplies Table. MFPP will pay at the maximum allowable cost (MAC) for generic medications.
Refer to the following when billing for family planning services:
Refer to the Lab Services section when ordering or referring lab tests.
Certified MFPP providers may perform or order lab tests found in MFPP Procedure Codes List above that are performed during the PE period under the conditions that the MFPP-certified provider found the recipient presumptively eligible.
Applicable secondary MFPP procedure codes are listed on the last page of the Minnesota Family Planning Program (MFPP) Procedure Codes list. Listed secondary services are covered only when they meet one of the following:
MFPP does not cover the full MHCP benefit set. MFPP does not cover the following services:
MFPP reimbursement rates are the same as MHCP fee-for-service reimbursement rates. Recipients may not be charged or billed for MFPP services. MFPP services have no copays.
Bill other insurance only if insurance is listed on the current eligibility response.
Refer to the Lab Services section when billing lab tests.
MFPP-certified physicians treating recipients that have presumptive eligibility (PE) for MFPP may bill for lab tests or services when:
• The tests or services are performed at your facility
• The tests or services are performed on the same day as other family planning services
• The primary diagnosis is in the applicable range
If you send lab tests to a reference or independent lab provider, refer to the Reference and Outside Lab Services policy in the Lab Services section. Give the lab provider the following information so the lab can bill for the service:
If an MFPP recipient does not have an MHCP ID number:
All MHCP-enrolled labs are required to perform lab tests ordered for recipients during the PE period and after a recipient’s MFPP ID number is determined and available on EVS or MN–ITS (usually 3 business days after the physician determines PE).
Minnesota Statutes 9505.5305 (definitions)
Minnesota Statutes 9505.5310 (eligibility, application, enrollment, and documentation)
Minnesota Statutes 9505.5315 (providers of family planning services)
Minnesota Statutes 9505.5325 (appeals)
Section 1902(a)(32) of the Social Security Act (Reference Labs)