The State Medicaid Agency determines if medical necessity can be presumptive when services are preventive in nature and targeted at a general population group. Medical necessity criterion is determined by the state in accordance with 42 CFR 440.230(d).
Date
Topic
Sub Topic
FAQ ID
181126
FAQ Question
When preventive services are targeted at a general population group, can the services be assumed to be medically necessary for the entire population of Medicaid-enrolled students, instead of documenting medical necessity for each individual?