Common use of Youth Treatment Clause in Contracts

Youth Treatment. Treatment Contractors that provide youth treatment services shall comply with the Rule regarding Financial Eligibility and Third Party Payment. If services for a client are covered by private insurance or a third party payor, but Contractor is not eligible for reimbursement by a client’s private insurance or third party payor, Contractor shall refer the client to a treatment program that is approved by the client’s private insurance or third party payor for services and reimbursement. If the approved treatment program refuses treatment services to the client and documents that refusal, Contractor may provide treatment services and bill the Department provided- the refusal, including insurance or third party payor and approved treatment program, is documented in the client file; the client meets the Diagnostic Statistical Manual IV diagnostic criteria for substance abuse/dependence; and the client’s treatment for residential care is approved by the designated OSAR contractor, if applicable. If client’s private insurance or third party payor would cover or approves partial or full payment for treatment services, Contractor may bill the Department for the non-reimbursed costs, including the deductible, provided - the client's parent refuses to file a claim with the private insurance or third party payor, or refuses to pay either the deductible or the non-reimbursed portion of the cost of treatment, and Contractor has obtained a signed statement from the parent that the parent refuses to pay, and Contractor has received approval from the DSHS substance abuse program services clinical coordinator to bill for the deductible or non-reimbursed portion of the cost; the client’s parent cannot afford to pay the deductible and/or the non-reimbursed portion of the cost of treatment; or the family has an adjusted income at or below 200% of the Federal poverty guidelines. If a client has exhausted all insurance coverage and requires continued treatment, Contractor may provide the continued treatment services and bill the Department as long as the client meets b)1) or b)2) above. c) If a client’s parent, who does not have insurance or other third party coverage for the client’s treatment services, can afford, but refuses, to pay for those services, Contractor may bill the Department for the cost of the client’s treatment, if Contractor has obtained a signed statement from the parent that the parent refuses to pay and Contractor has received approval from DSHS to bill for the cost of the services.

Youth Treatment. Treatment Contractors that provide youth treatment services shall comply with the Rule regarding Financial Eligibility and Third Party Payment. If services for a client are covered by private insurance or a third party payor, but payor that the Contractor is not eligible for reimbursement by a client’s private insurance or third party payorreimbursement, Contractor shall refer the client to a treatment program that is approved by the client’s private insurance or third party payor for services and reimbursementpayor. If the approved treatment program refuses treatment services to the client and documents that refusal, Contractor may provide treatment services and bill the Department provided- DSHS provided - the refusal, including insurance or third party payor and approved treatment program, is documented in the client file; the client meets the Diagnostic Statistical Manual IV diagnostic criteria for substance abuse/dependence; and the client’s treatment for residential care is approved by the designated OSAR contractor, if applicableuse disorder. If client’s private insurance or third party payor would cover or approves partial or full payment for treatment services, Contractor may bill the Department DSHS for the non-reimbursed costs, including the deductible, provided - the client's parent refuses to file a claim with the private insurance or third party payor, or refuses to pay either the deductible or the non-reimbursed portion of the cost of treatment, and Contractor has obtained a signed statement from the parent that the parent refuses to pay, and Contractor has received written approval from the DSHS substance abuse program services clinical coordinator to bill for the deductible or non-reimbursed portion of the cost; the client’s parent cannot afford to pay the deductible and/or or the non-reimbursed portion of the cost of treatment; or the family has an adjusted income at or below 200% of the Federal poverty guidelines. If a client has exhausted all insurance coverage and requires continued treatment, Contractor may provide the continued treatment services and bill the Department DSHS as long as the client meets b)1) or b)2) above. c) . If a client’s parentlegal guardian, who does not have insurance or has other third party coverage for the client’s treatment services, can afford, but refuses, services and is unable to pay for those services, Contractor may bill must obtain a signed statement from the Department legal guardian on refusal to pay before billing DSHS for the cost of the client’s treatment, if Contractor has obtained a signed statement from the parent that the parent refuses to pay and Contractor has received approval from DSHS to bill for the cost of the services.

