DEPARTMENT OF COMMUNITY HEALTH  
MEDICAL SERVICES ADMINISTRATION  
STERILIZATION AND HYSTERECTOMY CONSENT PROCEDURES  
(By authority conferred on the department of social services by sections 6, 10, and  
14 of Act No. 280 of the Public Acts of 1939, as amended, and section 453 of Act No.  
380 of the Public Acts of 1965, as amended, being SS400.6, 400.10, 400.14, and 16.553  
of the Michigan Compiled Laws)  
R 400.7701 Definitions.  
Rule 1. As used in these rules:  
(a) "Acknowledgement of receipt of hysterectomy information form" means the  
form approved by the department for use in the medical assistance program to obtain  
the recipient's acknowledgement that she has received the required hysterectomy  
information.  
(b) "Claim" means any written request for reimbursement for a service, a supply, or  
an item of equipment rendered to a recipient.  
(c) "Department" means the department of social services.  
(d) "General assistance medical program" means the department's program to  
provide for medical assistance established by section 55 of Act No. 280 of the Public  
Acts of 1939, as amended, being S400.55 of the Michigan Compiled Laws.  
(e) "Hysterectomy" means a medical procedure or operation for the purpose of  
removing the uterus.  
(f) "Medical assistance program" means the department's program to provide for  
medical assistance established by section 105 of Act No. 280 of the Public Acts of 1939,  
as amended, being S400.105 of the Michigan Compiled Laws, and title 19 of the  
federal social security act, 42 U.S.C. S1396 et seq.  
(g) "Provider" means an individual, firm, corporation, association, agency,  
institution, or other legal entity which has been approved to provide medical  
assistance to a recipient pursuant to the medical assistance program or the general  
assistance medical program.  
(h) "Recipient" means an individual eligible to receive medical assistance  
through the department.  
(i) "Sterilization" means any medical procedure, treatment, or operation that is  
performed for the purpose of rendering an individual permanently incapable of  
reproducing.  
(j) "Sterilization consent form" means the form approved and required by the United  
States department of health and human services and used by the department in the  
medical assistance program and the general assistance medical program to obtain the  
recipient's informed consent to sterilization.  
History: 1980 AACS.  
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R 400.7702 Recipients excluded from sterilization.  
Rule 2. A provider shall not be reimbursed for a sterilization procedure that is  
performed on a recipient in any of the following situations:  
(a) Where the recipient has been declared mentally incompetent by a federal,  
state, or local court.  
(b) Where the recipient is institutionalized in a corrective, penal, mental, or  
rehabilitative facility.  
(c) Where the recipient is under 21 years old.  
History: 1980 AACS.  
R 400.7703 Informed consent to sterilization.  
Rule 3. (1) A provider shall obtain an informed consent to the sterilization  
procedure from the recipient and shall complete a sterilization consent form.  
(2) The sterilization consent form shall be signed by the recipient to be sterilized,  
the person who obtained the recipient's consent, and the interpreter, if appropriate, not  
less than 30, nor more than 180, days before the sterilization procedure, except if a  
premature delivery or emergency abdominal surgery becomes necessary during the  
required minimum 30-day waiting period before the sterilization procedure. In a case  
of premature delivery, the recipient shall sign the sterilization consent form not less  
than 72 hours before the sterilization procedure and not less than 30 days before the  
expected delivery date. In a case of emergency abdominal surgery, the recipient shall  
sign the sterilization consent form not less than 72 hours before the sterilization  
procedure.  
(3) At the time that the recipient signs the sterilization consent form, the recipient  
shall not be less than 21 years old and shall not be in labor, seeking to obtain or  
obtaining an abortion, or under the influence of alcohol or other substance that affects  
the recipient's state of awareness.  
(4) The provider who obtains the recipient's consent shall comply with all of the  
following:  
(a) Permit the recipient to have a witness of his or her own choice present.  
(b) Give the recipient a copy of the sterilization consent form.  
(c) Advise the recipient that the sterilization will not be performed in less than 30  
days, except as set forth in subrule (2) of this rule.  
(d) Offer to answer any questions the recipient may have concerning sterilization.  
(e) Advise the recipient that he or she is free to withhold or withdraw consent to the  
sterilization at any time before the sterilization without affecting the right to future care  
or treatment and without the loss or withdrawal of any federal or state program benefits  
to which the recipient might be otherwise entitled.  
(f) Describe to the recipient available alternative methods of family planning and  
birth control.  
(g) Advise the recipient that the sterilization procedure is considered to be  
irreversible.  
(h) Give a thorough explanation of the specific sterilization procedure to be  
performed.  
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(i) Give a full description of the discomforts and risks that may accompany or  
follow the performing of the procedure, including an explanation of the type and  
possible effects of any anesthetic to be used.  
(j) Give a full description of the benefits or advantages that may be expected as a  
result of the sterilization.  
(5) If the recipient is deaf, blind, or otherwise handicapped, suitable arrangements  
shall be made by the provider who obtains the recipient's consent to ensure that the  
information required by these rules is effectively communicated to the recipient before  
the recipient signs the sterilization consent form.  
(6) If the recipient does not understand the language used on the sterilization  
consent form or the language used by the person who obtains the recipient's consent, the  
provider shall ensure that an interpreter is provided before the recipient signs the  
sterilization consent form.  
(7) In addition to the requirements of subrule (4) of this rule and shortly before  
the sterilization procedure, the provider who performs the sterilization shall explain  
orally to the recipient the requirements for informed consent set forth in subdivisions (d)  
to (j) of subrule (4) of this rule.  
(8) The provider who performs the sterilization shall sign the sterilization  
consent form after the sterilization procedure. This signature shall constitute  
certification that the requirements set forth in these rules have been met.  
History: 1980 AACS.  
R 400.7704 Hysterectomy requirements.  
Rule 4. (1) A provider shall not perform a hysterectomy on a recipient solely for  
family planning purposes.  
(2) A provider shall not perform a hysterectomy on a recipient for family  
planning purposes if the medical indications present do not, by themselves, mandate a  
hysterectomy.  
(3) The provider who performs the hysterectomy shall  
sign  
the  
acknowledgement of receipt of hysterectomy information form, thereby certifying  
compliance with this rule.  
(4) A provider shall obtain the recipient's or the recipient's representative's  
signature on the acknowledgement or receipt of hysterectomy information form.  
(5) The recipient shall be informed in writing, by means of the  
acknowledgement of receipt of hysterectomy information form, and orally, by the  
provider, that a hysterectomy will render her permanently incapable of reproducing.  
History: 1980 AACS.  
R 400.7705 Billing requirements.  
Rule 5. (1) The provider who performs the sterilization or hysterectomy procedure  
shall include any charge for compliance with these rules in the total charge for the  
sterilization or hysterectomy.  
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(2) Each provider, that is, the surgeon, anesthesiologist, or hospital, shall obtain a  
copy of the fully completed sterilization consent form from the provider who obtained the  
consent and shall submit it with any claim related to the sterilization procedure.  
(3) Each provider, that is, the surgeon, anesthesiologist, or hospital, shall obtain a  
copy of the fully completed acknowledgement of receipt of hysterectomy information  
form from the provider who obtained the consent and shall submit it with any claim  
related to the hysterectomy procedure.  
History: 1980 AACS.  
R 400.7706 Compliance.  
Rule 6. A provider who fails to submit a claim pursuant to the provisions of  
these rules shall forfeit the provider's right to payment and shall not seek  
reimbursement from the recipient.  
History: 1980 AACS.  
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