Revision 19-0; Effective July 1, 2019

 

 

11100 General Consent

Revision 19-0; Effective July 1, 2019

 

Contractors must obtain the individual’s written, informed, voluntary general consent to receive services prior to receiving any clinical services. A general consent explains the types of services provided and how an individual’s information may be shared with other entities for reimbursement or reporting purposes. If there is a period of three years or more during which a person does not receive services, a new general consent must be signed prior to reinitiating delivery of services.

Consent information must be effectively communicated to every individual in a manner that is understandable. This communication must allow the person to participate, make sound decisions regarding her or his own medical care and address any disabilities that impair communication (in compliance with Limited English Proficiency regulations). Only the person receiving services may give consent. For situations when the person is legally unable to consent, a parent (in case of an unemancipated minor) or legal guardian must consent on his or her behalf. Consent must never be obtained in a manner that could be perceived as coercive.

In addition, as described below, the contractor must obtain the informed consent of the person receiving services for procedures as required by the Texas Medical Disclosure Panel.

HHSC contractors should consult a qualified attorney to determine the appropriateness of the consent forms utilized by their health care agency.

 

11200 Procedure Specific Informed Consent

Revision 19-0; Effective July 1, 2019

 

11210 Sterilization Procedures and Sterilization Consent Form

Revision 19-0; Effective July 1, 2019

 

There are two consent forms required for sterilization procedures:

  • the Sterilization Consent Form; and
  • the Texas Medical Disclosure Panel Consent.

The Sterilization Consent Form is necessary for both abdominal and trans-cervical sterilization procedures in women and vasectomy in men. It is published in the Texas Medicaid Provider Procedures Manual (TMPPM) and is the only acceptable consent form for sterilizations funded by regular Medicaid (Title XIX), HTW or the HHSC FPP.

An electronic copy of the Sterilization Consent Form (in English and Spanish) may be found on the TMHP website. It is important that contractors use the most recent Sterilization Consent Form available. Additionally, it is the contractor’s responsibility to ensure that the form is complete and accurate prior to submission to TMHP.

In brief, the individual to be sterilized must:

  • be at least 21 years old at the time the consent is obtained;
  • be mentally competent;
  • voluntarily give his or her informed consent;
  • sign the consent form at least 30 days but not more than 180 days prior to the sterilization procedure*; and
  • may choose a witness to be present when the consent is obtained.

*An individual may consent to be sterilized at the time of premature delivery or emergency abdominal surgery, if at least 72 hours have passed after the individual gave informed consent to sterilization. In the case of premature delivery, the informed consent must have been given at least 30 days before the expected date of delivery.

The consent form must be signed and dated by the:

  • individual to be sterilized;
  • interpreter, if one is provided;
  • person who obtains the consent; and
  • physician who will perform the sterilization procedure.

Informed consent may not be obtained while the individual to be sterilized is:

  • in labor or in the process of delivering an infant or infants;
  • seeking to obtain or obtaining an abortion; or
  • under the influence of alcohol or other substances that affect the individual’s state of awareness.

 

11220 Texas Medical Disclosure Panel Consent

Revision 19-0; Effective July 1, 2019

 

The Texas Medical Disclosure Panel (TMDP) was established by the Texas Legislature to:

  • determine which risks and hazards related to medical care and surgical procedures must be disclosed by health care providers or physicians to their patients or persons authorized to consent for their patients; and
  • establish the general form and substance of such disclosure. TMDP has developed List A (informed consent requiring full and specific disclosure) for certain procedures, which can be found in the Texas Administrative Code (TAC).

Contractors that directly perform tubal sterilization and/or vasectomy (both List A procedures), must also complete the TMDP Disclosure and Consent Form. This consent is in addition to the Sterilization Consent Form noted in Section 11210 above.

The required disclosures for tubal sterilization are:

  • injury to the bowel and/or bladder;
  • sterility;
  • failure to obtain fertility (if applicable);
  • failure to obtain sterility (if applicable); and
  • loss of ovarian functions or hormone production from ovary(ies).

The required disclosures for vasectomy are:

  • loss of testicle; and
  • failure to produce permanent sterility.

For all other procedures not on List A, the physician must disclose, through a procedure-specific consent, all risks that a reasonable person would want to know about. This includes all risks that are inherent to the procedure (one which exists in and is inseparable from the procedure itself) and that are material (could influence a reasonable person in deciding to consent to the procedure).

 

11300 Consent for Services to Minors

Revision 19-0; Effective July 1, 2019

 

Minors age 17 and younger are required to obtain consent from a parent or guardian before receiving certain medical services. HHSC FPP contractors must have proof of a parent’s or guardian’s consent prior to providing FPP services to a minor. Proof of consent must be included in the minor’s medical record.

Minors may consent to HIV/STD testing and treatment for an STD. Minors may consent to other medical treatment services in certain circumstances, pursuant to Texas Family Code Chapter 32 as outlined below.

For information on health services and consent requirements for minors, see: Adolescent Health – A Guide for Providers and The Texas Family Code, Chapter 32, part of which is outlined below.

Texas Family Code, Chapter 32, Sec. 32.003, Consent to Treatment by Child: There are instances in which a child may consent to medical, dental, psychological, and surgical treatment for the child by a licensed physician or dentist if the child:

  • is on active duty with the armed services of the United States of America;
  • is:
    • 16 years of age or older and resides separate and apart from the child's parents, managing conservator, or guardian, with or without the consent of the parents, managing conservator, or guardian and regardless of the duration of the residence; and
    • managing the child's own financial affairs, regardless of the source of the income;
  • consents to the diagnosis and treatment of an infectious, contagious, or communicable disease that is required by law or a rule to be reported by the licensed physician or dentist to a local health officer or the Texas Department of Health, including all diseases within the scope of Section 81.041, Health and Safety Code;
  • is unmarried and pregnant and consents to hospital, medical, or surgical treatment, other than abortion, related to the pregnancy;
  • consents to examination and treatment for drug or chemical addiction, drug or chemical dependency, or any other condition directly related to drug or chemical use;
  • is unmarried, is the parent of a child, and has actual custody of his or her child and consents to medical, dental, psychological, or surgical treatment for the child; or
  • is serving a term of confinement in a facility operated by or under contract with the Texas Department of Criminal Justice, unless the treatment would constitute a prohibited practice under Section 164.052(a) (19), Occupations Code.

 

11400 Consent for HIV Tests

Revision 19-0; Effective July 1, 2019

 

Contractors must comply with Texas Health and Safety Code §81.105 and §81.106 as follows:

§81.105. Informed Consent

  • Except as otherwise provided by law, a person may not perform a test designed to identify HIV or its antigen or antibody without first obtaining the informed consent of the person to be tested.
  • Consent need not be written if there is documentation in the medical record that the test has been explained and the consent has been obtained.

§81.106. General Consent

  • A person who has signed a general consent form for the performance of medical tests or procedures is not required to also sign or be presented with a specific consent form relating to medical tests or procedures to determine HIV infection, antibodies to HIV, or infection with any other probable causative agent of AIDS that will be performed on the person during the time in which the general consent form is in effect.
  • Except as otherwise provided by this chapter, the result of a test or procedure to determine HIV infection, antibodies to HIV, or infection with any probable causative agent of AIDS performed under the authorization of a general consent form in accordance with this section may be used only for diagnostic or other purposes directly related to medical treatment.