Minn. R. agency 196, ch. 9505, CONDITIONS FOR MEDICAL ASSISTANCE AND GENERAL ASSISTANCE MEDICAL CARE PAYMENT, pt. 9505.5030

Current through Register Vol. 49, No. 25, December 16, 2024

Part 9505.5030 - CRITERIA FOR APPROVAL OF PRIOR AUTHORIZATION REQUEST

A request for prior authorization of a health service shall be evaluated by consultants using the criteria given in items A to F. A health service meeting the criteria in this part shall be approved, if the health service is otherwise a covered service under the MA or GAMC programs. The health service must:

A. be medically necessary as determined by prevailing medical community standards or customary practice and usage;

B. be appropriate and effective to the medical needs of the recipient;

C. be timely, considering the nature and present state of the recipient's medical condition;

D. be furnished by a provider with appropriate credentials;

E. be the least expensive appropriate alternative health service available; and

F. represent an effective and appropriate use of program funds.

Minn. R. agency 196, ch. 9505, CONDITIONS FOR MEDICAL ASSISTANCE AND GENERAL ASSISTANCE MEDICAL CARE PAYMENT, pt. 9505.5030

10 SR 842

Statutory Authority: MS s 256.991