HAR §17-1737-47. Hysterectomy

(a) Hysterectomy means a medical procedure or operation for the purpose of removing the uterus. (b) Hysterectomies shall be covered under the medicaid program when medically necessary except when performed: UNOFFICIAL 1737-65 (1) Solely for the purpose of rendering an individual permanently incapable of reproducing; or (2) Primarily for the purpose of rendering the individual permanently incapable of reproducing when there is more than one reason for the hysterectomy. (c) Reimbursement for hysterectomies shall be made only if the following conditions have been met, regardless of the age of the patient or the medical condition for which the hysterectomy was performed: (1) The physician authorized to perform the hysterectomy informs the individual or her representative, if any, orally and in writing, prior to the procedure that the hysterectomy will render the individual permanently incapable of reproducing; and (2) The individual or her representative, if any, signs a written acknowledgement of receipt of that information; or (3) If the individual is already sterile prior to a hysterectomy, the physician who performed the hysterectomy shall: (A) Certify in writing that the person was sterile; and (B) State the cause of the sterility; or (4) If the individual required a hysterectomy because of a life threatening emergency, the physician shall: (A) Certify that prior acknowledgement was not possible or practical; and (B) Provide a description of the nature of the emergency. For the purpose of this subsection, "sterility" shall be due to an established condition such as menopause, successful prior sterilization procedure or demonstrated bilateral tubal blockage due to disease. Lack of conception without demonstrated tubal blockage or endocrine dysfunction interfering with ovulation shall not be acceptable in meeting the definition of sterility. "Life threatening emergency" means actual emergencies such as a ruptured uterus or uteroplacental apoplexy or severe abdominal trauma. A hysterectomy which becomes medically advised during an operative procedure shall not be considered a life threatening emergency. The possibility of an associated hysterectomy shall be considered in all pelvic or lower abdominal operative procedures and the proper tentative warning provided. UNOFFICIAL 1737-66 (d) The department shall obtain documentation, showing the requirements of this section were met, before making payments. [Eff 08/01/94 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§441.255, 441.256)