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b. Out-of-Plan Benefits. 3. Medical necessity – The standard of "medical necessity" is used as the basis for determining whether access to Medicaid-covered services is required and appropriate. A "medically necessary service" means medical, surgical or other services required for the prevention, diagnosis, cure, or treatment of a health-related condition including any such services that are necessary to prevent a detrimental change in either medical or mental health status or substance use disorder or services needed to achieve age-appropriate growth and development or to attain, maintain, or regain functional capacity. Medically necessary services must be provided in the most cost-efficient and appropriate setting and must not be provided solely for the convenience of the member or service provider. 4. Early Periodic Screening, Diagnosis and Treatment (EPSDT) -- The EPSDT provision in Title XIX mandates that state Medicaid programs must provide coverage for all follow-up diagnostic and treatment services deemed medically necessary to ameliorate or correct defects and physical and mental illnesses and conditions discovered through screening or at any other occasion, whether or not those services are covered by Rhode Island's Medicaid State Plan or the State’s Medicaid Section 1115 waiver. This applies to members of the MACC group up to age nineteen (19), SSI- eligible children and young adults up to age twenty-one (21), including adults aging out of foster care up to age twenty-one (21). A young adult over age nineteen (19) who transitions from the MACC group for children to the MACC group for adults from age nineteen (19) to sixty-four (64) also receives EPSDT services until age twenty-one (21). 2.9 RIte Care In-Plan Capitated Benefits A. The benefits which the MCO provides or arranges within the capitated (fixed cost per enrollee per month) benefit are set forth below. B. In-Plan benefits subject to the capitated rate are organized as follows: the RIte Care comprehensive benefit package and the extended family planning benefit package. Adults who are found to be severely and persistently mentally ill have access to a comprehensive benefit package. All elements of the comprehensive benefit package are the responsibility of the MCO when beneficiaries in this group receive coverage through the RIte Care managed care delivery system. C. RIte Care comprehensive benefit package --The following benefits are included in the capitated rate on an annual basis, based on medical necessity: