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About the Initiative

Our Role in IPP LARC Placement

The Problem

In Arkansas in 2020, 54% of women reported pregnancies that were unintended (ADH, 2022). The healthcare consequences of unintended or closely spaced pregnancies can be devastating for the mother, neonate, family, and community at large. They can include delayed initiation of prenatal care, low birth weight infants, increased preterm birth rates, small for gestational age, neonatal and infant death, and lower breastfeeding rates (Guttmacher Institute 2017).

Short interpregnancy intervals are also associated with worse perinatal outcomes: maternal bleeding, anemia, death, preterm birth, and low birth weight (Jackson et al 2011; Conde-Agudelo 2006).

Arkansas ranks 50th nationally in maternal mortality. We realize that in order to improve these devastating statistics, a multifaceted approach is needed.

The Solution

Results from a two-year pilot study conducted at the University of Arkansas produced outcomes that were better than the national averages. Results from this study contributed to the passage of Arkansas HB 1385 in April of 2023.

HB 1385 allows birthing hospitals to obtain Medicaid reimbursement for immediate postpartum long-acting reversible contraception (IPP LARC). For these services to be reimbursed, they must be provided prior to discharge.

The Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences was awarded a privately funded grant to design a comprehensive training program for hospital administration and clinical providers on the placement of LARC devices during the immediate postpartum period.

Our Role

While the clinical application may be straightforward, the billing, coding, and financial consequences can be great for any hospital system initiating such a program.  Our program will evaluate the effectiveness of the training, and aid all partnering hospitals in ensuring that they are knowledgeable in billing, coding, and reimbursement.  We will continue to work with all partnering hospitals until they are comfortable with all aspects of this initiative and provide updates as claims data may change.

Why target the postpartum period?

ACOG supports immediate postpartum insertion as a best practice, recognizing its role in preventing rapid, repeat, and unintended pregnancy (Practice Bulletin 186). This period is particularly favorable for IUD or implant insertion as women are often highly motivated to use contraception and are known not to be pregnant. The hospital setting offers convenience for the patient and health care provider. Up to 40% of women do not return for their 6-week postpartum visit (Gurtecheff, 2011) and between 40 and 75% of women resume sexual activity before their postpartum check-up (Brito 2009, Connolly 2005).

The mission of the Arkansas Immediate Postpartum Long-Acting Reversible Contraceptive Initiative is to provide clinical provider training on insertion and removal of intrauterine devices and Nexplanon implants, reimbursement training for birthing hospitals on submitting clean claims, and the development of an Immediate Postpartum LARC toolkit. Our goal is to support delivering facilities and physicians in Arkansas by any means necessary to ensure this initiative is successful.

© 2024 IPP LARC Initiative. The IPP LARC Initiative is facilitated by the Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences