Upcoming changes related to reproductive health services coverage

The Pennsylvania Department of Human Services (DHS) and the Office of Children's Health Insurance Program (CHIP) recently issued guidance on future coverage and reimbursement processes for certain reproductive health services under Medicaid and CHIP programs. The guidance reflects changes resulting from ongoing legal proceedings and outlines how these services will be administered and funded.

DHS and CHIP are preparing for the expansion of coverage for certain medically necessary reproductive health services that historically were covered only in limited circumstances under federal funding rules. Because some of these services will be funded solely with state dollars, the state is establishing separate payment and reimbursement arrangements with managed care organizations.

No immediate action is required. The changes will go into effect at a future date established by DHS. Until then, current policies remain in place. DHS and CHIP will communicate further details as implementation moves forward.

Geisinger Health Plan is reviewing the guidance and preparing for any required operational, systems and provider education activities. Watch for communications from GHP as more information becomes available, including updates related to coverage, billing processes and administrative requirements.