- (1) Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)will be available for Medicaid-eligible recipients under the age of 21 years old. This coverage will be provided for medically necessary health care, diagnosis, treatment and/or other measures described in §1905(a) of the Social Security Act and more specifically in Chapter 11 of the Alabama Medicaid Administrative Code.
- (2) The services must be necessary to correct or ameliorate a defect, physical or mental illness, or other conditions discovered during or as a result of an EPSDT screen, whether or not the services are covered or exceed benefit limits as stated in the State Plan. Misspent funds identified as a result of retrospective review will be recouped in accordance with the procedures in Chapter 4 of the Alabama Medicaid Administrative Code.
Author: Kathy Hall, Deputy Commissioner, Program Administration
Statutory Authority: State Plan, Attachment 3.1-A; Title IX, Social Security Act §1905; 42 C.F.R. 440,441; OBRA-89 §6403.
History: Rule effective December 14, 1990. Amended: Filed September 11, 2013; effective October 16, 2013.