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016.06.20-216.400. Sterilizations.

AR ADC 016.06.20-216.400Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 20. Hospital/Critical Access Hospital (CAH)/End-Stage Renal Disease (ESRD) Provider Manual (Refs & Annos)
Section 210.000. Program Coverage -- Hospital and Critical Access Hospital.
Ark. Admin. Code 016.06.20-216.400
016.06.20-216.400. Sterilizations.
Currentness
A. Medicaid covers sterilization of men and women.
1. All adult (aged 21 or older) male and female Medicaid beneficiaries who are mentally competent are eligible for therapeutic and non-therapeutic sterilization procedures.
2. Adult (aged 21 or older) women who participate in the Women's Health (Family Planning Waiver) Program (Aid Category 69) and who are mentally competent are eligible for non-therapeutic sterilization procedures approved by CMS for the Women's Health Program and for non-therapeutic sterilizations not performed in conjunction with deliveries of infants.
B. Medicaid coverage of elective, non-therapeutic sterilization is contingent upon the provider's documented compliance with federal and state regulations, including obtaining the patient's signed consent in the manner prescribed by law.
C. A non-therapeutic sterilization is any procedure or operation for which the primary purpose is to render an individual permanently incapable of reproducing.
1. Non-therapeutic sterilization is neither
a. A necessary part of the treatment of an existing illness or injury nor
b. Medically indicated as an accompaniment of an operation of the genitourinary tract.
2. The reason the individual decides to take permanent and irreversible action is irrelevant. It may be for social, economic or psychological reasons, or because a pregnancy would be inadvisable for medical reasons.
D. Prior authorization is not required for a sterilization procedure. However, all applicable criteria described in this manual must be met.
E. Federal regulations are very explicit concerning coverage of non-therapeutic sterilization.
1. The person to be sterilized must voluntarily request the service.
2. The person must be mentally and legally competent to give informed consent.
3. The person must be 21 years of age or older when he or she gives informed consent.
4. The person to be sterilized shall not be an institutionalized individual. The regulations define “institutionalized individual” as a person who is
a. Involuntarily confined or detained under a civil or criminal statute in a correctional or rehabilitative facility, including a facility for mental illness, or
b. Confined under a voluntary commitment in a mental hospital or other facility for the care and treatment of mental illness.
5. The person has been counseled, both orally and in writing, regarding alternative methods of birth control and the effects and the impact of sterilization.
6. Informed consent and counseling must be properly documented. Only the official Sterilization Consent Form DMS-615, correctly completed, complies with documentation requirements. View or print Sterilization Consent Form DMS-615 and Checklist.
a. Copies may be ordered from EDS. View or print EDS supplied forms information. See Section V of any Arkansas Medicaid provider manual for forms and instructions for ordering forms and publications.
b. If the patient needs the Sterilization Consent Form in an alternative format, such as large print, contact our Americans with Disabilities Act Coordinator. View or print ADA Coordinator contact information.
7. Available by order from EDS are two free informational publications: Sterilization Consent Form-Information for Women (PUB-019) and Sterilization Consent Form-Information for Men (PUB-020). View or print a list of EDS supplied forms. See Section V of any Arkansas Medicaid provider manual for forms and instructions for obtaining forms and publications.
8. If you have any questions regarding any of these instructions, contact the Arkansas Medicaid Program before the sterilization.

Credits

Eff. Oct. 1, 2007.
<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 016.06.20-216.400, AR ADC 016.06.20-216.400
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