DHS 101.03(96m)(a)
(a) Required to prevent, identify or treat a recipient's illness, injury or disability; and
DHS 101.03(96m)(b)1.
1. Is consistent with the recipient's symptoms or with prevention, diagnosis or treatment of the recipient's illness, injury or disability;
DHS 101.03(96m)(b)2.
2. Is provided consistent with standards of acceptable quality of care applicable to the type of service, the type of provider and the setting in which the service is provided;
DHS 101.03(96m)(b)3.
3. Is appropriate with regard to generally accepted standards of medical practice;
DHS 101.03(96m)(b)4.
4. Is not medically contraindicated with regard to the recipient's diagnoses, the recipient's symptoms or other medically necessary services being provided to the recipient;
DHS 101.03(96m)(b)6.
6. Is not duplicative with respect to other services being provided to the recipient;
DHS 101.03(96m)(b)7.
7. Is not solely for the convenience of the recipient, the recipient's family or a provider;
DHS 101.03(96m)(b)8.
8. With respect to prior authorization of a service and to other prospective coverage determinations made by the department, is cost-effective compared to an alternative medically necessary service which is reasonably accessible to the recipient; and
DHS 101.03(96m)(b)9.
9. Is the most appropriate supply or level of service that can safely and effectively be provided to the recipient.
