Bill Text: CT HB05296 | 2010 | General Assembly | Introduced
Bill Title: An Act Concerning The Definition Of Medical Necessity.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2010-04-06 - File Number 317 [HB05296 Detail]
Download: Connecticut-2010-HB05296-Introduced.html
General Assembly |
Raised Bill No. 5296 | ||
February Session, 2010 |
LCO No. 1351 | ||
*01351_______HS_* | |||
Referred to Committee on Human Services |
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Introduced by: |
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(HS) |
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AN ACT CONCERNING THE DEFINITION OF MEDICAL NECESSITY.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective July 1, 2010) (a) For purposes of the administration of the Medicaid program by the Department of Social Services, "medically necessary" and "medical necessity" mean those services required to prevent, identify, diagnose, treat, rehabilitate or ameliorate a medical condition or mental illness, or its effects, in order to attain or maintain maximum achievable health, functioning and independence, provided such services are: (1) Consistent with generally-accepted standards of medical practice that are based on (A) credible scientific evidence published in peer-reviewed medical literature that is generally recognized by the relevant medical community, (B) recommendations of a physician-specialty society, (C) the views of physicians practicing in relevant clinical areas, and (D) any other relevant factors, as determined by the Department of Social Services; (2) clinically appropriate in terms of type, frequency, timing, site, extent and duration and considered effective for the patient's illness, injury or disease; and (3) not primarily for the convenience of the patient, physician or other health care providers and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease.
(b) The Department of Social Services, or a designee of the department, shall conduct an individualized assessment of a Medicaid recipient's medical condition or mental illness to determine whether services are medically necessary or a medical necessity, as defined in subsection (a) of this section, for the recipient.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
July 1, 2010 |
New section |
Statement of Purpose:
To define the terms "medically necessary" and "medical necessity" for the purpose of the administration of the Medicaid program.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]