MEDICALLY NECESSARY SERVICE. MEDICAL NECESSITY 13 Medically Necessary Services means a requested service which is reasonably calculated to 14 prevent, diagnose, correct, cure, alleviate, or prevent worsening of conditions in the individual 15 that endanger life, or cause suffering of pain, or result in an illness or infirmity, or threaten to 16 cause or aggravate a handicap, or cause physical deformity, or malfunction. There is no other 17 equally effective, more conservative, or substantially less costly course of treatment available 18 or suitable for the individual requesting the service. For the purpose of this section, "course 19 of treatment" may include mere observation or, where appropriate, no medical treatment at 20 all (WAC 182-500-0070).
MEDICALLY NECESSARY SERVICE. Those medical services which: (a) are essential to prevent, diagnose, prevent the worsening of, alleviate, correct or cure medical conditions that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or aggravate a handicap, or result in illness or infirmity of a Medicaid Managed Care Member; (b) are provided at an appropriate facility and at the appropriate level of care for the treatment of the Medicaid Managed Care Member's medical condition; and, (c) are provided in accordance with generally accepted standards of medical practice.
