WSR 20-17-041
[Filed August 10, 2020, 9:41 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 20-13-085.
Title of Rule and Other Identifying Information: WAC 182-531-1550 Sterilization physician-related services.
Hearing Location(s): On September 22, 2020, at 10:00 a.m.
In light of the current public health emergency and the Governor's Safe Start plan, it is unknown whether, by the date of this public hearing, restrictions on meeting in public places will be eased. Therefore, this hearing is being held virtually only. This will not be an in-person hearing and there is not a physical location available.
To attend, you must register prior to the public hearing (September 22, 2020, 10:00 a.m. Pacific Time) at, Webinar ID 725-281-419.
After registering, you will receive a confirmation email containing information about joining the webinar.
Date of Intended Adoption: Not sooner than September 23, 2020.
Submit Written Comments to: Health Care Authority (HCA) Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email, fax 360-586-9727, by September 22, 2020.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication[s] relay service 711, email, by September 11, 2020.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is amending WAC 182-531-1550 to remove subsection (5), which describes the circumstances under which the agency waives the thirty day consent waiting period for sterilization.
Reasons Supporting Proposal: The agency has determined this rule amendment is necessary to align with federal rule, specifically 42 C.F.R. 50.203(d) and 50.204 (7)(e)(1).
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Statute Being Implemented: RCW 41.05.021, 41.05.160.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Brian Jensen, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-0815; Implementation and Enforcement: Melissa Kundur, P.O. Box 45506, Olympia, WA 98504-5506, 360-725-5297.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rule relates to client medical consent and does not impose any costs on businesses.
August 10, 2020
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 20-06-034, filed 2/27/20, effective 3/29/20)
WAC 182-531-1550Sterilization 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 waives the thirty-day consent waiting period for sterilization when the client requests that sterilization be performed at the time of delivery and completes a sterilization consent form. One of the following circumstances must apply:
(a) The client became eligible for medical assistance during the last month of pregnancy;
(b) The client did not obtain medical care until the last month of pregnancy; or
(c) The client was a substance abuser during pregnancy, but is not using alcohol or illegal drugs at the time of delivery.
(6))) 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.
(((7)))(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.
(((8)))(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.
(((9)))(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.