Current through Register Vol. 48, No. 51, June 17, 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; andF. represent an effective and appropriate use of program funds.Statutory Authority: MS s 256.991