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Medical necessity is a legal doctrine in the United States related to activities that may be justified as reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care. In contrast, unnecessary health care lacks such justification. Other countries may have medical doctrines or legal rules covering broadly similar ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
The Mental Health Parity Act (MHPA) is legislation signed into United States law on September 26, 1996 that requires annual or lifetime dollar limits on mental health benefits to be no lower than any such dollar limits for medical and surgical benefits offered by a group health plan or health insurance issuer offering coverage in connection with a group health plan. [1]
Operating ICFs/IID certified companies and organizations must recognize the developmental, cognitive, social, physical, and behavioral needs of individuals with intellectual disabilities who live in their setting or environment by requiring that each individual receives active treatment in regards to appropriate habilitation of their functions to be eligible for Medicaid funding. [6]
A Certified Community Behavioral Health Clinic (CCBHC) is a type of health clinic in the United States that treats mental health and substance abuse disorders regardless of the patient's health insurance status and ability to pay for care. [1] [2] [3] CCBHCs are funded through Medicaid or SAMHSA grants. [2] [4]
The Community Mental Health Act of 1963 (CMHA) (also known as the Community Mental Health Centers Construction Act, Mental Retardation Facilities and Construction Act, Public Law 88-164, or the Mental Retardation and Community Mental Health Centers Construction Act of 1963) was an act to provide federal funding for community mental health ...
They will be doing so at a time when internal records show Optum has deployed more than 90 “care advocates” to question clinicians about the medical necessity of their patients’ ABA ...
Among the many areas of practice represented in the CARF standards are aging services; behavioral health, which replaces institutional behavior management; psychosocial rehabilitation; child and youth services (with younger and established family services and support); durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS ...