Common use of Medical Necessity Clause in Contracts

Medical Necessity. 6.1. CONTRACTOR will ensure that services provided are medically necessary in compliance with BHIN 21-073 and pursuant to Welfare and Institutions Code section 14184.402(a). Services provided to a client must be medically necessary and clinically appropriate to address the client’s presenting condition. Documentation in each client’s chart as a whole will demonstrate medical necessity as defined below, based on the client’s age at the time of service provision. 6.2. For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions Code section 14059.5. 6.3. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.

Appears in 19 contracts

Samples: Contract for Services, Contract for Services, Contract for Services

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Medical Necessity. 6.12.4.1. CONTRACTOR will ensure that services provided are medically necessary in compliance with BHIN 21-073 and pursuant to Welfare and Institutions Code section 14184.402(a). Services provided to a client member must be medically necessary and clinically appropriate to address the clientmember’s presenting condition. Documentation in each clientmember’s chart as a whole will demonstrate medical necessity as defined below, based on the clientmember’s age at the time of time-of-service provision. 6.22.4.2. For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions Code section 14059.5. 6.32.4.3. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.

Appears in 4 contracts

Samples: Contract for Services, Contract for Services, Contract for Services

Medical Necessity. 6.1. CONTRACTOR Contractor will ensure that services provided are medically necessary in compliance with BHIN 21-073 and pursuant to Welfare and Institutions Code section 14184.402(a). Services provided to a client must be medically necessary and clinically appropriate to address the client’s presenting condition. Documentation in each client’s chart as a whole will demonstrate medical necessity as defined below, based on the client’s age at the time of service provision. 6.2. For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions Code section 14059.5. 6.3. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.

Appears in 3 contracts

Samples: Contract for Services, Contract for Services, Contract Amendment

Medical Necessity. 6.1. CONTRACTOR will ensure that services provided are medically necessary in compliance with BHIN 21-073 and pursuant to Welfare and Institutions Code section 14184.402(a). Services provided to a client must be medically necessary and clinically appropriate to address the client’s presenting condition. Documentation in each client’s chart as a whole will demonstrate medical necessity as defined below, based on the client’s age at the time of time-of- service provision. 6.2. For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions Code section 14059.5. 6.3. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.

Appears in 2 contracts

Samples: Contract for Services, Contract for Services

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Medical Necessity. 6.1. CONTRACTOR A. Contractor will ensure that services provided are medically necessary in compliance with BHIN 21-073 and pursuant to Welfare and Institutions Code section 14184.402(a). Services provided to a client must be medically necessary and clinically appropriate to address the client’s presenting condition. Documentation in each client’s chart as a whole will demonstrate medical necessity as defined below, based on the client’s age at the time of time-of- service provision. 6.2. B. For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions Code section 14059.514056.5. 6.3. C. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(51366d(r)(5) of Title 42 of the United States Code.

Appears in 1 contract

Samples: Specialty Mh Service Agreement

Medical Necessity. 6.1. CONTRACTOR will ensure that services provided are medically necessary in compliance with BHIN 21-073 and pursuant to Welfare and Institutions Code section 14184.402(a). Services provided to a client must be medically necessary and clinically appropriate to address the client’s presenting condition. Documentation in each client’s chart as a whole will demonstrate medical necessity as defined below, based on the client’s age at the time of service provision. 6.2. For individuals 21 years of age or older, ,a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions Code section 14059.5. 6.3. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.

Appears in 1 contract

Samples: Contract for Services

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