Medicaid Authority. Medical necessity for an adolescent individual (an individual under the age of twenty-one 11 (21)) is determined using the following criteria:
Medicaid Authority. The Medicaid elements of the initiative shall operate according to existing Medicaid law and regulation and sub-regulatory guidance, as amended or modified, except to the extent waived as provided for in Appendix 5. As a term and condition of the initiative, Participating Plans will be required to comply with Medicaid managed care requirements under Title XIX and 42 C.F.R. §438 et. seq., and applicable sub-regulatory guidance, as amended or modified, except to the extent specified in this MOU, including Appendix 5 and, for waivers of sub-regulatory guidance, the three-way contract.
Medicaid Authority. The Medicaid elements of the Model shall operate according to Medicaid law, regulation and sub-regulatory guidance, including but not limited to all requirements of Vermont’s Medicaid demonstration project under Section 1115 of the Act.
Medicaid Authority. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service is necessary to correct or ameliorate screened health conditions. Consistent with federal guidance, services need not be curative or completely restorative to ameliorate a health condition, including substance misuse and SUDs. Services that sustain, support, improve, or make more tolerable substance misuse or a SUD are considered to ameliorate the condition and are thus covered as EPSDT services.
Medicaid Authority. The Medicaid elements of the Demonstration shall operate according to existing Medicaid law and regulation and sub-regulatory guidance, including but not limited to all requirements of the 1915(c) waivers for those Enrollees in a 1915(c) waiver, as amended or modified, except to the extent waived as provided for in Appendix 5. As a term and condition of the Demonstration, the State and Demonstration Plans will be required to comply with Medicaid managed care requirements under Title XIX of the Social Security Act and 42 CFR 438 et. seq., other applicable regulations, and applicable sub-regulatory guidance, as amended or modified, except to the extent specified in this MOU, including Appendix 5 and, for waivers of sub-regulatory guidance, the Three-way Contract. The State will add concurrent authority to the relevant 1915(c) programs via amendments due no later than July 1, 2013.
Medicaid Authority. See Section H on Medicaid Authority and Appendix 5 of the MOU. IV.C.2. Eligibility
Medicaid Authority. The Medicaid elements of the Demonstration shall operate according to existing Medicaid law, regulation, and sub-regulatory guidance and are subject to existing requirements for financial and program integrity, and Colorado’s approved State Plan and applicable waiver programs, except to the extent these requirements are waived or modified as provided for in Appendix 5. Colorado will submit a 1932(a) State Plan amendment to allow Medicare-Medicaid enrollees to participate in the ACC Program. Implementation of this Demonstration is contingent on CMS approval of the necessary State Plan authority.
Medicaid Authority. The Medicaid elements of the Demonstration shall operate according to existing Medicaid statute, regulation and regulatory guidance, including but not limited to all requirements of any Section 1115(a) demonstration and the 1915(c) waivers applicable to those MAP Participants who may be enrolled in a 1915(c) waiver. MAP Plans are required to comply with Medicaid managed care requirements under Title XIX of the Social Security Act, 42 CFR 422.629-634 and Part 438 et. seq., and applicable regulatory guidance, as amended or modified, except to the extent specified in this MOU.
Medicaid Authority. The Medicaid elements of the initiative shall operate according to existing Medicaid law and regulation and sub-regulatory guidance, including but not limited to all requirements of the 1915(b) and 1915(c) waivers for those ICO enrollees in a 1915(c) waiver, as amended or modified, except to the extent waived as provided for in Appendix 5. As a term and condition of the initiative, ICOs will be required to comply with Medicaid managed care requirements under Title XIX and 42 C.F.R. § 438 et. seq., and applicable sub- regulatory guidance, as amended or modified, except to the extent specified in this MOU, including Appendix 5 and, for waivers of sub-regulatory guidance, the three-way contract.
