Minn. R. 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.
Notes
Statutory Authority: MS s 256.991
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