Question Answers/Format Do you have immediate postpartum protocols and process flows in place for implants? Have not started Working on it In place departments have implemented a protocol to support immediate postpartum placement of implants? (check all that apply) (Check both "L&D" and "Postpartum unit" if hospital has combined L&D/postpartum unit.) L&D Postpartum unit OB OR Pharmacy Billing Other: _____________ Hospital has coding/billing strategies in for reimbursement for IPLARC If your hospital carries LARC devices, does your hospital use 340B purchasing for LARC devices? Hospital is not eligible for/doesn’t participate in 340B Eligible, not yet participating Eligible, participating Do not know Have you implemented billing for IUDs? Haven’t started Working on it In place Have you implemented billing codes for implants? Haven’t started Working on it In If billing codes are implemented for IUD, implant, or both, with which payers do you have billing strategies in place? Traditional Medicaid/Medicaid FFS Medicaid MCOs Private insurers (please specify, check all that apply) Ambetter Assurant Health BCBS of IL Coventry Harken Health Humana United Health ____________ Has your hospital billed for the devices you placed? Yes No Not yet placed any devices Have you received reimbursement for the devices that you placed? (check all that apply) Yes, traditional Medicaid/Medicaid FFS Yes, from MCO(s) Yes, from at least 1 Medicaid MCO Yes, from all Medicaid MCOs with whom the hospital contracts Yes, from all Medicaid MCOs, even those with whom the hospital does not contract Yes, from private payer(s) Yes, from at least 1 private payers Yes, from all private payers with whom the hospital contracts No Not yet placed any devices
Question Answers/Format Hospital can document IPLARC placement in IT/EMR systems. Does your hospital have IT /EMR revisions implemented for tracking and documentation of immediate postpartum placement of IUDs? Have not started Working on it In 16a. If “in place,” where does IUD documentation occur? (check all that Delivery template – Providers Delivery template – nurses Separate EMR form – providers Separate EMR form – nurses Other: _____________ If “In place,” which IT / EMR revisions have been completed to assure adequate tracking, and documentation for IUDs (check all that apply) EMR for consent EMR for contraceptive choice counseling, including IPLARC sets Pharmacy system (acquisition and stocking) Billing system Tracking tools Other: ____________ Does your hospital have IT /EMR revisions implemented for tracking and documentation of immediate postpartum placement of implants? Have not started Working on it In 18a. If “in place,” where does implant documentation occur? (check all that Delivery template – Providers Delivery template – nurses Separate EMR form – providers Separate EMR form – nurses Other: _____________ If “in place,” which IT / EMR revisions have been completed to assure adequate tracking, and documentation for implants? (check all that apply) EMR for consent EMR for contraceptive choice counseling, including IPLARC Order sets Pharmacy system (acquisition and stocking) Billing system Tracking tools Other: ____________ Hospitals have provided education materials for affiliated prenatal care sites and to patients at their hospital during delivery admission Number of affiliated prenatal care sites Number: _______________ Have you provided patient education materials and counseling protocols and process flow for affiliated prenatal care sites regarding IPLARC, including all contraception options? Yes, one or more Yes, all No 21a. If yes, one or more, please specify the number of affiliated prenatal care centers to whom you’ve provided materials Number: _____________