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Centers for Medicare & Medicaid Services, HHS §441.61

§441.56(b) upon the request of an eligi-ble recipient.(b) To avoid duplicate screening serv-ices, the agency need not provide re-quested screening services to anEPSDT eligible if written verificationexists that the most recent age-appro-priate screening services, due under theagency’s periodicity schedule, have al-ready been provided to the eligible.

§441.60Continuing care.

(a)

Continuing care provider.

For pur-poses of this subpart, a continuing careprovider means a provider who has anagreement with the Medicaid agency toprovide reports as required under para-graph (b) of this section and to provideat least the following services to eligi-ble EPSDT recipients formally enrolledwith the provider:(1) With the exception of dental serv-ices required under §441.56, screening,diagnosis, treatment, and referral forfollow-up services as required underthis subpart.(2) Maintenance of the recipient’sconsolidated health history, includinginformation received from other pro-viders.(3) Physicians’ services as needed bythe recipient for acute, episodic orchronic illnesses or conditions.(4) At the provider’s option, provisionof dental services required under§441.56 or direct referral to a dentist toprovide dental services required under§441.56(b)(1)(vi). The provider mustspecify in the agreement whether den-tal services or referral for dental serv-ices are provided. If the provider doesnot choose to provide either service,then the provider must refer recipientsto the agency to obtain those dentalservices required under §441.56.(5) At the provider’s option, provisionof all or part of the transportation andscheduling assistance as required under§441.62. The provider must specify inthe agreement the transportation andscheduling assistance to be furnished.If the provider does not choose to pro-vide some or all of the assistance, thenthe provider must refer recipients tothe agency to obtain the transpor-tation and scheduling assistance re-quired under §441.62.(b)

Reports.

A continuing care pro-vider must provide to the agency anyreports that the agency may reason-ably require.(c)

State monitoring.

If the State planprovides for agreements with con-tinuing care providers, the agencymust employ methods described in theState plan to assure the providers’compliance with their agreements.(d)

Effect of agreement with continuingcare providers.

Subject to the require-ments of paragraphs (a), (b), and (c) of this section, CMS will deem the agencyto meet the requirements of this sub-part with respect to all EPSDT eligiblerecipients formally enrolled with thecontinuing care provider. To be for-mally enrolled, a recipient or recipi-ent’s family agrees to use one con-tinuing care provider to be a regularsource of the described set of servicesfor a stated period of time. Both the re-cipient and the provider must signstatements that reflect their obliga-tions under the continuing care ar-rangement.(e) If the agreement in paragraph (a)of this section does not provide for allor part of the transportation andscheduling assistance required under§441.62, or for dental service under§441.56, the agency must provide forthose services to the extent they arenot provided for in the agreement.

§441.61Utilization of providers andcoordination with related pro-grams.

(a) The agency must provide referralassistance for treatment not coveredby the plan, but found to be needed asa result of conditions disclosed duringscreening and diagnosis. This referralassistance must include giving thefamily or recipient the names, address-es, and telephone numbers of providerswho have expressed a willingness tofurnish uncovered services at little orno expense to the family.(b) The agency must make availablea variety of individual and group pro-viders qualified and willing to provideEPSDT services.(c) The agency must make appro-priate use of State health agencies,State vocational rehabilitation agen-cies, and Title V grantees (Maternaland Child Health/Crippled Children’sServices). Further, the agency should