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§ 51242. EPSDT Diagnosis and Treatment Provider and EPSDT Supplemental Services Provider.

22 CA ADC § 51242Barclays Official California Code of Regulations

Barclays California Code of Regulations
Title 22. Social Security
Division 3. Health Care Services
Subdivision 1. California Medical Assistance Program (Refs & Annos)
Chapter 3. Health Care Services
Article 3. Standards for Participation
22 CCR § 51242
§ 51242. EPSDT Diagnosis and Treatment Provider and EPSDT Supplemental Services Provider.
Currentness
(a) An EPSDT diagnosis and treatment provider shall meet the requirements for participation in the Medi-Cal program as specified in this chapter, excepting the requirements specified in subsection (b).
(b) A provider seeking to provide EPSDT supplemental services, who is not enrolled as a provider pursuant to subsection (a), shall first submit a provider enrollment application to the department to become an EPSDT supplemental services provider. The application shall be accompanied by a request for prior authorization, pursuant to Section 51340(c), for the initial service the provider seeks to provide.
(c) An EPSDT case manager, defined in Section 51184(h)(4), seeking to provide EPSDT case management services shall be considered to be an EPSDT supplemental services provider and shall comply with the requirements of this section.
(d) In order to be approved as an EPSDT supplemental services provider for the particular service sought, the provider shall supply documentation or other evidence which the Department determines establishes that both of the following conditions are met:
(1) The services to be provided meet the standard of medical necessity set forth in Section 51340(e).
(2) The provider is licensed, certified, or otherwise recognized or authorized under state law governing the healing arts to provide the service pursuant to Division 2 (commencing with section 500) of the Business and Professions Code or is a licensed pediatric day health and respite care facility pursuant to Section 1760 of the Health and Safety Code, and meets any applicable requirements in federal Medicaid law to provide the particular service requested.
(e) Notwithstanding the provisions of paragraph (d)(1), an entity or individual seeking to provide EPSDT case management services pursuant to Section 51340(j)(3) shall supply documentation enabling the Department to determine that both of the following requirements are met:
(1) The criteria specified in Section 51340(f) are met.
(2) The entity or individual is qualified by education, training, or experience to provide EPSDT case management services to the beneficiary.
(f) The Department shall not approve an application pursuant to subsection (b) or (c) of this section if the Department determines that the service to be provided is accessible and available in an appropriate and timely manner through existing Medi-Cal certified provider types or other Medi-Cal programs.
(g) Once enrolled as an EPSDT supplemental services provider, the provider shall remain enrolled only for the purpose of providing subsequent EPSDT supplemental services within his or her scope of practice, or within the scope of the facility's license, unless disenrolled by provider choice or the Department's administrative action, pursuant to Chapter 3, Division 3, Title 22, California Code of Regulations.
(h) A provider who is currently enrolled as a Medi-Cal services provider shall not be required to enroll as an EPSDT supplemental services provider.
(i) Notwithstanding subsections (a) and (d), a local health department as defined in Section 101185 of the Health and Safety Code or a comprehensive environmental agency as referenced in Section 101275 of the Health and Safety Code may provide onsite investigations to detect the source of lead contamination as an EPSDT supplemental service, as specified in 51340.1(d). To be eligible for payment, the service must be rendered by an individual who is a Registered Environmental Health Specialist registered in accordance with Article 1 of Chapter 4 of Part 1 of Division 104 of the California Health and Safety Code (commencing with Section 106600) and who has been certified in accordance with Section 35005 of Title 17 of the California Code of Regulations as a Certified Lead Inspector/Assessor of the Department.

Credits

Note: Authority cited: Sections 10725, 14124.5 and 14195, Welfare and Institutions Code. Reference: Sections 14059, 14132 and 14132.10, Welfare and Institutions Code.
History
1. New section filed 4-4-94 as an emergency; operative 4-4-94 (Register 94, No. 14). A Certificate of Compliance must be transmitted to OAL by 8-2-94 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 8-1-94 as an emergency; operative 8-1-94 (Register 94, No. 31). A Certificate of Compliance must be transmitted to OAL by 11-29-94 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 10-24-94 as an emergency; operative 10-24-94 (Register 94, No. 43). A Certificate of Compliance must be transmitted to OAL by 2-21-95 or emergency language will be repealed by operation of law on the following day.
4. New section refiled 2-22-95; operative 2-22-95 (Register 95, No. 8). A Certificate of Compliance must be transmitted to OAL by 6-22-95 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 2-22-95 order including amendment of section heading and section transmitted to OAL 3-16-95 and filed 4-27-95 (Register 95, No. 17).
6. New subsection (i) and amendment of Note filed 4-13-99 as an emergency; operative 4-13-99 (Register 99, No. 16). A Certificate of Compliance must be transmitted to OAL by 8-11-99 or emergency language will be repealed by operation of law on the following day.
7. New subsection (i) and amendment of Note refiled 8-5-99 as an emergency; operative 8-5-99 (Register 99, No. 32). A Certificate of Compliance must be transmitted to OAL by 12-3-99 or emergency language will be repealed by operation of law on the following day.
8. Amendment of subsections (d)(1), (d)(2) and (g) and amendment of Note filed 11-10-99 as an emergency; operative 11-10-99 (Register 99, No. 46). A Certificate of Compliance must be transmitted to OAL by 3-9-2000 or emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 8-5-99 order transmitted to OAL 12-1-99 and filed 1-12-2000 (Register 2000, No. 2).
10. Certificate of Compliance as to 11-10-99 order transmitted to OAL 3-8-2000 and filed 4-19-2000 (Register 2000, No. 16).
This database is current through 4/26/24 Register 2024, No. 17.
Cal. Admin. Code tit. 22, § 51242, 22 CA ADC § 51242
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