Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 484.000 - Abortion Clinic Services › Section 484.006 - Report Requirement

Current through Register 1525, July 5, 2024
(A)
Completion of the Certification for Payable Abortion (CPA 2)
			 Form
. All providers (
i.e
., physicians, physician
			 assistants, certified nurse practitioners, certified nurse midwives, hospitals,
			 outpatient departments, and ambulatory abortion clinics), must complete a
			 Certification for Payable Abortion (CPA 2) form and retain the form in the
			 member's record. To identify those abortions that meet federal reimbursement
			 standards, the MassHealth agency must secure on the CPA 2 form the
			 certifications described in 130 CMR 484.006(A)(1), (2), and (3) when
			 applicable. For all medically necessary abortions not included in 130 CMR
			 484.006(A)(1), (2), or (3), the certification described in 130 CMR
			 484.006(A)(4) is required on the CPA 2 form. The provider must indicate on the
			 CPA 2 form which of the following circumstances is applicable, and shall
			 complete that portion of the form with the appropriate signatures:
(1)
Life of the Pregnant
			 Individual Would Be Endangered
. The attending provider must
			 certify that, in their professional judgment, the life of the pregnant
			 individual would be endangered if the pregnancy were carried to term.
(2)
Severe and Long-lasting
			 Damage to Pregnant Individual's Physical Health
. The attending
			 provider and another provider must each certify that, in their professional
			 judgment, severe and long lasting damage to the pregnant individual's physical
			 health would result if the pregnancy were carried to term. At least one of the
			 providers must also certify that they are not an "interested provider," defined
			 as one:
(a) whose income is directly or
			 indirectly affected by the fee paid for the performance of the abortion;
			 or
(b) who is the spouse of, or
			 another relative who lives with, a provider whose income is directly or
			 indirectly affected by the fee paid for the performance of the
			 abortion.
(3)
Victim of Rape or Incest
. The provider is responsible
			 for retaining signed documentation from a law enforcement agency or public
			 health service certifying that the person upon whom the procedure was performed
			 was a victim of rape or incest which was reported to the agency or service
			 within 60 days of the incident. (A public health service is defined as either
			 an agency of the federal, state, or local government that provides health or
			 medical services; or a rural health clinic, provided that the agency's
			 principal function is not the performance of abortions.) The documentation must
			 include the date of the incident, the date the report was made, the name and
			 address of the victim and of the person who made the report (if different from
			 victim), and a statement that the report included the signature of the person
			 who made the report.
(4)
Other Medically Necessary Abortions
. The attending
			 provider must certify that, in their medical judgment, for reasons other than
			 those described in 130 CMR 484.006(A)(1), (2), and (3), the abortion performed
			 was necessary in light of all factors affecting the pregnant individual's
			 health.