A range of procedures or interventions that is appropriate and necessary for the diagnosis, treatment, or support in response to an
assessment of a consumer’s condition or need. Medically necessary means services and supplies that are:

∙ Provided for the diagnosis, secondary or tertiary prevention, amelioration, intervention, rehabilitation, or care and treatment of a mental health, developmental disability or substance abuse condition, and
∙ Necessary for and appropriate to the conditions, symptoms, intervention, diagnosis, or treatment of a mental health, developmental disability or substance abuse condition, and
∙ Within generally accepted standards of medical practice, and
∙ Not primarily for the convenience of an Consumer, and
∙ Performed in the least costly setting and manner appropriate to treat the
Consumer’s mental health, developmental disability or substance abuse condition.



Page last modified: October 15, 2015
« Back to Glossary Index