Medically Necessary Services for the State plan services in Addendum VIII.B and C medically necessary has the meaning in Wis. Admin. Code DHS §101.03(96m): Medicaid services (as defined under Wis. Stat. § 49.46 and Wis. Admin. Code § DHS 107) that are required to prevent, identify or treat a member’s illness, injury or disability; and that meet the following standards:
Medically Necessary Services. Medically necessary services are defined as services, supplies, or equipment provided by a licensed health care professional that:
Medically Necessary Services. Services must be provided in a way that provides all protections to the Enrollee provided by Medicare and Medi-Cal. Per Medicare, services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, or otherwise medically necessary under 42 U.S.C. § 1395y. In accordance with Title XIX law and related regulations, and per Medi-Cal, medical necessity means reasonable and necessary services to protect life, to prevent significant illness or significant disability, or to alleviate severe pain through the diagnosis or treatment of disease, illness, or injury under the Welfare and Institutions Code section 14059.5.
Medically Necessary Services. Services must be provided in a way that provides all protections to covered individuals provided by Medicare and Michigan Medicaid. Per Medicare, services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, or otherwise medically necessary under 42 U.S.C. 1395y. Per Medicaid, determination that a specific service is medically (clinically) appropriate, necessary to meet needs, consistent with the person’s diagnosis, symptomatology and functional impairments, is the most cost-effective option in the most integrated setting, and is consistent with clinical standards of care. Medical necessity includes, but is not limited to, those supports and services designed to assist the person to attain or maintain a sufficient level of functioning to enable the person to live in his or her community.
Medically Necessary Services. Per Medicare, services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, or otherwise Medically Necessary under 42 U.S.C. § 1395y. In accordance with Medicaid law and regulations, and per Rhode Island Medicaid, the term “Medical Necessity,” “Medically Necessary,” or “Medically Necessary Service” means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health- related condition including such services necessary to prevent a detrimental change in either medical or mental health status. Medically Necessary Services must be provided in the most cost effective and appropriate setting and shall not be provided solely for the convenience of the Enrollee or service provider.
Medically Necessary Services. As defined by the Social Security Act, Section 1905 (42 USC 1396d(a)), the State Plan, and Administrative Code, Medically Necessary Services are also the most appropriate services that help achieve age-appropriate growth and development and will allow a Member to attain, maintain, or regain capacity. Medically Necessary Services may also be those services for Members that are necessary to correct or ameliorate defects and physical and mental illnesses and conditions, whether such services are covered or exceed the benefit limits in the Medicaid State Plan and Title 23 of Mississippi Administrative Code.
Medically Necessary Services. The Subscriber acknowledges and agrees that enrollment in this program does not entitle the Subscriber to use the Fire District ambulance services or transportation that is not medically necessary. Medically necessary is defined as specific need for ambulance services or transportation where use of other services or forms of transportation, such as a private car or taxi, would be medically inappropriate. The absence of alternative services or methods of transportation does not, by itself, constitute medical necessity. If a subscriber and/or eligible dependent requests the Fire District’s ambulance service and it is determined by the Fire District that it was not medically necessary, the Subscriber/dependent will be liable for the actual costs incurred in providing such service. The Fire District reserves the right to require a physician’s certification of medical necessity.
Medically Necessary Services. Coverage hereunder excludes charges for any service or supply which is not Medically Necessary for the care of the patient's sickness, injury or condition.
Medically Necessary Services. Medicaid services (as defined under s. 49.46, Wis. Stats., and ch. 107 Wis. Admin. Code) that are required to prevent, identify or treat a member’s illness, injury or disability; and that meet the following standards:
Medically Necessary Services. Services must be provided in a way that provides all protections to the Enrollee provided by Medicare and MassHealth. Per Medicare, services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, or otherwise medically necessary under 42 U.S.C. § 1395y. In accordance with Medicaid law and regulations, and per MassHealth, services must be:
