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UNOFFICIAL 1700.1-42 nurses' aid services, sufficient to meet nursing care needs; and a physician's guidance on the professional aspects of operating the institution. “Medical necessity” means those procedures and services, as determined by the department, which are considered to be necessary and for which payment will be made. Medically necessary health interventions (services, procedures, drugs, supplies, and equipment) must be used for a medical condition. There shall be sufficient evidence to draw conclusions about the intervention's effects on health outcomes. The evidence shall demonstrate that the intervention can be expected to produce its intended effects on health outcomes. The intervention's beneficial effects on health outcomes shall outweigh its expected harmful effects. The intervention shall be the most cost- effective method available to address the medical condition. Sufficient evidence is provided when evidence is sufficient to draw conclusions, if it is peer-reviewed, is well-controlled, directly or indirectly relates the intervention to health outcomes, and is reproducible both within and outside of research settings. “Medical pensioner” means a person receiving medical assistance under the medical payments for pensioner's program. “Medically frail” includes individuals: (1) With disabling mental disorders (including children with serious emotional disturbances and adults with serious mental illness); (2) With serious and complex medical conditions; (3) With a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living; or (4) With a disability determination based on criteria under the Social Security Act. “Medically institutionalized” means an individual who is an inpatient in a nursing facility, intermediate care facility for the developmentally or