[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR441.60]



[Page 274-275]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 441_SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC 

 

Subpart B_Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) 

                       of Individuals Under Age 21

 

Sec.  441.60  Continuing care.



    (a) Continuing care provider. For purposes of this subpart, a 

continuing care provider means a provider who has an



[[Page 275]]



agreement with the Medicaid agency to provide reports as required under 

paragraph (b) of this section and to provide at least the following 

services to eligible EPSDT recipients formally enrolled with the 

provider:

    (1) With the exception of dental services required under Sec.  

441.56, screening, diagnosis, treatment, and referral for follow-up 

services as required under this subpart.

    (2) Maintenance of the recipient's consolidated health history, 

including information received from other providers.

    (3) Physicians' services as needed by the recipient for acute, 

episodic or chronic illnesses or conditions.

    (4) At the provider's option, provision of dental services required 

under Sec.  441.56 or direct referral to a dentist to provide dental 

services required under Sec.  441.56(b)(1)(vi). The provider must 

specify in the agreement whether dental services or referral for dental 

services are provided. If the provider does not choose to provide either 

service, then the provider must refer recipients to the agency to obtain 

those dental services required under Sec.  441.56.

    (5) At the provider's option, provision of all or part of the 

transportation and scheduling assistance as required under Sec.  441.62. 

The provider must specify in the agreement the transportation and 

scheduling assistance to be furnished. If the provider does not choose 

to provide some or all of the assistance, then the provider must refer 

recipients to the agency to obtain the transportation and scheduling 

assistance required under Sec.  441.62.

    (b) Reports. A continuing care provider must provide to the agency 

any reports that the agency may reasonably require.

    (c) State monitoring. If the State plan provides for agreements with 

continuing care providers, the agency must employ methods described in 

the State plan to assure the providers' compliance with their 

agreements.

    (d) Effect of agreement with continuing care providers. Subject to 

the requirements of paragraphs (a), (b), and (c) of this section, CMS 

will deem the agency to meet the requirements of this subpart with 

respect to all EPSDT eligible recipients formally enrolled with the 

continuing care provider. To be formally enrolled, a recipient or 

recipient's family agrees to use one continuing care provider to be a 

regular source of the described set of services for a stated period of 

time. Both the recipient and the provider must sign statements that 

reflect their obligations under the continuing care arrangement.

    (e) If the agreement in paragraph (a) of this section does not 

provide for all or part of the transportation and scheduling assistance 

required under Sec.  441.62, or for dental service under Sec.  441.56, 

the agency must provide for those services to the extent they are not 

provided for in the agreement.