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
School-Based Services
Sub Topic
Services and Documentation
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Billing/Funding
FAQ ID
181126
FAQ Page
Medicaid School-Based Services Frequently Asked Questions (FAQs)
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?