for NIPS testing? 1 Close to 90% of Medicaid But this coverage - PowerPoint PPT Presentation

Who has access to coverage for NIPS testing? 1

Close to 90% of Medicaid But this coverage covered lives can depend on a woman’s age. have some access to NIPS 2

State Medicaid Programs that Cover “All Risk” Florida, Pennsylvania, Minnesota, Ohio and Virginia cover NIPS for all women -- regardless of their age or risk. 3

State Medicaid Programs that Cover “High Risk” 35 states provide access to NIPS is limited to pregnant women NIPS only for high risk who: Alaska Montana • Are over the age of 35 Arkansas New Hampshire California New Jersey Colorado • History of a prior pregnancy with a North Carolina Connecticut Oklahoma trisomy Delaware Oregon Georgia South Carolina • Fetal ultrasound finding show Hawaii South Dakota Illinois Tennessee increased risk of aneuploidy Iowa Texas Kansas Utah • Positive first or second-trimester Kentucky Vermont Maryland Washington standard biomarker screening test Massachusetts West Virginia Michigan Wisconsin Mississippi 4

Medicaid Managed Care plans also vary in their coverage of NIPS for all However, if a Medicaid fee- women. for-service program covers a particular service, MCOS are legally obligated to cover that same service with no additional criteria. 5

Many major commercial insurance plans cover NIPS 6

Blue Cross Blue Shield Plans Covering Average Risk • BCBS Kansas • BCBS Arkansas • BCBS/Anthem Ohio • BCBS/Anthem Kentucky • BCBS Arizona • BCBS Rhode Island • BCBS/Anthem Maine • BS California • BCBS South Carolina • BCBS Massachusetts • BCBS/Care First Maryland • BCBS Tennessee • BCBS Michigan • BCBS Connecticut • BCBS/Anthem Virginia • BCBS Mississippi • BCBS Florida • BCBS/Anthem Wisconsin • BCBS/Anthem Missouri • BCBS Empire (New York) • BCBS Wyoming • BCBS Nebraska • BCBS Excellus (Central New • BCBS North Carolina BCBS York) of North Dakota • BCBS Nevada • BCBS Georgia • Capital Blue • BCBS New Hampshire • BlueCross Idaho • Premera Washington • BCBS New Jersey • BCBS/Anthem Indiana • Regence Washington • BCBS/Anthem Ohio 7

What does NIPS coverage in Washington state look like? 8

Washington State Coverage Commercial These insurance companies cover NIPS for all women in Washington State 9

Washington State Coverage Commercial This insurance company covers NIPS only for high risk women 10

Washington State Coverage Medicaid Washington State Medicaid Fee-for-Service only covers NIPS for high risk women. Washington births financed 49% by Medicaid Source: Kaiser Family Foundation “Births Financed by Medicaid”: https://www.kff.org/medicaid/state- indicator/births-financed-by-medicaid/ 11

Washington State Coverage Medicaid Managed Care Organizations Covers NIPS for high risk Covers NIPS for all women: women: 12

Coverage Disparities 13

CPT Codes NIPS Standard Serum Screening • 81420 • 84702: Chorionic • 81507 gonadotropin test • 84163: PAPPA serum Amnio • 86336: Inhibin A • 59000 • 76813: 1st trimester nuchal CVS translucency ultrasound • 59015 14