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016.06.3-216.110. Abortion When the Life of the Mother Would be Endangered if the Fetus Were Ca...

AR ADC 016.06.3-216.110Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 3. Ambulatory Surgical Center Provider Manual (Refs & Annos)
Section 210.000. Program Coverage
Ark. Admin. Code 016.06.3-216.110
016.06.3-216.110. Abortion When the Life of the Mother Would be Endangered if the Fetus Were Carried to Term
Currentness
Providers submitting claims to Medicaid for an abortion procedure when the life of the mother would be endangered if the fetus were carried to term must attach the following information to the claim:
A. A completed Form DMS-2698 (Certification Statement for Abortion). View or print form DMS-2698. The DMS-2698 form must include the name and address of the patient and must be dated prior to the date of the surgery.
1. The patient may sign the Certification Statement for Abortion (DMS-2698) for herself at eighteen (18) years of age or older.
2. If a guardian signs the Certification Statement for Abortion (DMS-2698), the guardian must furnish a copy of the order appointing him or her as guardian or the letters of guardianship issued by the court clerk.
B. Patient history and physical examination records.
C. Discharge summary, if available..
The physician performing the abortion is responsible for providing the required documentation to other providers (hospital, anesthetist, etc.) for billing purposes.

Credits

Eff. Nov. 1, 2007; Oct. 13, 2003.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.3-216.110, AR ADC 016.06.3-216.110
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