Necessity or Appropriateness of Services a. Use of Approved Service Authorization Policies The IDT shall use the MCO’s Department-approved service authorization policies and procedures to authorize services. The IDT shall not deny services that are necessary to reasonably and effectively support the member’s long term care outcomes identified in the comprehensive assessment as well as those necessary to assist the member to be as self- reliant and autonomous as possible.
Necessity or Appropriateness of Services a. Use of Approved Service Authorization Policies The IDT shall use the PO’s Department-approved service authorization policies and procedures to authorize services. The IDT shall not deny services that are reasonable and necessary to cost-effectively support the member’s long-term care outcomes identified in the comprehensive assessment as well as those necessary to assist the member to be as self- reliant and autonomous as possible. Long-term care outcomes for which services are authorized may relate to: The prevention, diagnosis, and treatment of a disease, condition, and/or disorder that results in health impairments and/or disability; The ability to achieve age-appropriate growth and development; The ability to attain, maintain, or regain functional capacity; and The opportunity to have access to the benefits of community living, to achieve person-centered goals, and live and work in the setting of their choice.
