(a) Hysterectomy means a medical procedure or
operation for the purpose of removing the uterus.
(b) Hysterectomies shall be covered under the
medicaid program when medically necessary except when performed:
(1) Solely for the purpose of rendering an
individual permanently incapable of reproducing; or
(2) Primarily for the purpose of rendering
the individual permanently incapable of reproducing when there is more than one
reason for the hysterectomy.
(c) Reimbursement for hysterectomies shall be
made only if the following conditions have been met, regardless of the age of
the patient or the medical condition for which the hysterectomy was performed:
(1) The physician authorized to perform the
hysterectomy informs the individual or her representative, if any, orally and
in writing, prior to the procedure that the hysterectomy will render the
individual permanently incapable of reproducing; and
(2) The individual or her representative, if
any, signs a written acknowledgement of receipt of that information;
or
(3) If the individual is already
sterile prior to a hysterectomy, the physician who performed the hysterectomy
shall:
(A) Certify in writing that the person
was sterile; and
(B) State the
cause of the sterility; or
(4) If the individual required a hysterectomy
because of a life threatening emergency, the physician shall:
(A) Certify that prior acknowledgement was
not possible or practical; and
(B)
Provide a description of the nature of the emergency.
For the purpose of this subsection, "sterility" shall be
due to an established condition such as menopause, successful prior
sterilization procedure or demonstrated bilateral tubal blockage due to
disease. Lack of conception without demonstrated tubal blockage or endocrine
dysfunction interfering with ovulation shall not be acceptable in meeting the
definition of sterility. "Life threatening emergency" means actual emergencies
such as a ruptured uterus or uteroplacental apoplexy or severe abdominal
trauma. A hysterectomy which becomes medically advised during an operative
procedure shall not be considered a life threatening emergency. The possibility
of an associated hysterectomy shall be considered in all pelvic or lower
abdominal operative procedures and the proper tentative warning
provided.
(d) The department shall obtain
documentation, showing the requirements of this section were met, before making
payments.
