§ 1101.21a. Clarification regarding the definition of ‘‘medically necessary’’—statement of policy.

 A service, item, procedure or level of care that is necessary for the proper treatment or management of an illness, injury or disability is one that:

   (1)  Will, or is reasonably expected to, prevent the onset of an illness, condition, injury or disability.

   (2)  Will, or is reasonably expected to, reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury or disability.

   (3)  Will assist the recipient to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the recipient and those functional capacities that are appropriate of recipients of the same age.


   The provisions of this §  1101.21a adopted April 20, 2007, effective April 21, 2007, 37 Pa.B. 1880.

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