B-9200, Medical Necessity/Level of Care Determination at Redetermination

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.