1. (a) The department will pay for a hysterectomy performed by a physician if the

   1. (1) department has given prior authorization;
   2. (2) procedure is performed for medical reasons;
   3. (3) recipient has given her informed consent in writing using the form provided by the department or a form provided by the physician that includes the same information;

   4. (4) consent from was signed by the recipient before surgery, unless the provider who performs the surgery certified in writing that

      1. (A) the recipient was sterile before the hysterectomy and states the cause of the sterility; or
      2. (B) the hysterectomy was performed under a life-threatening emergency, that is described by the provider, and getting prior consent from the recipient was not possible; and
   5. (5) consent form is attached to the provider claim.
2. (b) The department will not pay for a hysterectomy performed only for the purpose of rendering a woman permanently incapable of reproducing.

(Eff. 2/1/2010, Register 193)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040