FAQs - FPE CAP Application Process

Q. i WORK at a health organization with multiple health center locations. can i apply for more than one site?

A. Yes! We recognize the value in building regional capacity for contraceptive care. Organizations are encouraged to carefully consider which health centers in their network would be best poised to start or expand family planning services. Note that while more than one health center within an organization may take part in FPE CAP, the maximum cash grant awarded to any organization cannot exceed $100,000.

Because the needs and plans for each health center within an organization may vary, we do require a separate application package for each site you’d like us to consider for membership. However, many responses in the application form may be duplicated across sites as long as responses are applicable to each setting. Organizations may also opt to submit one integrated budget rather than a separate budget for each health center.

Q. how many provider champions do i need on my fpe team?

A. Each FPE CAP health center should have at least one provider champion: a physician or advanced practice clinician committed to the goal of providing comprehensive contraceptive care (including LARC services) on-site. The core FPE CAP team should also include health center staff centrally involved in FPE CAP program implementation. Team size and composition will vary between health centers, but may include a clinic manager, MA or RN champion, lead health educator, CFO or billing manager, and/or community outreach staff. When designating your core FPE CAP team, consider not only which roles are immediately relevant to contraceptive services, but also staff interest & commitment to FPE CAP goals. Make your team a team of champions!

Q. If now is not the right time for us to apply, are there other ways to be involved?

A.  Absolutely. We will select three cohorts over the life of the program, so you may choose to consider FPE CAP membership at another time. The application process for cohort 2 will begin in April 2019, and the application process for cohort 3 will begin in October 2019. Join our mailing list to stay in the loop about important program updates and announcements.

If FPE CAP membership isn’t a great fit for your health center, there are several ways you can stay involved with FPE:

  • Want a one-day primer or booster on contraceptive care? Join us for the FPE Contraceptive Education and Training Conference on January 18th, 2019 in Salt Lake City. This conference is open to all providers, clinical support staff, and administrative staff looking to improve their family planning skills and services. Space is limited, so early registration is encouraged.

  • Can’t make it in-person? Check out our online resources for patients and providers, including the REPP webinar series and recorded sessions from the January 2019 FPE Contraceptive Education and Training Conference. Let us know what additional topics and technical resources you’d like to see covered in the future.

Want to contribute to our research initiatives? We’re currently seeking clinics who are not taking part in FPE CAP at all during the project lifecycle to contribute ongoing contraceptive service data. Contact Rebecca Simmons (rebecca.simmons@hsc.utah.edu) to learn more about clinic requirements and compensation for participation.

Q. Is the cash grant amount for each year of the grant term, or for the entire two-year program?

A.  Cash grants in the amount of $38,000 - $100,00 will be awarded to organizations for the total two-year project period, not for each grant year. Payments will be disbursed at regular intervals during the program (quarterly or semiannually), as determined in the Memorandum of Agreement.  

Q. Should I include contraceptive methods and insertion/removal services in my budget, or are those separate from the cash grant?

A.  No, you do not need to include the cost of contraceptive methods in your budget. FPE CAP will provide health centers with a free supply of IUDs and implants, and will reimburse health centers for the purchase of other contraceptive methods. We’ll work with FPE CAP members to plan for the initial procurement and purchase of short-acting methods so that if sites have difficulty covering the up-front cost of stocking these methods until we provide reimbursement, we can account for this in the MOA. But the short answer is no, you don’t need to budget for the methods themselves.

You also do not need to include the cost of insertion or removal services in the cash grant. Health centers will submit to us a monthly invoice for eligible services provided and we will reimburse for these independent of the cash grant.

Q. Can you provide some examples of ineligible budgetary expenses for FPE CAP?

A.  There are just a few identified expenses that we wouldn’t expect to cover in health center budgets. Keep in mind, however, that we’re able to be fairly flexible in considering “ineligible” expenses on a case-by-case basis when health centers make a compelling case for their need. If you have something in mind that falls into one of the categories below, let us know and we can discuss further:

  • Contraceptive methods. We will either provide these to clinics directly (IUDs & implants) or provide vouchers or reimbursement for their purchase (short-acting methods), so they do not need to be included in the health center budget.

  • Trainings. We anticipate that most technical assistance requested by FPE CAP members can be provided either by our immediate team or by our extended network of colleagues; as such, we wouldn’t expect health centers to propose costs in their budgets for external trainings. At the same time, we want to encourage members to think creatively about technical assistance they’d benefit from—chances are other health centers may need the same thing, and our team can work to bring that training or resource to all FPE CAP members.

