Form DSSMS146 Download Printable PDF or Fill Online Medicaid
Medicaid Sterilization Consent Form 2023. Claims submitted with the consent form dated april 2022 will continue to be accepted until july 30,2023, as providers have 365 days to submit a claim. The sterilization consent form found on the u.s.
Form DSSMS146 Download Printable PDF or Fill Online Medicaid
14, 2023, to update dates providers should be using each consent form. It is available in english and spanish. If an actual or apparent conflict between this document and an hca rule arises, hca rules apply. The sterilization consent form found on the u.s. Billing guides are updated on a regular basis. Consent to sterilization i have asked for and received information about. Web washington apple health (medicaid) sterilization supplemental billing guide october 1, 2020 disclaimer every effort has been made to ensure this guide’s accuracy. Web this form allows an individual to provide consent for sterilization. Statements are also included for an interpreter, a person obtaining consent, and a physician. Your decision at any time not to be sterilized will not result in the withdrawal or withholding of any benefits provided by programs or projects receiving federal funds.
The form begins with a cover page describing the purpose of the form and its expiration date. The estimated effective date for this policy update is aug. Web this form allows an individual to provide consent for sterilization. If an actual or apparent conflict between this document and an hca rule arises, hca rules apply. Statements are also included for an interpreter, a person obtaining consent, and a physician. Your decision at any time not to be sterilized will not result in the withdrawal or withholding of any benefits provided by programs or projects receiving federal funds. It is available in english and spanish. 14, 2023, to update dates providers should be using each consent form. Kmap general bulletin 22080 (pdf) effective april 30, 2022, the federal consent for sterilization form on the kansas medical assistance program (kmap) website has expired. Department of health & human services (hhs) website has been updated. Web this bulletin replaces updated sterilization consent form published on feb.
