Pediatric medical necessity standard

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NE

"e.  Medically necessary treatment will be provided according to 471 NAC. Treatment services also include rehabilitative and habilitative services for HEALTH CHECK (EPSDT) eligible children.  That is, diagnosis and treatment, covered by the Nebraska Medical Assistance Program (NMAP), federally defined and medically necessary, to treat, prevent or ameliorate a condition; to promote growth and development; to attain or maintain functional status; or prevent deterioration.  The Contractor must provide information and referral in addressing social, educational, and other health needs as requested.  Refer requests for treatment not covered by NMAP to the Department."  Nebraska Contract, page 77.