  • Marketing materials. FPE will be contracting with a digital media and marketing agency to develop messaging, materials, and online resources to improve patient education and awareness of contraceptive services available (including expanded eligibility for Medicaid). These will be customizable for member clinic locales, so we don’t see a large need for health centers to undertake additional marketing activities in their budget. However, if a health center has an articulated need for an expense that wouldn’t necessarily be covered by our centralized media campaign, we’re open to considering it.

  • Travel: We envision most travel during the program will be members of our team coming out to FPE CAP health centers rather than vice versa. Travel to Salt Lake City or regional towns for FPE CAP-sponsored trainings or events will be covered by the project. In general, we don’t plan to fund members’ travel to national conferences or trainings except on a case-by-case basis (for example, presenting on FPE CAP at a conference).

  • Indirect cost rates (for facilities and administration) as a percentage of the overall budget are also not permitted.

Q. So, if we don’t have to include contraceptive methods or services in our budget, what should we spend the cash grant on?

A.  Even with free provision of contraceptive methods, reimbursement for services, and technical training, we anticipate that health centers face remaining cost barriers to providing comprehensive contraceptive care-- whether that’s a lack of personnel to deliver or manage FPE CAP activities or perhaps a shortage of clinic equipment and supplies to accommodate an increased volume of family planning services.

  • For personnel costs, consider whether additional clinical staff, medical support staff, or administrative staff need to be hired or what portion of existing staff time may need to be allocated and funded by FPE CAP over the two-year project period.

  • For clinic equipment and supplies, consider medical equipment that may need to be purchased for LARC insertion/removal (medical instruments, autoclave, exam table). It may be helpful to review your health center’s historical expenditures for contraceptive supplies and equipment to plan for replacements, upgrades, and additional items to accommodate expanded contraceptive services.

Lastly, though FPE CAP has a cash grant request range of $38,000 - $100,000, we are happy to accept budgets less than this amount if your health center has reviewed all potential expenditures and determined your total cash grant need to be less than $38,000.

 

FAQs - FPE CAP Program

Q. What are the reimbursement rates and how quickly will I be reimbursed for services?

A.  Reimbursement rates for services and methods provided to FPE CAP clients will be set according to the Medicaid fee schedule applicable for your health center setting. Specific rates will be reviewed with member clinics and finalized in the Memorandum of Agreement. Clinics will submit a service reimbursement invoice each month and can expect to receive payment within 60 days.

Q. Will FPE require MY health center to document the citizenship status of our patients? We serve a large number of undocumented patients, but we don’t want to ask about citizenship.

A.  We appreciate health center sensitivity around documenting citizenship status, and for this reason, we will not require organizations to provide us with proof of their undocumented clients’ eligibility for covered contraceptives through FPE CAP. When clinics submit reimbursement claims to us for clients below 100% FPL (or 138%, if Medicaid expansion passes), this indicates to us that health centers have determined to the best of their ability that these clients are ineligible for Medicaid (but eligible for FPE CAP) on the basis of citizenship status.

Similarly for the FPE CAP application, we don’t require precise figures for undocumented patients served—an estimate based on the best clinic & demographic data available to you is acceptable.

Q. As an FPE CAP member, will my health center be expected to provide sterilization as a contraceptive option?

A.  FPE CAP does not currently require health centers to provide on-site sterilization as a contraceptive option, though clinics will be expected to identify and facilitate linkages with nearby referral sites for sterilization. Currently, FPE CAP does not reimburse health centers for providing vasectomy and tubal ligation to FPE CAP clients, though technical training and reimbursement for sterilization may be available in later stages of the program.

Q. How does FPE define “success” for FPE CAP members?  

A.  We want to help FPE CAP members achieve a reality in which clients can visit their local health center, access quality contraceptive counseling, and if desired, receive a method of their choosing without cost barriers. Just as each FPE CAP member faces a unique set of challenges to offering this kind of comprehensive contraceptive care, we anticipate that the pathway and timeframe for achieving it may vary from health center to health center--and that’s okay! We’ll use quarterly update calls, periodic technical assistance visits, and monthly service provision reports to help each member assess progress toward their goals.  Members should be assured that “success” will not be determined by the number or type of contraceptive services provided through FPE CAP. While the combination of improved clinical capacity, increased community demand, and expanded coverage for contraception will likely result in more clients receiving contraception, the focus of FPE is increasing contraceptive access, not use. FPE CAP will never expect members to achieve targets for the number or type of contraceptives provided.

