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