Each eligible member may receive covered services that are medically necessary within the limitations of this section. DHHS reserves the right to request additional information to evaluate medical necessity and review utilization of services. DHHS requires Prior Authorization (PA) for some services reimbursed under this section. DHHS may require Utilization Review for all services reimbursed under this section.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-65, subsec. 144-101-II-65.04