Ala. Admin. Code r. 560-X-14-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-14-.04 - Sterilizations

Surgical procedures for male and female recipients as a method of birth control are covered services under the rules and regulations set forth below:

(1)Rules and Regulations Concerning Federal Financial Participation for Sterilization, effective February 6, 1979, apply in the following instances:

(a) The individual is at least twenty-one (21) years old at the time consent is obtained;

(b) The individual is not a mentally incompetent individual;

(c) The individual has voluntarily given informed consent in accordance with all requirements;

(d) At least 30 days, but not more than 180 days have passed between the date of informed consent and the date of the sterilization, except in the case of premature delivery or emergency abdominal surgery.

(e) An individual may consent to be sterilized at the time of a premature delivery or emergency abdominal surgery if at least 72 hours have passed since informed consent for the sterilization was given. In case of premature delivery, the informed consent must have been given at least 30 days before the expected date of delivery.

(2) Mentally Incompetent or Institutionalized Individuals: Payment is not available for the sterilization of a mentally incompetent or institutionalized individual.

(3) Claims for Sterilization Procedure Performed on or after February 6, 1979:

Sterilization claims will be paid only when in conformity with the guidelines set forth in this regulation, and completion of consent forms, (three (3) copies of the MSA-FP-78-10). See Chapter 560-X-28 for consent form sample. In the event that the recipient does not meet the above requirements and elects to have the sterilization, the provider may bill the recipient for the sterilization.

(4) Sterilization consent forms are to be completed as follows:

(a) The patient's birth date will reflect the patient was at least 21 years of age when he/she signed and dated the consent form.

(b) The counselor's signature date, as well as the patient's signature date will reflect at least 30 days, but not more than 180 days have passed prior to the procedure being done.

(c) Due to the wording of the physician's statement, the physician signature and date can only be affixed after the procedure has been completed. The physician statement and signature must reflect at least 30 but not more than 180 days have passed since the patient signed.

(d) It is of vital importance that each copy of the consent form MSA-FP-78-10 be utilized in the correct manner. When these forms are fully completed:

Copy I - Patient - to be given to the patient.

Copy 2 - Payment Purpose - to be utilized for payment.

Copy 3 - Patient's Permanent Record - to be placed in the patient's permanent record with copies being made to accommodate both the facility and physician.

(5) Providers must submit a sterilization consent form with his claim or it will be returned. The provider must submit the claim within the time frame set forth by regulations in Chapter 1, General.

(6) Sterilization reversals requested as a result of a previous voluntary surgical sterilization will not be covered.

Authors: Delores Argo, Gail Ellerbrake, Deborah K. Crawford, Dee Lockridge

Ala. Admin. Code r. 560-X-14-.04

Rule effective October 1, 1982. Amended: effective July 9, 1984; October 11, 1986; December 10, 1987; August 12, 1992. Amended: Filed August 6, 1993; effective September 10, 1993.

Statutory Authority: State Plan; 42 C.F.R. §§441.250, 441.251, 441.252, 441.253, 441.257, 441.258 and Appendix to Subpart F; Title XIX, Social Security Act.