Informational Bulletin 22-9: Sterilization Consent Form

Louisiana Department of Health issued Informational Bulletin 22-9: Sterilization Consent Form on March 31, 2022.

Louisiana Medicaid has been in communication with the Office of Population Affairs (OPA) concerning the upcoming expiration date of April 30, 2022, on the Sterilization Consent Form (OMB No. 0937-0155).

• OPA is in the process of renewing the current form and may extend the expiration date. Providers must check the OPA site directly for updates and are responsible for using the most current form on the date the consent is obtained.
• Medicaid fee-for-service will continue to accept the current form until OPA publishes an updated form and new expiration date.
• Managed care organizations (MCO) are expected to honor the current form until a final update has been made by OPA. Once the final OPA sterilization consent form update is published, further guidance will be provided as needed.

Questions regarding this message and fee for service claims/consents are to be directed to Gainwell Technologies Provider Relations at (800) 473-2783 or (225) 924-5040.

Providers are encouraged to review Informational Bulletin 22-9: Sterilization Consent Form for additional information.