Family Planning Rule 4700.1900

PURPOSE, SCOPE, AND APPLICABILITY.

The purpose and scope of parts 4700.1900 to 4700.2500 is to prescribe requirements applicable to family planning special project grants, to establish minimum standards for family planning services supported in whole or in part by family planning special project grant funds, and to provide criteria for the review of family planning special project grant applications. 

Minnesota Statutes, section 145.925, contains a provision prohibiting use of these funds for abortions, and for family planning services to unemancipated minors in an elementary or secondary school building; requiring notice to parents or guardians of unemancipated minors to whom abortion or sterilization is advised, except as provided in Minnesota Statutes, sections 144.341 and 144.342; and prohibiting coercing anyone to undergo an abortion or sterilization.

STAT AUTH: MS s 144.05; 144.12; 145.925

HIST: 12 SR 1562; 16 SR 170
Current as of 05/12/97

4700.2000 DEFINITIONS.

Subpart 1.  Scope.  For purposes of parts 4700.1900 to 4700.2500, the following terms have the meanings given them in this part.

Subp. 2.  Approvable application.  "Approvable application" means an application which meets the criteria for award, as specified in part 4700.2300.

Subp. 3.  Community health board.  "Community health board" means a board of health established, operating, and eligible for a subsidy under Minnesota Statutes, sections 145A.09 to 145A.13.

Subp. 4.  Current award.  "Current award" means the amount of family planning special project grant funds received in the year immediately preceding the one for which a new grant of family planning special project funds is requested.

Subp. 5.  Current recipient.  "Current recipient" means an agency receiving family planning special project grant funds in the year immediately preceding the one for which a new grant of family planning special project funds is requested.

Subp. 6.  Family planning.  "Family planning" means voluntary planning and action by individuals to attain or prevent pregnancy.

Subp. 7.  Family planning methods.  "Family planning methods" means agents and devices for the purpose of fertility regulation prescribed by a licensed physician, and other agents and devices for the purpose of fertility regulation including, spermicidal agents, diaphragms, condoms, oral contraceptives, intrauterine devices, natural family planning methods, sterilizations, and the diagnosis and treatment of infertility by a licensed physician, which can be paid for in whole or in part by family planning special project grant funds.

Subp. 8.  Family planning services components.  "Family planning services components" means the public information, outreach, counseling, method, referral, and follow-up categories under which all services provided by family planning service providers must be described.  The minimum standards in part 4700.2210 serve to define these components.

Subp. 9.  High risk person.  "High risk person" means an individual whose age, health, prior pregnancy outcome, or socioeconomic status increases her chances of experiencing an unplanned pregnancy or problems during pregnancy. High risk persons include, but are not limited to, women under 18 or over 35; women who have experienced premature labor and delivery; women with existing health problems such as diabetes, anemia, and obesity; and persons whose individual or family income is determined to be at or below 200 percent of the official income poverty line as defined by United States Code, title 42, section 9902, and as published by the Federal Office of Management and Budget and revised annually in the Federal Register.  A copy of the most current guideline is available from the Office of Planning and Evaluation, Department of Health and Human Services, Washington, D.C., 20201, (202) 245-6141.

Subp. 10.  Linkages.  "Linkages" means formal or informal arrangements between the applicant and other family planning providers including contracts, reciprocal referral agreements, and committees. 

Subp. 11.  New applicant.  "New applicant" means an agency which did not receive family planning special project funds in the year immediately preceding the one for which a grant of family planning special project funds is requested.

Subp. 12.  Provide.  "Provide" means to directly supply or render or to pay for in whole or in part.

Subp. 13.  Publicly subsidized.  "Publicly subsidized" means funded by federal, state, county, or city tax dollars, but does not include title XIX of the Social Security Act medical assistance funds.

Subp. 14.  Region.  "Region" means that group of counties represented by a single person on the executive committee of the State Community Health Advisory Committee.  The counties in each region are as follows:

Northeastern Northwestern West Central
Aitkin
Carlton
Cook
Itasca
Koochiching
Lake
Saint Louis
Becker
Beltrami
Clearwater
Hubbard
Kittson
Lake of the Woods
Mahnomen
Marshall
Norman
Pennington
Polk
Red Lake
Roseau
Clay
Douglas
Grant
Otter Tail
Pope
Stevens
Traverse
Wilkin
 
Central Metro South Central
Benton
Cass
Chisago
Crow Wing
Isanti
Kanabec
Mille Lacs
Morrison
Pine
Sherburne
Stearns
Todd
Wadena
Wright
Anoka
Carver
Dakota
Hennepin
Ramsey
Scott
Washington
Blue Earth
Brown
Faribault
Le Sueur
McLeod
Martin
Meeker
Nicollet
Sibley
Waseca
Watonwan
 
