25.3.3.32 Sterilization ServicesThe Texas Medicaid Program benefits include payment for elective sterilization (performed solely for the purpose of rendering the individual incapable of bearing or fathering children) of eligible clients when providers comply with HHS regulations (42 CFR 441.250, Subpart F). Payment of elective sterilization is not made if the client is:
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• If a client eligible for Medicaid decides not to be sterilized after entering the hospital, the hospital may be reimbursed for its services. The hospital must submit a valid consent form signed by the client. The physician's signature is not required. TMHP must have a signed, valid sterilization consent form on file to reimburse elective sterilization procedures. Typewritten, blocked, or facsimile stamped signatures are not acceptable for signature requirements. When TMHP receives a valid consent form, the client's eligibility file is updated to reflect receipt. Subsequent claims received by TMHP for the sterilization covered by the consent are referenced to the valid consent and reimbursed even if they are not accompanied by a valid consent. It is to the provider's benefit to submit a consent form with claims for sterilization rather than relying on a fellow provider. A legible valid copy of the consent is acceptable. The "Sterilization Consent Form Instructions (2 Pages)" and the HHS-approved form (supplied by TMHP) are the only acceptable forms. Providers may use their own consent form as long as the form has the HHS-approved language and required fields. The only exception is if the provider obtains prior approval from HHS. Refer to: "Elective Sterilization Services" . "Sterilization and Sterilization-Related Procedures" for elective sterilization services requirements and instructions. |
Younger than 21 years of age at the time the consent form is signed.
