Ala. Admin. Code r. 560-X-47-.03

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-47-.03 - Service Providers

To participate in the Alabama Medicaid Program, rehabilitative services providers must meet the following requirements. Service providers must demonstrate that they meet the criteria in either (1), (2), or (3), and both (4) AND (5) below.

(1) A provider must be certified as a 310-board community mental health center by DMH and must have demonstrated the capacity to provide access to the following services through direct provision or referral arrangements:

(a) Inpatient services through referral to community hospitals and through the attending physician for community hospitalizations

(b) Substance abuse services including intensive outpatient services and residential services

(c) Must submit an application to and receive approval from DMH to provide mental health rehabilitative services under the Medicaid Rehabilitative Option program.

(2) For the provision of Substance Abuse Rehabilitative Services an entity:

(a) Must be an organization that is currently certified by the Alabama Department of Mental Health (DMH) to provide alcohol and other drug treatment services under the provisions of Chapter 580 of the Alabama Administrative Code; and

(b) Must submit an application to and receive approval by DMH to provide Substance Abuse Rehabilitative Services under the Medicaid Rehabilitative Option program.

(3) The Department of Human Resources (DHR), the Department of Youth Services (DYS), Department of Mental Health

(DMH) for ASD, and the Department of Children's Services (DCS) are eligible to be rehabilitative services providers for children under age 21 if they have demonstrated the capacity to provide an array of medically necessary services, either directly or through contract. Additionally, DHR may provide these services to adults in protective service status. At a minimum, this array includes the following:

(a) Individual, group, and family counseling

(b) Crisis intervention services

(c) Consultation and education services

(d) Case management services Assessment and evaluation

(4) A provider must demonstrate the capacity to provide services off-site in a manner that assures the recipient's right to privacy and confidentiality and must demonstrate reasonable access to services as evidenced by service location(s), hours of operation, and coordination of services with other community resources.

(5) A provider must ensure that Medicaid recipients receive quality services in a coordinated manner and have reasonable access to an adequate array of services delivered in a flexible manner to best meet their needs. Medicaid does not cover all services listed above, but the provider must have demonstrated the capacity to provide these services.

Ala. Admin. Code r. 560-X-47-.03

Rule effective August 11, 1990. Amended: effective August 14, 1991; March 13, 1993. Emergency rule effective March 1, 1994. Amended: Filed May 6, 1994, effective June 14, 1994. Amended: Filed November 6, 1996; effective December 12, 1996. Amended: Filed December 7, 2000; effective January 11, 2001. Amended: Filed May 11, 2001; effective June 15, 2001. Amended: Filed May 12, 2005; effective June 16, 2005. Amended: Filed August 10, 2006; effective September 14, 2006. Amended: Filed January 11, 2006; effective February 15, 2007.

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 12, September 30, 2015, eff. 10/1/2015.

Amended by Alabama Administrative Monthly Volume XXXVII, Issue No. 12, September 30, 2019, eff. 11/14/2019.

Author: Karen M. Watkins-Smith, Associate Director, Mental Health Programs

Statutory Authority:42 C.F.R., § 440.130(d); Social Security Act, Title XIX, Omnibus Budget Reconciliation Act of 1987, P.L.

100-203, §4105; State Plan for Medical Assistance, Attachment 3.1-A.