Southeastern Southwestern  
Dodge
Fillmore
Freeborn
Goodhue
Houston
Mower
Olmsted
Rice
Steele
Wabasha
Winona
Big Stone
Chippewa
Cottonwood
Jackson
Kandiyohi
Lac Qui Parle
Lincoln
Lyon
Murray
Nobles
Pipestone
Redwood
Renville
Rock
Swift
Yellow Medicine
 

STAT AUTH: MS s 144.05; 144.12; 145.925

HIST: 12 SR 1562; 16 SR 170
Current as of 05/12/97

4700.2100 CONTENT OF APPLICATION.

The application shall identify the geographic area to be served by the applicant and shall provide the following required information:

A.  An inventory of existing family planning services provider agencies in the geographic area served by the applicant.  The inventory shall include, for each provider agency, at least the agency name; addresses of all agency service sites; the target population served, including total number served if available (if unavailable, estimates will be acceptable); and the family planning service components provided.

B.  An assessment of unmet needs of the geographic area to be served by the applicant.  The assessment of unmet needs must, at least, identify unavailable family planning service components or unserved or underserved populations.  A description of the method used in making the assessment shall be provided by the applicant.

C.  A description of the family planning service components to be provided by the applicant.  Each component to be provided with family planning special project funds must meet the standards for that component described in part 4700.2210. The application must include a budget and budget justification and summary of applicable training or experience of persons providing services relevant to these components.  Also, for each component provided, the application must describe:

(1) the goals;

(2) the population to be served (target population);

(3) the specific objectives to be achieved during the funding period;

(4) the methods by which each objective will be achieved; and

(5) the criteria to be used to evaluate the progress towards each objective.

D.  A description of the linkages between the applicant and other family planning services in the geographic area. 

E.  A description of fees to be charged individuals for any family planning services.  Fees must be charged for services to individuals and must be in accordance with a sliding fee schedule for services and supplies based on the cost of such services or supplies and on the individual's ability to pay as determined by income, family size, and other relevant factors. Services shall not be denied based on ability to pay as specified in item H. 

F.  Assurance that services will be provided in accordance with state and federal laws and rules.

G.  Assurance that the use of third-party sources of funding will be employed whenever possible.

H.  Assurance that services will be provided without regard to age, sex, race, religion, marital status, income level, residence, parity, or presence or degree of disability except as otherwise required by law.

I.  Assurance that arrangements shall be made for communication to take place in a language understood by the family planning service recipient.

J.  Assurance that the privacy of the service recipient will be maintained in accordance with law.

K.  Original signature on face sheet and budget forms.

STAT AUTH: MS s 144.05; 144.12; 145.925

HIST: 12 SR 1562; 16 SR 170
Current as of 05/12/97

4700.2200 [Repealed, 12 SR 1562]
Current as of 05/12/97

4700.2210 MINIMUM STANDARDS FOR FAMILY PLANNING SERVICE COMPONENTS.

An applicant is not required to provide all components to be eligible for funding.  However, the applicant must make available the names and addresses of other family planning services provider agencies in the geographic area, if any, who offer components and services not offered by the applicant. 

All funded projects must establish linkages to facilitate access to outreach, counseling, and other component services for service recipients.

Procedures for referral and follow-up must be incorporated into all services that are provided by the applicant on a one-to-one basis.

The provision of all service components except public information shall include information on family planning services available from the applicant.

Service components to be provided by the applicant shall be defined by, and shall meet or exceed, the following minimum standards: 

A.  Public information must include specific activities designed to inform the general population about family planning and how to obtain information on all family planning service components available in the geographic area.

B.  Outreach must include specific activities designed to inform members of the target population about family planning and all the family planning service components available in the geographic area.  Outreach activities shall include one-to-one or small group contacts with the target population.

Outreach must be conducted at times and places convenient to the target population.  Persons conducting outreach shall have training or experience in family planning services.

C.  Counseling must include utilization of nondirective techniques in a decision-making format which enables individuals to voluntarily determine their participation in family planning services and their family planning method of choice, if any.  "Nondirective techniques" means techniques that employ open-ended questions to enable individuals to consider their feelings, attitudes, and values about alternatives and outcomes.  A decision-making format means a format that allows individuals to consider alternatives and outcomes, weigh advantages and disadvantages, and make choices. 

When individuals are seeking to prevent pregnancy, counseling shall include the provision and explanation of factual information on all family planning pregnancy prevention methods in a nonjudgmental manner.  "Nonjudgmental manner" means a manner in which the counselor's personal values and beliefs do not interfere with the client's choices.

