C.F.R.
»
Title 42
» CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 441—SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES › Subpart B—Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) of Individuals Under Age 21
(a) The agency must provide referral assistance for treatment not covered by the plan, but found to be needed as a result of conditions disclosed during screening and diagnosis. This referral assistance must include giving the family or beneficiary the names, addresses, and telephone numbers of providers who have expressed a willingness to furnish uncovered services at little or no expense to the family.
(b) The agency must make available a variety of individual and group providers qualified and willing to provide EPSDT services.
(c) The agency must make appropriate use of State health agencies, State vocational rehabilitation agencies, and Title V grantees (Maternal and Child Health/Crippled Children's Services). Further, the agency should make use of other public health, mental health, and education programs and related programs, such as Head Start, Title XX (Social Services) programs, and the Special Supplemental Food Program for Women, Infants and Children (WIC), to ensure an effective child health program.
Notes of Decisions
Salazar v. Dist. of Columbia, 954 F. Supp. 278 (D.D.C. 1996).
· cites it 3× “232). Finally, based on Findings No. 117-118, Defendants do not ensure that providers of EPSDT services are “qualified and willing to provide EPSDT services,” in violation of 42 C.”
John B. v. Emkes, 852 F. Supp. 2d 944 (M.D. Tenn. 2012).
· cites it 7× “Defendants characterize paragraph 43 as implicating subsection (30)(A) and the “network adequacy” requirement, while Plaintiffs again contend that the provision is meant to enforce and remedy subsection (43)(B) and its implementing regulation, 42 C.F.R. § 441.61 (b). The Court…”
John B. Ex Rel. L.A. v. Menke, 176 F. Supp. 2d 786 (M.D. Tenn. 2001).
“” 42 C.F.R. § 441.61 (2001). The proof shows that the State has failed to adequately ensure the coordination of EPSDT services among the various governmental, private and non-profit providers of services.”
John B. v. Mark Emkes, 710 F.3d 394 (6th Cir. 2013).
“The district court held that the parties based these paragraphs on a federal Medicaid regulation, 42 C.F.R. § 441.61 (c). That regulation has two main requirements.”
John B. Ex Rel. L.A. v. Goetz, 661 F. Supp. 2d 871 (M.D. Tenn. 2009).
· cites it 3× “; and that necessary transportation and scheduling assistance is available; for children in institutions, this should include the administrator of the institution; see State Medicaid Manual § 5121(B), (C); (f) creation of a system so that families can readily access an accurate…”
Chisholm v. Hood, 110 F. Supp. 2d 499 (E.D. La. 2000).
· cites it 2× “” 42 C.F.R. § 441.61 (b) (emphasis supplied).”
Katie A. Ex Rel. Ludin v. Los Angeles Cnty., 481 F.3d 1150 (9th Cir. 2007).
“§ 1396a(a)(8) (stating that all medical assistance, including EPSDT, must be furnished with “reasonable promptness”); 42 C.F.R. § 441.61 (b) (providing that state must make available a variety of qualified providers willing to provide EPSDT).”
Risinger Ex Rel. Risinger v. Concannon, 117 F. Supp. 2d 61 (D. Me. 2000).
“56 (e), and that they have violated 42 C.F.R. § 441.61 (b) by adopting policies, practices, and procedures that have diminished the availability of a variety of individual and group providers qualified and willing to provide EPSDT services.”
Risinger v. Concannon, 201 F.R.D. 16 (D. Me. 2001).
“§§ 1396a(a)(30), 1396a(a)(43), 1396d(a)(4)(B), 1396d(r)(5), and 42 C.F.R. § 441.61 (b) by failing to provide EPSDT screening, case management, and in-home treatment services, as well as by failing to adopt policies, practices, and procedures to ensure the availability of…”
J.E. ex rel. Egan v. Wong, 125 F. Supp. 3d 1099 (D. Haw. 2015).
“” 42 C.F.R. § 441.61 (b). Despite these obligations, Plaintiffs allege that no list.”
EMILY Q. v. Bonta, 208 F. Supp. 2d 1078 (C.D. Cal. 2001).
“Under 42 C.F.R. § 441.61 (b), “[DHS] must make available a variety of individual and group providers qualified and willing to provide EPSDT services.”
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