§ 441.255 Sterilization by hysterectomy.

(a) FFP is not available in expenditures for a hysterectomy if— (1) It was performed solely for the purpose of rendering an individual permanently incapable of reproducing; or (2) If there was more than one purpose to the procedure, it would not have been performed but for the purpose of rendering the individual permanently incapable of reproducing. (b) FFP is available in expenditures for a hysterectomy not covered by paragraph (a) of this section only under the conditions specified in paragraph (c), (d), or (e) of this section. (c) FFP is available if— (1) The person who secured authorization to perform the hysterectomy has informed the individual and her representative, if any, orally and in writing, that the hysterectomy will make the individual permanently incapable of reproducing; and (2) The individual or her representative, if any, has signed a written acknowledgment of receipt of that information. (d) Effective on March 8, 1979 or any date thereafter through the date of publication of these regulations at the option of the State, FFP is available if— (1) The individual— (i) Was already sterile before the hysterectomy; or (ii) Requires a hysterectomy because of a life-threatening emergency situation in which the physician determines that prior acknowledgment is not possible; and (2) The physician who performs the hysterectomy— (i) Certifies in writing that the individual was already sterile at the time of the hysterectomy, and states the cause of the sterility; or (ii) Certifies in writing that the hysterectomy was performed under a life-threatening emergency situation in which he or she determined prior acknowledgment was not possible. He or she must also include a description of the nature of the emergency. (e) Effective March 8, 1979, or any date thereafter through the date of publication of these regulations at the option of the State, FFP is available for hysterectomies performed during a period of an individual's retroactive Medicaid eligibility if the physician who performed the hysterectomy certifies in writing that— (1) The individual was informed before the operation that the hysterectomy would make her permanently incapable of reproducing; or (2) One of the conditions in paragraph (d)(1) of this section was met. The physician must supply the information specified in paragraph (d)(2) of this section.