E.B., APPELLANT,
v.
AGENCY FOR HEALTH CARE ADMINISTRATION, APPELLEE
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The court reversed and remanded because the hearing officer failed to apply the federal EPSDT standard when determining Medicaid home health aide services coverage for a child with Rett Syndrome.
A hearing officer's determination regarding Medicaid home health aide services must be made under the federal EPSDT standard, which requires coverage of necessary health care services to correct or ameliorate defects and illnesses discovered by screening.
[1] Under the federal EPSDT standard, a state must provide Medicaid coverage for necessary health care, diagnostic services, and treatment to correct or ameliorate defects an…
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Join FLexlaw to unlock all legal intelligence“[S]uch other necessary health care, diagnostic services, treatment, and other measures described [as medical assistance] to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan”
Explanation of the federal EPSDT program requirements cited from Smith v. Benson
E.B., a twelve-year-old with Rett Syndrome, requested pre-authorization for twelve hours per day of home health aide services through the Medicaid HHA…
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This appeal stems from the appellant, E.B., requesting pre-authorization from the appellee, Agency for Health Care Administration (“AHCA”), for twelve hours per day of home health aide services through the Medicaid Home Health Aide Services Program (“Medicaid HHA Program”). E.B. is a twelve-year-old female who has been diagnosed with Rett Syn-drone, a physically disabling autism disorder. A hearing officer determined that E.B. was entitled to four hours of home health aide services per day on Monday through Friday. The record reflects that the hearing officer failed to consider the federal early, periodic, screening, diagnostic and treatment (“EPSDT”) standard in making its determination as to which services requested by E.B. were covered by the Medicaid HHA Program. See Smith v. Benson, 703 F.Supp.2d 1262, 1268-69 n. 8 (S.D.Fla.2010) (explaining that the federal EPSDT program requires states to pro*709vide Medicaid coverage for “[s]uch other necessary health care, diagnostic services, treatment, and other measures described [as medical assistance] to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan”) (citation omitted). Thus, this case is remanded so that the hearing officer may consider E.B.’s request under the EPSDT standard. See C.F. v. Dep’t of Children & Families, 934 So.2d 1, 6 (Fla. 3d DCA 2005) (reversing and remanding where hearing officer failed to apply EPSDT standard in determining Medicaid coverage).
Reversed and remanded.
STEVENSON, HAZOURI and GERBER, JJ., concur.
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Citator
Cited By
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Q.H. c/o AMY Hill v. Sunshine State Health Plan, Inc. (Fla. 4th DCA 2020)
Authorities Cited
- C.F. v. Dep't of Child. & Families, 934 So. 2d 1 (Fla. 3d DCA 2005)
- Smith Ex Rel. Smith v. Benson, 703 F. Supp. 2d 1262 (S.D. Fla. 2010)