Ala. Admin. Code r. 560-X-11-.05

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

Section 560-X-11-.05 - Providers Of Screening Services

(1) In-state and borderline out-of-state (within 30-mile radius of state line) health care agencies and physicians wishing to participate in the EPSDT Program may request enrollment information from the Alabama Medicaid Agency. Exception: The Fiscal Agent will be responsible for enrolling any Title XVIII (Medicare) providers that wish to enroll as a QMB-only provider.

(2) All providers of screening services must enter into an agreement with Alabama Medicaid Agency to participate in the EPSDT Program as a screening provider. Exception: QMB-only providers. Each off-site location will require a separate application, a separate contract, and will be assigned a provider number distinct from any other the provider may have with Medicaid.

(3) All health care agencies enrolled shall be under the direction of a duly-licensed physician, a currently licensed registered nurse, or a certified nurse practitioner who shall be responsible for assuring that requirements of participation are met and that the procedures established by the Medicaid program are carried out.

(4) Screening programs conducted under the direction of a registered nurse or certified nurse practitioner must have a licensed physician acting as medical consultant.

(5) EPSDT services may be offered by School-Based screening providers.

Author: Lynn Sharp, Associate Director, Policy Development, Medical Services Division

Ala. Admin. Code r. 560-X-11-.05

Rule effective October 1, 1982. Amended: Effective May 9, 1984; July 9, 1984. Emergency rule effective December 1, 1986. Amended: Effective March 12, 1987; July 13, 1989. Emergency rule effective October 1, 1990. Amended: Effective February 13, 1991, Filed April 5, 1995, effective May 11, 1995. Amended: Filed November 6, 1996; effective December 12, 1996. Amended: Filed April 5, 1999; effective May 10, 1999.

Statutory Authority: Title XIX, Social Security Act; State Plan; 42 C.F.R. Section 400.203, Section 441.56. Medicare Catastrophic Coverage Act of 1988 ( Public Law 100-360). OBRA '89-Section 6403.