Myth vs. Fact: Consent for Tubal Ligation

In response to concerns from hospitals and providers that Medicaid may be unable to reimburse the costs for the entire obstetrical delivery if there are problems with the documentation of the patient's consent for tubal ligation, the TCHMB Executive Committee asked collaborative researchers to investigate the issue. This Myth vs. Fact explains the reality.

Myth:  If consent for tubal ligation is not documented correctly, Medicaid will not reimburse the claim for the inpatient obstetrical delivery.

Fact: Inpatient obstetrical delivery reimbursement is not affected by failure to document consent for tubal ligation. Medicaid will reimburse the delivery, even if the consent for tubal ligation was not documented correctly. However, the tubal ligation will not be reimbursed unless consent has been correctly documented on HHSC’s Sterilization Consent Form.

In Texas, all sterilization procedures require a valid consent (regardless of payer). In addition, the Sterilization Consent Form is required for reimbursement from Medicaid, Healthy Texas Women, or the Family Planning Program.

This form (which is available in English and in Spanish, with instructions in English) must be signed by the patient at least 30 days and not more than 180 days prior to the procedure. An exception is made if the patient undergoes emergency abdominal surgery or preterm birth, in which case the form must be signed at least 72 hours before the sterilization procedure (and at least 30 days prior to the expected date of delivery if preterm birth is the reason for the exception).

Additional details on the federal and state policies regarding sterilization can be found below:

Federal regulations:

• Federal regulations regarding Sterilization of Persons in Federally Assisted Family Planning Projects: 42 Code of Federal Regulations (CFR), Part 50, Subpart B
• Federal regulations regarding sterilizations in Medicaid: 42 CFR Part 441, Subpart F

State policies (Texas Medicaid, Healthy Texas Women & Family Planning Program):

• Texas Medicaid Provider Procedures Manual (TMPPM) Medicaid sterilization policy:
• TMPPM Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook, Section 2.2.8TMPPM Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook, Section 2.2.8
• Healthy Texas Women sterilization policy: TMPPM Women’s Health Services Handbook, Section 2.3.7
• Family Planning Program sterilization policy: TMPPM Women’s Health Services Handbook, Section 3.2.9