Ala. Admin. Code r. 560-X-13-.15

Current through Register Vol. 42, No. 12, September 30, 2024

Section 560-X-13-.15 - Oxygen Therapy Coverage

(1) Oxygen Therapy is covered for the entire Medicaid population based on medical necessity and must be prior authorized by Medicaid. Requests for prior authorization must be made on the appropriate Alabama Prior Review and Authorization Request Form. The request must be accompanied by appropriate medical and other required documentation in accordance with Rule No. 560-X-13-.03.

(2) The medical diagnosis must indicate a chronic debilitating medical condition, with evidence that other forms of treatment (such as medical and physical therapy directed at secretions, bronchospasm and infection) were tried without success and that continuous oxygen therapy is required. Oxygen will not be approved for as needed (PRN) use only.

Ala. Admin. Code r. 560-X-13-.15

New Rule: Filed October 12, 2001; effective November 16 ,2001. Amended: Filed December 12, 2008; effective January 16, 2009.

Amended by Alabama Administrative Monthly Volume XXXIV, Issue No. 04, January 29, 2016, eff. 2/25/2016.

Author: Kellie Littlejohn Newman, PharmD, Director, Clinical Services

Statutory Authority: State Plan; 42 CFR, Section 440.70 ; Title XIX, Social Security Act.