Revision 09-4; Effective December 1, 2009
When reviewing an MEPD case, verify medical necessity/level of care determination if:
- the recipient's medical necessity or level of care determination has been denied, or
- the recipient has relocated to a different facility and no medical necessity/level of care determination has been received.
If the medical necessity/level of care determination has been denied, do not sustain the review.
Reference: See Section B-7431, Denial of Level of Care/Medical Necessity Determination, for procedures when medical necessity/level of care is denied.