Youth Treatment. Treatment Contractors that provide youth treatment services shall comply with the Rule 25 TAC regarding Financial Eligibility and Third Party PaymentPayment requirement. If services for a client are covered by private insurance or a third party payor, but payor that the Contractor is not eligible for reimbursement by a client’s private insurance or third party payorreimbursement, Contractor shall refer the client to a treatment program that is approved by the client’s private insurance or third party payor for services and reimbursementpayor. If the approved treatment program refuses treatment services to the client and documents that refusal, Contractor may provide treatment services and bill the Department provided- DSHS provided - the refusal, including insurance or third party payor and approved treatment program, is documented in the client file; the client meets the Diagnostic Statistical Manual IV diagnostic criteria for substance abuse/dependence; and the client’s treatment for residential care is approved by the designated OSAR contractor, if applicableuse disorder. If client’s private insurance or third party payor would cover or approves partial or full payment for treatment services, Contractor may bill the Department DSHS for the non-reimbursed costs, including the deductible, provided - the client's parent refuses to file a claim with the private insurance or third party payor, or refuses to pay either the deductible or the non-reimbursed portion of the cost of treatment, and Contractor has obtained a signed statement from the parent that the parent refuses to pay, and Contractor has received written approval from the DSHS substance abuse program services clinical coordinator to bill for the deductible or non-reimbursed portion of the cost; the client’s parent cannot afford to pay the deductible and/or or the non-reimbursed portion of the cost of treatment; or the family has an adjusted income at or below 200% of the Federal poverty guidelines. If a client has exhausted all insurance coverage and requires continued treatment, Contractor may provide the continued treatment services and bill the Department DSHS as long as the client meets b)1) or b)2) above. c) . If a client’s parentlegal guardian, who does not have insurance or has other third party coverage for the client’s treatment services, can afford, but refuses, services and is unable to pay for those services, Contractor may bill must obtain a signed statement from the Department legal guardian on refusal to pay before billing DSHS for the cost of the client’s treatment, if Contractor has obtained a signed statement from the parent that the parent refuses to pay and Contractor has received approval from DSHS to bill for the cost of the services.

Youth Treatment. Treatment Contractors that provide youth treatment services shall comply with the Rule 25 TAC regarding Financial Eligibility and Third Party PaymentPayment requirement. If services for a client are covered by private insurance or a third party payor, but payor that the Contractor is not eligible for reimbursement by a client’s private insurance or third party payorreimbursement, Contractor shall refer the client to a treatment program that is approved by the client’s private insurance or third party payor for services and reimbursement. payor. a) If the approved treatment program refuses treatment services to the client and documents that refusal, Contractor may provide treatment services and bill the Department provided- DSHS provided - 1) the refusal, including insurance or third party payor and approved treatment program, is documented in the client file; ; 2) the client meets the Diagnostic Statistical Manual IV diagnostic criteria for substance abuse/dependence; and the client’s treatment for residential care is approved by the designated OSAR contractor, if applicable. use disorder. b) If client’s private insurance or third party payor would cover or approves partial or full payment for treatment services, Contractor may bill the Department DSHS for the non-reimbursed costs, including the deductible, provided - - 1) the client's parent refuses to file a claim with the private insurance or third party payor, or refuses to pay either the deductible or the non-reimbursed portion of the cost of treatment, and Contractor has obtained a signed statement from the parent that the parent refuses to pay, and Contractor has received written approval from the DSHS substance abuse program services clinical coordinator to bill for the deductible or non-reimbursed portion of the cost; ; 2) the client’s parent cannot afford to pay the deductible and/or or the non-reimbursed portion of the cost of treatment; or or 3) the family has an adjusted income at or below 200% of the Federal poverty guidelines. . c) If a client has exhausted all insurance coverage and requires continued treatment, Contractor may provide the continued treatment services and bill the Department DSHS as long as the client meets b)1) or b)2) above. cd) If a client’s parentlegal guardian, who does not have insurance or has other third party coverage for the client’s treatment services, can afford, but refuses, services and is unable to pay for those services, Contractor may bill must obtain a signed statement from the Department legal guardian on refusal to pay before billing DSHS for the cost of the client’s treatment, if Contractor has obtained a signed statement from the parent that the parent refuses to pay and Contractor has received approval from DSHS to bill for the cost of the services.