Current through Register Vol. 54, No. 45, November 9, 2024
Section 1221.55 - Payment conditions for sterilizations(a) Payment for covered sterilization procedures shall be made 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 § 1221.2 (relating to definitions).(b) For the purposes of this chapter, an individual requesting sterilization has voluntarily given informed consent only if all of the following requirements are met: (1) The consent form is completed correctly in accordance with all instructions in the Provider Handbook and within the time frame specified in subsection (c)(1). See Provider Handbook for a facsimile of the consent form and 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 may not result in the withdrawal or withholding of benefits provided by programs or projects receiving Federal funds and has offered to answer questions the individual may have concerning the sterilization procedure.(4) The individual providing informed consent has been permitted to have a witness of his choice present when informed consent is 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) Additional State or local laws for obtaining consent have been met.(c) A consent form 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 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 is 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.The provisions of this §1221.55 adopted December 5, 1980, effective 12/1/1980, 10 Pa.B. 4599.