Sterilization

Sterilization A. The Division of Medicaid covers sterilization procedures in an inpatient or outpatient hospital setting in accordance with current standards of medical practice for beneficiaries who: 1. Are male or female, 2. Are non-institutionalized, 3. Are twenty-one (21) years of age or older at the time of consent, and 4. Are mentally competent, able to understand the nature and consequences of the procedure, knowingly and voluntarily request the procedure, and give informed consent to be sterilized. B. The informed consent form for sterilization: 1. Must be accurate and complete with all required signatures, 2. Must be voluntarily and knowingly signed by the beneficiary, 3. Must be signed by the beneficiary, defined as the individual to be sterilized and not the personal or legal representative, 4. Is valid for one hundred eighty (180) days from the date it is signed by the beneficiary, and 5. Must comply with 42 CFR § 441 et al. C. At least thirty (30) days but not more than one hundred eighty (180) days must have passed between the date of the beneficiary signature on the informed consent form and the date the sterilization will be performed except in the case of premature delivery or emergency abdominal surgery. 1. In the case of premature delivery, defined as a delivery prior to the expected due date, informed consent must have been given at least thirty (30) days before the expected date of delivery. 2. A beneficiary may be sterilized at the time of premature delivery or emergency abdominal surgery if at least seventy-two (72) hours have passed since signing the informed consent form for the sterilization. A Caesarean delivery is not routinely considered emergency abdominal surgery. 3. The physician must justify and describe the circumstance for any premature delivery or emergency abdominal surgery and document the expected date of delivery for premature deliveries in the medical record and further certify that at least thirty (30) days have passed between the date of the beneficiary’s signature on the informed consent form and the date the sterilization was performed. D. The Division of Medicaid covers a subsequent sterilization that is due to a previously failed sterilization. Documentation in the beneficiary’s medical record must reflect the date of the first sterilization and the reason for the procedure failure.