08 AM 33
0653
ADOPTED
Senator Moody of the 56th offered the following amendment:
Senator Moody of the 56th offered the following amendment:
Amend
SB 507 by striking the word
"basic"
on line 2 of page 1.
By
inserting after
"appeals;"
on line 6 of page 1 the following:
to
provide for statutory construction;
By
striking lines 6 through 10 of page 2.
By
renumbering paragraphs (2) through (5) of Code Section 49-4-169.1 as paragraphs
(1) through (4), respectively.
By
striking lines 18 through 19 of page 2 and inserting in lieu thereof the
following:
(5)
'Medically necessary services' means services or treatments that are prescribed
by a physician or other licensed practitioner, and which, pursuant to the EPSDT
Program, diagnose or correct or ameliorate defects, physical and mental
illnesses, and health conditions, whether or not such services are in the state
plan.
By
striking lines 22 through 25 of page 2 and inserting in lieu thereof the
following:
(5)
'Therapy services' means occupational therapy, speech therapy, physical
therapy, or other services provided pursuant to the EPSDT Program to an eligible
Medicaid beneficiary 21 years of age or younger and which are recommended as
medically necessary by a physician.
By
striking the word "basic"
and the words
"without prior approval" on line 28 of
page 2.
By
striking lines 6 through 28 of page 3 and inserting in lieu thereof the
following:
children.
Prior approval for therapy services shall be for a period of up to six months as
consistent with the needs of the individual recipient.
By
striking the words "services in excess of
basic" on line 6 of page 4.
By
striking lines 11 through 15 of page 4 and inserting in lieu thereof the
following:
(e)
Prescriptions and prior approval for services shall be for general areas of
treatment, treatment goals, or ranges of specific treatments or processing
codes. Clinical coverage criteria or guidelines, including restrictions such as
location of service and prohibitions on multiple services on the same day or at
the same time, shall not be the sole determinant used by the
department,
By
striking the words "speech, occupational,
or physical" on line
21 of page 4.