N.Y. Comp. Codes R. & Regs. tit. 18 § 505.13

Current through Register Vol. 46, No. 51, December 18, 2024

Section 505.13 - Family planning

(a)Definitions.

(1)Family planning services mean the offering, arranging and furnishing of those health services which enable individuals, including minors who may be sexually active, to prevent or reduce the incidence of unwanted pregnancies. Such services include professional medical counseling services, prescription drugs, nonprescription drugs and medical supplies prescribed by a qualified physician, nurse practitioner or physician's assistants, and sterilization. Family planning services do not include hysterectomy procedures.

(2)Offering of and arranging for family planning means providing services under the medical assistance program such as:

(i) disseminating information, either orally or in writing, about available family planning health services;

(ii) providing for individual or group discussions regarding family planning health services; and

(iii) providing assistance with arranging visits with medical family planning providers.

(3)Sterilization means any medical procedure, treatment or operation for the purpose of rendering an individual permanently incapable of having children.

(4)Hysterectomy means a medical procedure or operation for the purpose of removing the uterus.

(5)Medical family planning provider means physicians qualified to participate in the medical assistance program, qualified nurse-midwives, hospitals, hospital out-patient departments, diagnostic and treatment centers and health maintenance organizations operated in compliance with applicable provisions of law.

(6)Nonmedical family planning provider means persons or facilities, not otherwise eligible to enroll as a Medicaid provider, with whom a local social services district contracts to offer and arrange family planning services under the medical assistance program, title XIX of the Social Security Act.

(7)A mentally incompetent individual means an individual who has been declared mentally incompetent for any purpose by a Federal, State or local court of competent jurisdiction, unless the individual has been declared competent for purposes which include the ability to consent to sterilization.

(8)An institutionalized individual means an individual who is involuntarily confined or detained, under a civil or criminal statute, in a correctional or rehabilitative facility including a mental hospital or other facility for the care and treatment of mental illness; or, confined under a voluntary commitment, in a mental hospital or other facility for the care and treatment of mental illness.

(b)General.

(1) Medical assistance shall include family planning services furnished, either directly by local social services districts or under contract with a local social services district, to individuals of child-bearing age who are eligible for medical assistance and who desire such services.

(2) Contracts with nonmedical providers shall include arrangements with medical providers willing to accept referred recipients as patients.

(c)Recipient rights.

(1) Recipients shall be free from coercion or mental pressure to use family planning services.

(2) Recipients shall be free to choose the medical provider of services and the method of family planning to be used.

(d)Payment policy.

(1) Payment for professional medical services shall be made to medical family planning providers at appropriate rates or fees established by the Department of Health and approved by the Division of the Budget.

(2) Payment for contracts with medical family planning providers to offer and arrange family planning services shall not duplicate payment for services, the cost of which is included in the Medicaid rate or fee established for that provider by the Department of Health and approved by the Division of the Budget.

(3) Payment for contracts with nonmedical family planning providers to offer and arrange family planning services shall be at rates negotiated by the local social services districts.

(4) Contracts and rates negotiated by local districts in accordance with this section shall be subject to approval by the Department of Social Services.

(e)Sterilizations.

(1) Payment is available under the medical assistance program for sterilizations only if:

(i) the individual has given informed written consent to the sterilization;

(ii) the individual is at least 21 years old at the time consent is obtained;

(iii) the individual is not mentally incompetent;

(iv) the individual is not an institutionalized individual;

(v) at least 30 days, but not more than 180 days, have passed between informed consent and the date of sterilization except in the case of premature delivery or emergency abdominal surgery. 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 the informed consent for sterilization was given. In the case of premature delivery, the informed consent must have been given at least 30 days before the expected date of delivery.

(2) Informed consent.

(i) An individual has given informed consent only if:

(a) the person who obtained consent for the sterilization procedure offered to answer any questions the individual to be sterilized may have concerning the procedure, provided a copy of the consent form and provided all of the following information or advice orally to the individual to be sterilized:

(1) advice that the individual is free to withhold or withdraw consent to the procedure at any time before the sterilization without affecting the right to future care or treatment and without loss or withdrawal of any federally funded program benefits to which the individual might be otherwise entitled;

(2) a description of available alternative methods of family planning and birth control;

(3) advice that the sterilization procedure is considered to be irreversible;

(4) a thorough explanation of the specific sterilization procedure to be performed;

(5) a full description of the discomforts and risks that may accompany or follow the performing of the procedure, including an explanation of the type and possible effects of any anesthetic to be used;

(6) a full description of the benefits or advantages that may be expected as a result of the sterilization; and

(7) advice that the sterilization will not be performed for at least 30 days, except under the circumstances specified in subparagraph (1)(v) of this subdivision;

(b) suitable arrangements were made to insure that the information specified in clause (a) of this subparagraph was effectively communicated to any individual who is blind, deaf or otherwise handicapped;

(c) an interpreter was provided if the individual to be sterilized did not understand the language used on the consent form or the language used by the person obtaining consent;

(d) the individual to be sterilized was permitted to have a witness of his or her choice present when consent was obtained;

(e) the consent form requirements of paragraph (3) of this subdivision were met; and

(f) any additional requirement of State or local law for obtaining consent, except a requirement for spousal consent, was followed.

(ii) When informed consent may not be obtained. Informed consent may not be obtained while the individual to be sterilized is:

(a) in labor or childbirth; or

(b) seeking to obtain or obtaining an abortion; or

(c) under the influence of alcohol or other substances that affect the individual's state of awareness.

(3) Consent form requirements.

(i) Content of consent form. The consent form must be on a form approved by the department.

(ii) Required signatures. The consent form must be signed and dated by all of the following:

(a) the individual to be sterilized;

(b) the interpreter, if one was provided;

(c) the person who obtained the consent; and

(d) the physician who performed the sterilization procedure.

(iii) Required certifications.

(a) The person securing the consent must certify, by signing the consent form, that:

(1) before the individual to be sterilized signed that consent form, such person advised the individual to be sterilized that no federally funded benefits may be withdrawn because of the decision not to be sterilized;

(2) such person orally explained the requirements for informed consent as set forth on the consent form; and

(3) to the best of such person's knowledge and belief, the individual to be sterilized appeared mentally competent and knowingly and voluntarily consented to be sterilized.

(b) The physician performing the sterilization must certify, by signing the consent form, that:

(1) shortly before the performance of the sterilization, such physician advised the individual to be sterilized that no federally funded benefits may be withdrawn because of the decision not to be sterilized;

(2) such physician orally explained the requirements for informed consent as set forth on the consent form; and

(3) to the best of such physician's knowledge and belief, the individual appeared mentally competent and knowingly and voluntarily consented to be sterilized. Except in the case of premature delivery or emergency abdominal surgery, the physician must further certify that at least 30 days have passed between the date of the individual's signature on the consent form and the date upon which the sterilization was performed.

(c) In the case of premature delivery or emergency abdominal surgery performed within 30 days of consent, the physician must certify that the sterilization was performed less than 30 days, but not less than 72 hours after informed consent was obtained because of premature delivery or emergency abdominal surgery, and:

(1) in the case of premature delivery, must state the expected date of delivery; or

(2) in the case of abdominal surgery, must describe the emergency.

(d) If an interpreter is provided, the interpreter must certify that he or she translated the information and advice presented orally and read the consent form and explained its contents to the individual to be sterilized and that, to the best of the interpreter's knowledge and belief, the individual understood what the interpreter told him or her.

(f)Reimbursement.

Reimbursement for family planning services shall be available in accordance with provisions of section 368-a of the Social Services Law.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 505.13