Ala. Admin. Code r. 560-X-1-.28

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-1-.28 - Early And Periodic Screening, Diagnosis And Treatment

(1) Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) will be available for Medicaid-eligible recipients under the age of 21 years old. This coverage will be provided for medically necessary health care, diagnosis, treatment and/or other measures described in §1905(a) of the Social Security Act and more specifically in Chapter 11 of theAlabama Medicaid Administrative Code.

(2) The services must be necessary to correct or ameliorate a defect, physical or mental illness, or other conditions discovered during or as a result of an EPSDT screen,whether or not the services are covered or exceed benefit limits as stated in the State Plan. Misspent funds identified as aresult of retrospective review will be recouped in accordance with the procedures in Chapter 4 of the Alabama Medicaid Administrative Code.

Rule effective December 14, 1990. Amended: Filed September 11, 2013; effective October 16, 2013.

Author: Kathy Hall, Deputy Commissioner, Program Administration

Statutory Authority: State Plan, Attachment 3.1-A; Title IX,Social Security Act §1905; 42 C.F.R. 440, 441 ; OBRA-89 §6403.