Updated sterilization consent form
Use the updated sterilization consent form (MA 31) when providing these services for GHP Family members.
The Pennsylvania Department of Human Services (DHS) has issued an update to the Sterilization Consent Form (MA 31), aligning it with federal requirements. All Medical Assistance (MA) providers who perform sterilization procedures should begin using the updated form immediately.
Federal regulations (42 CFR § 50.205) require the use of a sterilization consent form to ensure MA beneficiaries receive clear, voluntary, and informed consent before undergoing sterilization procedures. Read the Medical Assistance Bulletin.
The updated Pennsylvania Sterilization Consent Form (MA 31) aligns with the federal HHS-687 form, which has been extended with an expiration date of July 31, 2028. Instructions and required fields remain unchanged. The form requires that consent be obtained at least 30 days, but not more than 180 days, prior to the procedure. Make sure the form is correctly completed to secure reimbursement.
Begin using the updated MA 31 immediately for your GHP Family claims.
Be sure you’ve completed all fields on the form legibly and accurately. Incomplete or unclear entries may result in claim denial.
