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Medicaid State Plan Amendment (09-61) – Written Orders/Referrals

Written Orders and Referrals must include (continued):

The time period for which services are being ordered;

The ordering practitioner’s National Provider Identifier (NPI) or license number; and,

Patient diagnosis and/or reason/need for ordered services.

*For purposes of the SSHSP, where written referrals are permitted

(e.g., speech therapy services, psychological counseling services),

the written referral must include the information listed above

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