Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter A - ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM
PAYMENT FOR HOSPITAL SERVICES
Section 1163.60 - Payment conditions for sterilizations

(1) The individual requesting sterilization has voluntarily given informed consent under subsection (b).

(2) The individual is 21 years old or older at the time informed consent is obtained.

(3) The individual is not a mentally incompetent individual or an institutionalized individual. For the purposes of this chapter, a mentally incompetent individual is a person who has been declared mentally incompetent by a Federal, State or local court of competent jurisdiction for any purpose unless he has been declared competent for purposes which include the ability to consent to sterilization.

(1) A consent form has been completed correctly in accordance with the instructions in the Provider Handbook and within the time limit specified in subsection (c)(1).

(2) The person obtaining informed consent has explained orally all elements of informed consent that are 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 will 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 giving informed consent was permitted to have a witness of his choice present when informed consent was given.

(5) The individual was offered a language interpreter, if necessary, or an appropriate interpreter if the individual is blind, deaf or otherwise handicapped.

(6) The requirements of additional State or local laws for obtaining consent have been met.

(1) Except as specified under subsections (d) and (e), at least 30 days, but no more than 180 days, have passed between the date the individual gave written informed consent and the date of the sterilization procedure. In the case of a sterilization performed during emergency abdominal surgery, 72 hours shall have passed between the time of informed consent and the time of sterilization. In the case of sterilization performed during premature delivery, informed consent shall 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 was given.

(3) Another 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.