California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 7 - Payment for Services and Supplies › Section 51532.1 - Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplemental Services Provided by Registered Nurses, Licensed Vocational Nurses and Certified Home Health Aides

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Reimbursement for EPSDT supplemental services defined in Section
					 51184, provided in the home by
					 Registered Nurses, Licensed Vocational Nurses and certified Home Health Aides
					 shall be in accordance with the maximum reimbursement rates set forth in this
					 section. However, in no case shall the services billed exceed charges made to
					 the general public for the provision of similar services. For the purposes of
					 this section, "in the home" means the beneficiary's residence, or foster care
					 placement pursuant to Section
					 17731,
					 Welfare and Institutions Code. "In the home" does not include a licensed health
					 facility.
(b) Reimbursement for
					 EPSDT supplemental nursing services and home health aide services provided by a
					 home health agency shall be as follows:
Procedure
								Code
Description
Hourly
								Rate
Z5832
Registered Nurse
$40.57
Z5834
Licensed Vocational
								Nurse
$29.41
Z5836
Registered Nurse providing
								supervision
$45.43
Z5838
Home Health Aide
$18.90
(c) Reimbursement for EPSDT supplemental
					 nursing services provided by licensed registered nurses and licensed vocational
					 nurses enrolled as EPSDT supplemental services providers acting within the
					 scope of their practice, under the written order and direction of the patient's
					 treating physician pursuant to Section
					 51242, shall be as follows:
Procedure
								Code
Description
Hourly
								Rate
Z5804
Registered Nurse
$31.94
Z5806
Licensed Vocational
								Nurse
$24.42
Z5840
Registered Nurse providing
								supervision
$35.77
(d) The name of the treating physician shall
					 be included with each Treatment Authorization Request submitted pursuant to
					 this section.
1. New
						section filed 8-10-99 as an emergency; operative 8-10-99 (Register 99, No. 33).
						A Certificate of Compliance must be transmitted to OAL by 12-8-99 or emergency
						language will be repealed by operation of law on the following
						day.
2. Certificate of Compliance as to 8-10-99 order transmitted to
						OAL 12-7-99 and filed 1-14-2000 (Register 2000, No. 2).
3. Amendment
						of subsections (b)-(c) and amendment of NOTE filed 11-17-2000 as an emergency;
						operative 11-17-2000 (Register 2000, No. 46). A Certificate of Compliance must
						be transmitted to OAL by 3-19-2001 or emergency language will be repealed by
						operation of law on the following day.
4. Certificate of Compliance
						as to 11-17-2000 order transmitted to OAL 3-8-2001 and filed 4-19-2001
						(Register 2001, No. 16).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code; Section
						  100275,
						  Health and Safety Code. Reference: Sections
						  14059
						  and
						  14132,
						  Welfare and Institutions Code;
						  42 United States Code,
						  Section 1396d(r); and
						  Statutes of 2000, Chapter 52, Items 4260-101-0001 and
						  4260-101-0890.