State Law

Pennsylvania Admin. Code-Title 31-Part X-Chapter 301-Health Maintenance Organization

08/22/2023 Pennsylvania Section 301.2


Medical Necessity-Definition

Medical necessity or medically necessary—Appropriate and necessary services as determined by the HMO which are rendered to a member for a condition requiring, according to generally accepted principles of good medical practice, the diagnosis or direct care and treatment of an illness or injury and which are not provided only as a convenience.