(A) in subparagraph (A), by inserting after 
clause (i) the following new clause: 
‘‘(ii) the contract with the entity satisfies the 
requirements of subparagraph (C) (relating to pay-
ment for, and coverage of, such services under an in-
dividual’s education program, an individualized fam-
ily service plan, or when furnished in or through an 
educational program or setting);’’; and 
(B) by inserting after subparagraph (B), 
the following new subparagraph: 
‘‘(C) For purposes of clause (ii) of subparagraph (A), 
the requirements of this subparagraph are the following: 
‘‘(i) The contract with the entity specifies the 
coverage and payment responsibilities of the entity 
in relation to medical assistance for items and serv-
ices that are covered under the State plan and in-
cluded in the contract, when such items and services 
are furnished in or through an educational program 
or setting. 
‘‘(ii) In any case in which the entity is obligated 
under the contract to pay for items and services cov-
ered under the State plan, the contract with the en-
tity requires the entity to— 
‘‘(I) enter into a provider network service 
agreement with the qualified provider or pro-
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viders furnishing such items or services in or 
through an educational program or setting; 
‘‘(II) promptly pay such providers at a rate 
that is at least equal to the rate that would be 
paid to a provider furnishing the same service 
in a non-educational program or setting; and 
‘‘(III) treat as final and binding deter-
minations by State licensed providers or pro-
viders eligible for reimbursement under the 
State plan working in an educational program 
or setting regarding the medical necessity of an 
item or service. 
‘‘(iii) The contract with the entity specifies the 
obligation of the entity to ensure that providers of 
items or services that are furnished in or through an 
educational program or setting refer children fur-
nished such items or services to the entity and its 
provider network for additional services that are not 
available in or through such program or setting but 
that are covered under the State plan and included 
in the entity’s contract with the State. 
‘‘(iv) The contract with the entity requires, with 
respect to payment for, and coverage of, services for 
which the entity is responsible for, that the entity 
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must demonstrate that the entity has established 
procedures to— 
‘‘(I) ensure coordination between the State, 
a local educational agency and the lead agency 
in the State with responsibility for admin-
istering part C of the Individuals with Disabil-
ities Education Act with respect to those serv-
ices for an individual who has not attained age 
21 and who is eligible for medical assistance 
under the State plan (including an individual 
who has an individualized education program 
established pursuant to part B of the Individ-
uals with Disabilities Education Act or other-
wise or an infant or toddler with a disability 
who has an individualized family service plan 
established pursuant to part C of such Act) 
which are required for the individual under the 
individual’s education program or the individ-
ualized family service plan, or are furnished to 
the individual pursuant to section 504 of the 
Rehabilitation Act of 1973, and which are not 
specifically included in the services required 
under the contract, but are the responsibility of 
the State, a local educational agency, or the 
lead agency in the State with responsibility for 
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