Pennsylvania Code
Title 28 - HEALTH AND SAFETY
Part I - General Health
Chapter 9 - MANAGED CARE ORGANIZATIONS
Subchapter H - AVAILABILITY AND ACCESS
Section 9.677 - Requirements of definitions of "medical necessity"
Universal Citation: 28 PA Code ยง 9.677
Current through Register Vol. 54, No. 44, November 2, 2024
The definition of "medical necessity" shall be the same in the plan's provider contracts, enrollee contracts and other materials used to evaluate appropriateness and to determine coverage of health care services. The definition shall comply with the HMO Act, the PPO Act, Act 68 and this chapter.
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