1. (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.

2. (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

3. (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

4. (d) The name of the treating physician shall be included with each Treatment Authorization Request submitted pursuant to this section.

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.

History

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 A Certificate of Compliance must be transmitted to OAL by 12-8-99 or emergency language will be repealed by operation of law on the following day.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).