Excluded Diagnosis Clause Samples
Excluded Diagnosis. A Beneficiary’s face-to-face assessment determines that the 34 Beneficiary has an excluded diagnosis and therefore does not meet medical necessity criteria for 35 receiving treatment from either COUNTY or CONTRACTOR.
36 1) CONTRACTOR may have Network Providers who are capable of treating these 37 Beneficiaries and can ▇▇▇▇ the State for these excluded diagnoses under the remaining FFS system. 1 CONTRACTOR shall identify such providers within CONTRACTOR’s network and shall make the 2 appropriate referral in a timely manner.
3 2) CONTRACTOR may also refer these Beneficiaries to those community clinics not 4 under contract with COUNTY to provide Mental Health Services for these Beneficiaries.
Excluded Diagnosis. A Beneficiary’s face-to-face assessment determines that the 5 Beneficiary has an excluded diagnosis and therefore does not meet medical necessity criteria for 6 receiving treatment from either COUNTY or CONTRACTOR.
7 1) CONTRACTOR may have Network Providers who are capable of treating these 8 Beneficiaries and can ▇▇▇▇ the State for these excluded diagnoses under the remaining FFS system.
Excluded Diagnosis. A Beneficiary’s face-to-face assessment determines that the 18 Beneficiary has an excluded diagnosis and therefore does not meet medical necessity criteria for 19 receiving treatment from either COUNTY or CONTRACTOR, and a NOA-A shall be provided, if 20 applicable. This does not apply to DMC
21 1) CONTRACTOR may have Network Providers who are capable of treating these 22 Beneficiaries and can ▇▇▇▇ the State for these excluded diagnoses under the remaining FFS system. 23 CONTRACTOR shall identify such providers within CONTRACTOR’s network and shall make the 24 appropriate referral in a timely manner. This does not apply to DMC.
25 2) CONTRACTOR may also refer these Beneficiaries to those community clinics not 26 under contract with COUNTY to provide mental health services for these Beneficiaries. This does not 27 apply to DMC.