Current through Register Vol. 54, No. 44, November 2, 2024
(a) Payment for covered sterilization
procedures is made to a physician only if all of the following requirements are
met:
(1) The individual requesting
sterilization has voluntarily given informed consent in accordance with all
requirements described in subsection (b) of this section.
(2) The individual is at least 21 years old
at the time informed consent is obtained.
(3) The individual is not a mentally
incompetent individual or an institutionalized individual as defined in §
1141.2 (relating to definitions).
(b) An individual requesting sterilization
has voluntarily given informed consent only if all of the following
requirements are met:
(1) The Consent Form, MA
31, is completed correctly in accordance with all instructions in the Provider
Handbook and within the time frame specified in subsection (c)(1). See Appendix
A for a facsimile of the Consent Form and the Provider Handbook for detailed
instructions on its completion.
(2)
The person obtaining informed consent has explained orally all elements of
informed consent as included in the Consent to Sterilization section of the
Consent Form.
(3) The person
obtaining informed consent has advised the individual that a decision not to be
sterilized shall not result in the withdrawal or withholding of any benefits
provided by programs or projects receiving Federal funds and has offered to
answer any questions the individual may have concerning the sterilization
procedure.
(4) The individual
providing informed consent has been permitted to have a witness of his or her
choice present when informed consent was given.
(5) The individual has been offered a
language interpreter, if necessary, or an appropriate interpreter if the
individual is blind, deaf, or otherwise handicapped.
(6) Any additional State or local laws for
obtaining consent have been met.
(c) A Consent Form, MA 31, is considered to
be completed correctly only if all of the following requirements are met:
(1) At least 30 days, but no more than 180
days, have passed between the date the individual has given written informed
consent and the date of the sterilization procedure.
Exception: In the case of emergency
abdominal surgery, 72 hours must have passed between the time of informed
consent and the time of surgery. In the case of premature delivery, informed
consent must have been given at least 30 days before the expected date of
delivery.
(2) The person
obtaining informed consent has properly signed the Consent Form in accordance
with instructions in the Provider Handbook on the same date that informed
consent is given.
(3) Any other
witness or interpreter has properly signed the Consent Form in accordance with
instructions in the Provider Handbook.
(4) The physician performing the
sterilization procedure has certified and signed the Physician's Statement
section of the Consent Form after the procedure has been performed.
This section cited in 55 Pa. Code §
1141.51 (relating to general
payment policy); 55 Pa. Code §
1141.52 (relating to payment
conditions for various services); 55 Pa. Code §
1141.53 (relating to payment
conditions for outpatient services); and 55 Pa. Code §
1141.54 (relating to payment
conditions for inpatient services).
