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PDFWAC 182-531-1550

Sterilization physician-related services.

(1) For purposes of this section, sterilization is any medical procedure, treatment, or operation for the purpose of rendering a client permanently incapable of reproducing.
Hysterectomy results in sterilization and is not covered by the medicaid agency solely for that purpose. (See WAC 182-531-0150 and 182-531-0200 for more information about hysterectomies.)
(2) The agency covers sterilization when all of the following apply:
(a) The client is at least eighteen years of age at the time an agency-approved consent form is signed;
(b) The client is a mentally competent individual;
(c) The client participates in a medical assistance program (see WAC 182-501-0060);
(d) The client has voluntarily given informed consent; and
(e) The date the client signed a sterilization consent is at least thirty days and not more than one hundred eighty days before the date of the sterilization procedure.
(3) Any medicaid provider who is licensed to do sterilizations within their scope of practice may provide vasectomies and tubal sterilizations to any medicaid client.
(4) The agency requires at least a seventy-two hour waiting period rather than the usual thirty-day waiting period for sterilization in either of the following circumstances:
(a) At the time of a premature delivery when the client gave consent at least thirty days before the expected date of delivery. (The expected date of delivery must be documented on the consent form.)
(b) For emergency abdominal surgery. (The nature of the emergency must be described on the consent form.)
(5) The agency does not accept informed consent obtained when the client is:
(a) In labor or childbirth;
(b) In the process of seeking to obtain or obtaining an abortion; or
(c) Under the influence of alcohol or other substances, including pain medications for labor and delivery, that affects the client's state of awareness.
(6) The agency has certain consent requirements that the provider must meet before the agency reimburses sterilization of an institutionalized client or a client with mental incompetence. The agency requires both of the following:
(a) A court order, which includes both a statement that the client is to be sterilized, and the name of the client's legal guardian who will be giving consent for the sterilization; and
(b) A sterilization consent form signed by the legal guardian, sent to the agency at least thirty days before the procedure.
(7) The agency reimburses epidural anesthesia in excess of the six-hour limit for deliveries if sterilization procedures are performed in conjunction with or immediately following a delivery.
(a) For reimbursement, anesthesia time for sterilization is added to the time for the delivery when the two procedures are performed during the same operative session.
(b) If the sterilization and delivery are performed during different operative sessions, the anesthesia time is calculated separately.
(8) The agency reimburses all attending providers for the sterilization procedure only when the provider submits an agency-approved and complete consent form with the claim for reimbursement.
(a) The physician must complete and sign the physician statement on the consent form within thirty days of the sterilization procedure.
(b) The agency reimburses attending providers after the procedure is completed.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 20-20-010, § 182-531-1550, filed 9/24/20, effective 1/1/21; WSR 20-06-034, § 182-531-1550, filed 2/27/20, effective 3/29/20. Statutory Authority: RCW 41.05.021, 74.09.520, 74.09.657, 74.09.659, and 74.09.800. WSR 13-16-008, § 182-531-1550, filed 7/25/13, effective 9/1/13. WSR 11-14-075, recodified as § 182-531-1550, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-24-071, § 388-531-1550, filed 11/30/10, effective 1/1/11. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 01-01-012, § 388-531-1550, filed 12/6/00, effective 1/6/01.]
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