Section 1141.55. Payment conditions for sterilizations

(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.

The provisions of this § 1141.55 adopted August 15, 1980, effective September 1, 1980, 10 Pa.B. 3386; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial pages (60740) to (60741).

Notation

Cross References

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).