Ala. Admin. Code r. 560-X-11-.10

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

Section 560-X-11-.10 - Reimbursement

(1) Governmental screening providers (including physicians) will be paid on a negotiated rate basis which will not exceed their actual costs. Nongovernmental screening providers will be paid their usual and customary charge which is not to exceed the maximum allowable rate established by Medicaid.

(2) In screening a recipient, the provider's contract screening cost will cover the following services: unclothed physical examination; vital signs; heights and weights; family, medical, mental health and immunization histories, vision and hearing testing; developmental assessment including anticipatory guidance and nutritional assessment; hematocrits or hemoglobins; and follow-up of all referred conditions to ensure whether or not treatment has been initiated.

(3) Providers may submit claims for immunization, TB skin test and treatment on the day of screening. These charges submitted on the CMS 1500 form are in addition to the screening charge, but no office visit should be charged at that time.

Ala. Admin. Code r. 560-X-11-.10

Rule effective October 1, 1982. Amended: Effective July 9, 1984. Emergency rule effective December 1, 1986. Amended: Effective March 12, 1987. Emergency rule effective October 1, 1990. Amended: Effective February 13, 1991. Amended: Filed June 11, 2009; effective July 16, 2009..

Author: Kaye Melnick, Program Manager, EPSDT, Medical Services Division

Statutory Authority: Title XIX, Social Security Act; State Plan; 42 C.F.R. § 441.50; OBRA '89 §6403.