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 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Reimbursement
					 for early and periodic screening services under the Child Health and Disability
					 Prevention program shall be made in accordance with the provisions of Title 17,
					 California Code of Regulations, Sections
					 6800 et seq.
(b) EPSDT screening services not provided
					 through CHDP providers shall be reimbursed up to the maximum allowance for
					 services set forth in this article.
(c) EPSDT diagnosis and treatment services,
					 and services authorized as EPSDT Supplemental Services in excess of the maximum
					 number of services specified in Section
					 51304, shall be reimbursed up to
					 the maximum allowance for services set forth in this article. Reimbursement for
					 EPSDT supplemental services not set forth in this article shall be based upon a
					 review of such services to determine their relationship to other services for
					 which maximum allowances are set forth.
(d) Reimbursement for EPSDT case management
					 services provided by entities or individuals serving EPSDT-eligible
					 beneficiaries pursuant to Section
					 51340(j)(3) shall
					 not duplicate reimbursement provided under other publicly funded
					 programs.
(e) Reimbursement for
					 EPSDT case management services provided pursuant to Section
					 51340(k) shall be
					 in accordance with the provisions of the contract between the Department and
					 the Medi-Cal managed care plan.
1. New
						section filed 2-27-75; effective thirtieth day thereafter (Register 75, No.
						9).
2. Amendment filed 8-1-80 as an emergency; effective upon filing
						(Register 80, No. 31). A Certificate of Compliance must be filed within 120
						days or emergency language will be repealed on 11-29-80.
3.
						Certificate of Compliance transmitted to OAL 11-28-80 and filed 12-24-80
						(Register 80, No. 52).
4. Amendment of section heading, text, and
						NOTE 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						language will be repealed by operation of law on the following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.
5. Amendment of section heading, text, and NOTE 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.
6. Amendment of
						section heading, text and NOTE 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.
7. Amendment of section heading, text and NOTE
						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.
8. Certificate of
						Compliance as to 2-22-95 order including amendment of subsection (c) and new
						subsections (d)-(e) transmitted to OAL 3-16-95 and filed 4-27-95 (Register 95,
						No. 17).
Note: Authority cited: Sections
						  208
						  and
						  320-
						  324.5,
						  Health and Safety Code; and Sections
						  14105
						  and
						  14125.4,
						  Welfare and Institutions Code. Reference: Sections
						  320-
						  324.5,
						  Health and Safety Code; Sections
						  14105
						  and
						  14125.4,
						  Welfare and Institutions Code; Item 265--Budget Act of 1979; and Item
						  291--Budget Act of 1980.