Common use of Medically Necessary Services Clause in Contracts

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. 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- 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.