(a) Coverage for abortions funded under the
MA Program is available only if:
(1) A
physician has certified in writing and documented in the patient's record that
the life of the woman would be endangered if the pregnancy were allowed to
progress to term. The decision as to whether the woman's life is endangered is
a medical judgment to be made by the woman's physician. Payment will be made
for an inpatient hospitalization for purposes of an abortion only if a
"Physician Certification for an Abortion" form signed by a licensed physician
is submitted with the invoice for payment. A sample of the required "Physician
Certification for an Abortion" form appears in the Provider Handbook.
(2) If the recipient was the victim of rape
or incest and the incident was reported to a law enforcement agency or to a
public health service within 72 hours of its occurrence in the case of rape and
in the case of incest within 72 hours of the time the physician notified the
patient that she was pregnant. A law enforcement agency is an agency or part of
an agency which is responsible for the enforcement of the criminal laws, such
as a local police department or sheriff's office. A public health service is an
agency of the Federal, State or local government or a facility certified by the
Federal government as a Rural Health Clinic which provides health or medical
services. Those agencies whose principal function is the performance of
abortions are not considered public health agencies.
(i) Payment is made for inpatient
hospitalization only if a "Physician Certification for an Abortion" form,
signed by a licensed physician is submitted with the invoice for payment along
with documentation signed by an official of the law enforcement agency or
public health service to which the rape or incest was reported. The
documentation must include:
(A) The
information specified in subsection (a)(2)(ii).
(B) A statement that the report was signed by
the person making the report.
(ii) The report of the rape or incest need
not be made by the victim herself but can be reported by another person. The
report need not be made in person but may be made by mail. The report itself
shall be signed by the person who reports the rape or incest and must include:
(A) The name and address of the
victim.
(B) The name and address of
the person who made the report if different from the victim.
(C) The date of the incident if it was
rape.
(D) The date the report was
made.
