New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 541 - FAMILY PLANNING SERVICES
Section He-W 541.05 - Covered Services

Universal Citation: NH Admin Rules He-W 541.05

Current through Register No. 40, October 3, 2024

The following services shall be covered as family planning services only if the items and procedures are clearly provided or performed for family planning purposes:

(a) Physician services, in accordance with He-W 531, certified midwife services in accordance with He-W 538, and advanced practice registered nurse services in accordance with He-W 534;

(b) Contraceptive devices or drugs, both prescription and non-prescription, in accordance with He-W 570;

(c) Pregnancy tests and screening for sexually transmitted diseases only when performed routinely as part of an initial, regular, or follow-up family planning visit; and

(d) Sterilization, in accordance with 42 CFR 441.253 and 42 CFR 441.254, as follows:

(1) The recipient shall be at least 21 years old at the time consent is obtained;

(2) The recipient shall not be a mentally incompetent individual;

(3) The recipient shall not be an institutionalized individual;

(4) The recipient shall voluntarily give informed consent in accordance with the requirements at 42 CFR 441.257 through 42 CFR 441.258;

(5) The provider shall submit the federal health and human services office of management and budget form HHS-687 "Consent for Sterilization" (OMB No. 0937-0166) to the department prior to the department's payment for the sterilization claim;

(6) At least 30 days, but not more than 180 days, shall have passed between the date of informed consent and the date of sterilization, with the exception of cases of premature delivery or emergency abdominal surgery as described in (7) below; and

(7) A recipient may consent to be sterilized at the time of a premature delivery or emergency abdominal surgery if at least 72 hours have passed since the recipient gave informed consent for the sterilization and, in the case of premature delivery, if the informed consent was given at least 30 days before the expected date of delivery.

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08

New. #9272, eff 9-19-08

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