Updated sterilization consent form

Washington State Health Care Authority sent this bulletin at 08/01/2025 11:00 AM PDT

August 1, 2025

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Updated sterilization consent form

The Centers for Medicare and Medicaid Services (CMS) has released the updated version of the sterilization consent form.

Use the updated form when obtaining initial consent

Effective immediately, use the updated sterilization consent form HHS-687 when obtaining initial consent for sterilization procedures. If the client has already provided initial consent by completing Sections I, II, and III on the expired version of HHS-687, it is not necessary to start the process over with a new form. HHS-687 forms with expiration date of July 31, 2025, will be accepted for sterilization claims with a date of service on or before January 31, 2026.

Where to find the updated form:

The Health Care Authority's (HCA) Provider billing guides and fee schedules webpage.
U.S. Department of Health & Human Services website.

The form is available in English, Spanish, or large print in both languages.

View the updated sterilization consent form

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.