Common use of Medicaid Authority Clause in Contracts

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. For individuals under 21 11 years of age, a service is “medically necessary” or a “medical necessity” if the service is necessary to 12 correct or ameliorate screened health conditions. Consistent with federal guidance, services need not be 13 curative or completely restorative to ameliorate a health condition, including substance misuse and 14 SUDs. Services that sustain, support, improve, or make more tolerable substance misuse or a SUD are 15 considered to ameliorate the condition and are thus covered as EPSDT services.

Medicaid Authority. For individuals under 21 1 years of age, a service is “medically necessary” or a “medical necessity” if the service is necessary to 2 correct or ameliorate screened health conditions. Consistent with federal guidance, services need not be 3 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. For individuals under 21 24 years of age, a service is “medically necessary” or a “medical necessity” if the service is necessary to 25 correct or ameliorate screened health conditions. Consistent with federal guidance, services need not be 26 curative or completely restorative to ameliorate a health condition, including substance misuse and 27 SUDs. Services that sustain, support, improve, or make more tolerable substance misuse or a an SUD are 28 considered to ameliorate the condition and are thus covered as EPSDT services.