Ala. Admin. Code r. 560-X-61-.02
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-61-.02 - Provider Participation(1) Eligible persons may receive Children's Specialty Clinic Services through providers who are under contractual agreement with Medicaid to provide services to children eligible for EPSDT services.(2) Providers under this section are clinics that are organized apart from any hospital and operate to provide an integrated multidisciplinary medical/rehabilitation program designed to upgrade the physical functioning of handicapped disabled individuals by bringing specialized staff together to perform as a team. (a) Clinics must meet recognized standards of care for children with special health care needs and employ on staff the following practitioners:3. Social workers/service coordinators7. Speech/language pathologists(b) Staff must be employed in sufficient numbers to meet the needs of the volume of children served.(c) Staff must meet the minimum qualifications of 42 CFR 485.705 incorporated herein by reference.(d) All practitioners serving children must meet state and federal criteria for participation in the Medicaid program.(3) All Children's Specialty Clinic Services must be furnished by or under the direction of a physician. The physician must see the patient, prescribe care, and regularly review the prescribed program for continued appropriateness.(4) Clinics must develop a patient care plan that provides medical and rehabilitative services to children with special health care needs as well as coordination and support services.(5) Clinics must meet the following requirements for participation in the Medicaid program: (a) Be licensed in the State of Alabama;(b) Be independent of any hospital or physician's office;(c) Submit to routine audits by Medicaid;(d) Complete an application with all required attachments;(e) Sign a provider agreement;(f) Sign a Direct Deposit Authorization;(g) Sign a Civil Rights Statement of Compliance;(h) Comply with the standards set out in (2) above.(6) Governmental providers must furnish documentation regarding the source of public funds, statutory authority of regulatory agency, and be subject to the rulemaking process of the applicable Administrative Code. Author: Debbie Flournoy
Ala. Admin. Code r. 560-X-61-.02
New Rule: Filed April 8, 1996; effective May 13, 1996. Amended: Filed June 8, 1999; effective July 13, 1999. Amended: Filed August 10, 2006; effective September 14, 2006.Statutory Authority: Title XIX, Social Security Act; State Plan; 42 C.F.R. §440.90, 485.705.