Common use of Diagnosis and Treatment Clause in Contracts

Diagnosis and Treatment. If a suspected problem is detected by a screening examination as described above, the child and/or young adults shall be evaluated as necessary for further diagnosis. This diagnosis is used to determine the treatment needs of the enrollee. EPSDT requires coverage for all follow up diagnostic and treatment services deemed Medically Necessary to ameliorate or correct a problem discovered during an EPSDT screen. Such Medically Necessary diagnosis and treatment services must be provided regardless of whether such services are covered by the State Medicaid Plan, if they are Medicaid-covered services as defined in the Social Security Act. Contractor shall assure that all Medically Necessary, Medicaid-covered diagnosis and treatment services are provided, either directly or by referral. However, if the services are neither covered by the State Medicaid Plan nor included in the comprehensive benefit package, Contractor may xxxx the State fee-for-service for these services if provided by Contractor. Such services are outlined in Attachment B of this Agreement.

Diagnosis and Treatment. If a suspected problem is detected by a screening examination as described above, the child and/or young adults shall be evaluated as necessary for further diagnosis. This diagnosis is used to determine the treatment needs of the enrollee. EPSDT requires coverage for all follow up diagnostic and treatment services deemed Medically Necessary to ameliorate or correct a problem discovered during an EPSDT screen. Such Medically Necessary diagnosis and treatment services must be provided regardless of whether such services are covered by the State Medicaid Plan, if they are Medicaid-covered services as defined in the Social Security Act. Contractor shall assure that all Medically Necessary, Medicaid-covered diagnosis and treatment services are provided, either directly or by referral. However, if the services are neither covered by the State Medicaid Plan nor included in the comprehensive benefit package, Contractor may xxxx bill the State fee-for-service for these services if provided by Contractor. Such services are outlined in Attachment B of this Agreement.