Ala. Admin. Code r. 560-X-15-.08

Current through Register Vol. 42, No. 10, July 31, 2024

Section 560-X-15-.08 - Submitted Charges

(1) Fees submitted shall not exceed usual, customary, and reasonable rates paid by the non-Medicaid population of the community.

(2) The provider shall not charge Medicaid for services rendered on a no-charge basis to the general public.

(3) If the provider offers discounts or rebate to the general public, a like amount shall be adjusted to the credit of Medicaid on the Medicaid claim form, or such other method as Medicaid may prescribe.

(4) Orthodontic services provided as a continuation of treatment initiated through multidisciplinary clinics administered by Alabama Children's Rehabilitation Service (CRS) or other qualified multidisciplinary clinics are reimbursable if the clinics are approved by and enter into a vendor agreement (contract) with Medicaid. Fees paid for the services shall not exceed the reasonable rates established in the Medicaid statewide profile for medically necessary orthodontic services.

Author:Tina Edwards, Dental Program

Ala. Admin. Code r. 560-X-15-.08

Emergency rule effective April 1, 1991. Rule effective June 12, 1991. Amended: Filed May 12, 2004; effective June 16, 2004.

Previous Rule 560-X-15-.08, Non-Covered Services - (Including But Not Limited To The Following), was repealed and Rule 560-X-15-.10, was renumbered as per certification filed May 12, 2004; effective June 16, 2004.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§401, etseq.