Ala. Admin. Code r. 560-X-11-.01

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

Section 560-X-11-.01 - Early And Periodic Screening, Diagnosis, And Treatment For Individuals under Twenty-One (21)-General

(1) Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) of Individuals Under Age twenty-one (21) is a mandatory service of the Medicaid Program intended by Congress to direct attention to the importance of preventive health services and early detection and treatment of disease in children eligible for medical assistance.

(2) The Alabama Medicaid Agency:

(a) Will provide for a combination of written and oral methods designed to effectively inform all EPSDT eligible individuals (or their families) about the EPSDT program. Generally, this information will be provided within 60 days of the individual's initial Medicaid eligibility determination and in the case of families which have not utilized EPSDT services, annually thereafter.

(b) Will using clear and nontechnical language, provide information about the following: the benefits of preventive health care, the services available under the EPSDT program, and how to obtain these services.

(c) Will inform recipients that the services provided under the EPSDT program are without cost to eligible individuals under 21 years of age. Exception: Copayment is required of individuals from eighteen (18) to under twenty-one (21).

(d) Will provide other medically necessary health care, diagnostic, treatment and/or other measures described in section 1905(a) of Title XIX to correct or ameliorate defects, physical and mental illnesses and conditions discovered during a screening.

(e) Will inform individuals that necessary transportation and scheduling assistance are available upon request.

(f) Will provide an extensive outreach program for EPSDT recipients.

(g) In conjunction with the Alabama Department of Human Resources, will jointly develop an agreement covering the responsibilities of the county Departments of Human Resources, county Health Departments and other screening providers for EPSDT.

Author: Laurie McEnery

Ala. Admin. Code r. 560-X-11-.01

Rule effective October 1, 1982. Amended: effective June 8, 1985. Emergency rule effective December 1, 1986. Amended: effective March 12, 1987. Emergency rule effective October 1, 1990. Amended: Effective May 13, 1991; January 13, 1993.

Statutory Authority: Title XIX, Social Security Act; State Plan; 42 C.F.R. §441.56; OBRA '89 §6403.