When individuals are seeking to attain pregnancy, counseling shall include the provision and explanation of factual information on infertility diagnosis and treatment and services for pregnant women available in the geographic area.

Counseling shall be available to any individual in the target population and shall be conducted at times and places convenient to the target population.

Counseling shall include documentation that information required in Minnesota Statutes, section 145.925, has been provided.  Counseling shall be conducted by persons with training or experience in counseling and family planning services.

D.  Method must include the provision to a service recipient of the recipient's family planning method of choice. Provision of any family planning method must include:

(1) procedures which document that the service recipient participated in counseling prior to selecting a family planning method to prevent pregnancy;

(2) voluntary selection of the family planning method by the service recipient;

(3) information on the advisability of females obtaining a gynecological examination with Pap smear prior to initiating any family planning method;

(4) education on the use of the selected family planning method, including the risks and benefits of the method; and

(5) medical/laboratory services prior to the provision of a family planning method when the selected method requires medical intervention for prescription, fitting, insertion, or for surgical or diagnostic procedures.  When the selected method does not require medical intervention, as described herein, the applicant shall encourage service recipients to obtain medical/laboratory services, but provision by the applicant is not required.  Medical/laboratory services shall include:

(a) social and medical/surgical history with emphasis on the reproductive system;

(b) height, weight, and blood pressure measures;

(c) bimanual pelvic examination for females;

(d) breast examination and instruction on self-examination for females;

(e) hemoglobin or hematocrit;

(f) urinalysis for sugar and protein;

(g) Pap smear; and

(h) when indicated by history or symptoms, for both male and female as appropriate, diagnosis and curative treatment of venereal disease, diagnosis and treatment of vaginitis, diagnosis of pregnancy, and for females, as appropriate, provision of rubella immunization.

Medical services shall be rendered by licensed physicians, or professional nurses with documentable training in gynecological care conducted under the supervision of a licensed physician, or nurse midwives certified by the American College of Nurse Midwifery, or physician's assistants, under the supervision of a licensed physician. Laboratory tests shall be conducted by personnel trained to conduct such tests.

E.  Referral must include the provision, in writing, of information to service recipients which enables them to participate in family planning and other needed health and human services.  Documentation of referrals must be maintained.

F.  Follow-up must include specific procedures of continuing care designed to encourage safe and consistent utilization of family planning and other needed health and human services, using protocols based on accepted professional standards of care.

STAT AUTH: MS s 145.925 subd 5; 144.05 para (f)

HIST: 12 SR 1562
Current as of 05/12/97

4700.2300 CRITERIA FOR AWARD OF FAMILY PLANNING SPECIAL PROJECT GRANTS.

Subpart 1.  Application criteria.  Applications which meet the requirements of law and parts 4700.1900 to 4700.2500 shall be deemed approvable applications and eligible for award according to the notice of availability and the following criteria. 

Subp. 2.  [Repealed, 16 SR 170]

Subp. 3.  Quality and content.  Applications will be evaluated on the basis of:

A.  the extent the funds will be used to meet unmet needs in the geographic area as identified in the application;

B.  the extent the application proposes an identifiable expansion in the scope of the family planning service system in the geographic area to be served by the applicant;

C.  the extent the application proposes to coordinate family planning services with organizations, agencies, and individual providers in the geographic area to be served;

D.  the extent the application proposes to serve high risk persons;

E.  the extent the application proposes to maximize use of alternative sources of funding; and

F. the extent the application proposes to provide family planning methods according to part 4700.2210, item D.

Subp. 4.  Agency.  When equivalent and competing applications are submitted for a geographic area, award priorities will be in accordance with the following:

A.  first priority will be given to community health boards; and

B.  second priority will be given to eligible nonprofit corporations.

Subp. 4a.  Priority.  Current recipients of family planning special project funds will not be accorded any priority over new applicants.

Subp. 5.  Review and comment by community health board.  Before submission to the commissioner, the applicant shall submit the proposal to the community health board responsible for the geographic area in which the applicant proposes to provide its services, for the community health board's review and comment.  The community health board's comments shall address the application based on the criteria in subpart 3.  Any comments of a community health board shall be submitted to the commissioner within 45 days of the date the proposal was received by the community health board.

STAT AUTH: MS s 144.05; 144.12; 145.925

HIST: L 1977 c 305 s 39; 12 SR 1562; L 1987 c 309 s 24; 16 SR 170
Current as of 05/12/97
4700.2400 [Repealed, 16 SR 170]
Current as of 05/12/97

4700.2410 ALLOCATION SCHEME.

Subpart 1.  Family planning hotline grant.  Five percent of the total annual funds available or $100,000 per year, whichever is less, must be allocated for a statewide family planning hotline.  Applications must contain identifiable plans and budget allocations for both the operation of the hotline and its promotion statewide.  If the grant award is not for the full amount of funds allocated under this subpart, the funds remaining must be reallocated for distribution under subpart 2.

