Minnesota Administrative Rules
Agency 196 - Human Services Department
Chapter 9505 - HEALTH CARE PROGRAMS
CONDITIONS FOR MEDICAL ASSISTANCE AND GENERAL ASSISTANCE MEDICAL CARE PAYMENT
Part 9505.5030 - CRITERIA FOR APPROVAL OF PRIOR AUTHORIZATION REQUEST
Current through Register Vol. 48, No. 39, March 25, 2024
A request for prior authorization of a health service shall be evaluated by consultants using the criteria given in items A to F. A health service meeting the criteria in this part shall be approved, if the health service is otherwise a covered service under the MA or GAMC programs. The health service must:
A. be medically necessary as determined by prevailing medical community standards or customary practice and usage;
B. be appropriate and effective to the medical needs of the recipient;
C. be timely, considering the nature and present state of the recipient's medical condition;
D. be furnished by a provider with appropriate credentials;
E. be the least expensive appropriate alternative health service available; and
F. represent an effective and appropriate use of program funds.
Statutory Authority: MS s 256.991