FAQs - Data & Evaluation

Q. If my organization is applying for Contraceptive Access Program membership on behalf of multiple health centers, do I need to generate Service Provision Reports for each Health center individually? Or can I submit one report for the organization as a whole?

A.  The purpose of evaluating this project is to determine whether there are clinic-specific improvements to contraceptive service provision over time (particularly as they relate to low-income clients eligible for the new Medicaid Family Planning waiver and to women who fall between 101%-250% FPL, to whom FPE will provide free contraception care during the program timeframe). In order to do this, we will have to track provision of contraceptive services at each health center over time. In short, application materials must include unique service provision reports for each health center interested in FPE CAP membership.

Additionally, as different health centers will need different things from FPE (in terms of training, technical assistance, supportive supervision, demand, etc), we need separate applications (and the data reports) for each health center that applies to ensure that we can tailor our support to best meet that health center’s needs.

Q. My organization wants to apply for FPE CAP membership, but I am not sure we can pull data from our EHR/EMR like the Monthly Report Template specifies. Does this mean we cannot apply?

A. While we do need to collect some specific data measures for evaluation purposes, we don’t want the data requirements to prevent organizations from applying for membership! The FPE Project Team is here to help organizations and community health centers wherever possible, even in the application stage. Reach out to our Data and Evaluation team (Rebecca Simmons, rebecca.simmons@hsc.utah.edu, or Alexandra Gero, alexandra.gero@hsc.utah.edu) directly with any specific data issues or concerns so that we can determine the best course of action together.

Q. I’m worried that this is too much of a data ask for my clinic.

A. We are hopeful that once the initial work of setting up the report is completed in the EHR (or EMR), it will be easy to pull subsequent reports. After setting up the initial pull, future reports should be a matter of inputting new dates into the report template and re-running. If you need assistance setting up your initial data pull, please reach out to our Data & Evaluation team for assistance. We want this to be as easy as possible.

Q. What specific criteria do you want us to use to define “contraceptive services”? Is it CPT/HCPCS driven?

A. For our purposes, a “contraceptive service” refers to any patient seen during the given reporting period whose visit record includes one of the applicable ICD-10 Diagnostic/Procedural, CPT, or HCPC codes listed in the Monthly Data Reporting Template (the complete list follows the template).

For example, if a client record has an E/M S4993, it would be counted as a client who received a contraceptive service, even if that record didn't contain a corresponding ICD-10 code (since the contraceptive method is identified). If the record had a generic CPT code (e.g.,  99201), with a corresponding ICD10 diagnostic code (e.g., Z30.011), then that client would also count as having received contraceptive services.

Q. On the data reporting form, the E/M CPT Codes are very general. Am I supposed to filter the patients included in those counts with some criteria or do you want to know all my E/M codes for the applicable periods?

A. We are only collecting E/M CPT codes that are attached to relevant contraceptive ICD-10 codes (i.e., those that are listed in the form). We have separated these out from other E/M CPT codes because we are trying to identify unique client visits (whereas there could theoretically be multiple ICD codes for a single client).

Q. Why are you collecting patient demographics?

A. While we will not collect individual-level data, understanding who is seeking contraceptive services at an aggregate level is important, as it helps us design other aspects of FPE to better support specific clinic populations.

Q. What are the client exit surveys? What role will my health center have in  collecting them?

A. The client exit surveys will hopefully be an easy lift for health centers. After clients finish their contraceptive service visit, we would ask health center staff to make them aware of the opportunity to complete a brief (~10 minutes), compensated ($20) survey around their clinic experience. If they are interested, they simply input their name and email address into a computer tablet (which we will provide), and FPE will email them the survey link. The clinic’s role in this process is mainly to inform clients that the survey is available, and provide them with the tablet to enter their information.

The client exit survey has two purposes: 1) we will be assessing clients’ exposure to the various media campaigns from FPE and other stakeholders, and 2) we want to hear about clients’ experiences accessing contraception.

We will conduct client exit surveys for 3 months at the beginning of the FPE CAP project, for 3 months at the mid-point of FPE CAP, and for 3 months after FPE CAP support ends.

Q. Why do you need 42 months of data when FPE CAP membership only lasts for 2 years?

A. Providing 6 months of pre-FPE CAP data and 12 months of post-FPE CAP data will allow us to account for trends in contraceptive service provision that might not be related to FPE. This increases our statistical confidence in identifying changes in contraceptive access that are due to FPE.