Subp. 2.  Family planning services grants.  The portion of the total funds remaining after the distribution made under subpart 1 must be allocated according to this subpart.  Except as provided in part 4700.2420, subpart 4, the family planning special project grant funds must be allocated on a regional basis according to the following needs-based distribution formula.

A.  Determine the regional need by totaling the following three factors:

(1) the number of resident women within the region who are 12 to 18 years of age, determined by using Department of Health data from the most recent year for which it is available;

(2) the number of resident women within the region 19 to 34 years of age who are on medical assistance as determined by using Department of Human Services data from the most recent year for which it is available; and

(3) the number of resident women within the region who are 35 to 44 years of age as determined by using Department of Health data from the most recent year for which it is available.

B.  Compute the regional proportion of the total state need for services by totaling the three factors in item A for each region and dividing each regional total by the sum of the three factors for the entire state.

C.  Calculate the amount of family planning special project grant funds available for each region by multiplying its regional proportion by the total amount of money available for family planning special projects under this subpart.

STAT AUTH: MS s 144.05; 144.12; 145.925

HIST: 16 SR 170
Current as of 05/12/97

4700.2420 FAMILY PLANNING SERVICES GRANT FUNDING.

Subpart 1.  Funding limit.  An applicant, other than an applicant for a family planning hotline grant, shall be limited to an annual application request of $75,000 per region.  Two or more agencies may submit a joint application; each agency that is a party to it shall be limited to an annual application request of $75,000 for each region covered by the joint application.

Subp. 2.  Grant allocations.  The applications, other than those for a family planning hotline grant, must be ranked in order within each region from highest to lowest based on the criteria for award in part 4700.2300.  The applications must be funded in rank order from highest to lowest until all available funds for the region are allocated. 

Subp. 3.  Funding awards.  If the amount requested by any applicant is more than that reasonably required to provide the proposed services, or if the proposed services are not based on part 4700.2210 or 4700.2300, the commissioner must either deny funding or award less than the amount the applicant requested.  When the commissioner decides to award less than requested, the applicant must submit a revised description of the target population, methodologies, budget, or budget justification as required by the commissioner to receive funding.

Subp. 4.  Contingency funding.  If any of the conditions in items A to D exist, the commissioner shall redistribute the funds according to this subpart. 

A.  If funds remain available in a region after all approvable applications are funded according to this part, the commissioner shall redistribute the funds to the other regions, proportional to their share of funding need, based upon the process stated in part 4700.2410, subpart 2.  The redistributed funds shall be awarded according to subpart 2.

B.  Funds remaining available after all approvable applications are funded at the funding limit in subpart 1, and awarded according to subpart 2, will be proportionally distributed to all applicants with approvable applications.  In order to receive additional funds, an applicant with an approvable application must submit a revised description of the target population, objectives, methodologies, budget, and budget justification to the commissioner within 60 days after receiving notice of the availability of additional funds.

C.  If the department funds for family planning special project grants are increased after awards have been made under part 4700.2410, subpart 1, or 4700.2420, subparts 2 to 4, funds must first be allocated to the family planning hotline grant recipient within the funding limits specified in part 4700.2410, subpart 1.  Remaining funds must then be distributed to the regions proportional to their share of funding need as determined according to part 4700.2410, subpart 2, and awarded according to part 4700.2420, subparts 2 to 4.

D.  If department funds for family planning special project grants are reduced after awards have been made under this subpart or subpart 2 and part 4700.2410, subpart 1, all awards must be reduced proportionate to the department's reduction in these funds.  A grant award recipient must submit a revised description of the target population, objectives, methodologies, budget, and budget justification to the commissioner within 60 days after receiving notice of reduced awards.

STAT AUTH: MS s 144.05; 144.12; 145.925

HIST: 16 SR 170
Current as of 05/12/97

4700.2500 USE OF STATE FUNDS AVAILABLE FOR FAMILY PLANNING SPECIAL PROJECT GRANTS.

Family planning special project grant recipients may not replace funds from other sources, such as existing federal, state, or local funds which the recipient uses for family planning information or services and over which the recipient exercises discretion, with family planning special project grant funds.  Recipients are not required to match funds available under family planning special project grants.

STAT AUTH: MS s 144.05; 144.12; 145.925

HIST: 12 SR 1562; 16 SR 170
Current as of 05/12/97

4700.2550 [Repealed, 16 SR 170]
Current as of 05/12/97