Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 6142 (September 30, 2023).

55 Pa. Code § 1126.55. Payment conditions for sterilizations.

§ 1126.55. Payment conditions for sterilizations.

 (a)  Payment for certified sterilization procedures provided at ASCs/SPUs is made only if:

   (1)  The individual requesting sterilization has voluntarily given informed consent under subsection (b).

   (2)  The individual is 21 years of age or older at the time informed consent is obtained.

   (3)  The individual is not a mentally incompetent individual or an institutionalized individual. For the purposes of this chapter, a mentally incompetent individual is a person who has been declared mentally incompetent by a Federal, State or local court of competent jurisdiction unless that person has been declared competent for purposes which include the ability to consent to sterilization.

 (b)  An individual requesting sterilization has voluntarily given informed consent only if:

   (1)  A consent form has been completed correctly in accordance with the instructions in the provider handbook and within the time limit specified in subsection (c)(1).

   (2)  The person obtaining informed consent has explained orally the elements of informed consent that are 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 will 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 giving informed consent was permitted to have a witness chosen by that individual present when informed consent was given.

   (5)  The individual was offered a language interpreter, if necessary, or an appropriate interpreter if the individual is blind, deaf or otherwise handicapped.

   (6)  The requirements of additional Federal, State or local laws for obtaining consent have been met.

 (c)  A consent form is considered to be completed correctly only if:

   (1)  At least 30 days, but no more than 180 days, have passed between the date the individual gave written informed consent and the date of the sterilization procedure. 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 was 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.

Cross References

   This section cited in 55 Pa. Code §  1126.51 (relating to general payment policy).

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