§ 51532. Early and Periodic Screening, Diagnosis, and Treatment (Epsdt) Services.

(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.

HISTORY

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 A Certificate of Compliance must be filed within 120 days or emergency language will be repealed on 11-29-80.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 A Certificate of Compliance must be transmitted to OAL by 8-2-94 or emergency language will be repealed by operation of law on the following day.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 A Certificate of Compliance must be transmitted to OAL by 11-29-94 or emergency language will be repealed by operation of law on the following day.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

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.