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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 151 Chapter 24 Long Term Care

24.48 ESTABLISHING MEDICAL NECESSITY Medical necessity is determined by the Bureau for Medical Services (BMS) Utilization Management Contract (UMC) agency. When the UMC sends the white DHS-2.FRM, along with the Notice of Decision letter, medical necessity is presumed to be determined. The Worker has responsibility in this process to obtain the letter from the UMC as verification of medical eligibility at application and redetermination. The BMS, UMC, or case manager notifies the Worker when a client no longer has a medical necessity for Traumatic Brain Injury (TBI) waiver services.

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Page 2076

Official source

West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 151 Chapter 24 Long Term Care

24.48 ESTABLISHING MEDICAL NECESSITY Medical necessity is determined by the Bureau for Medical Services (BMS) Utilization Management Contract (UMC) agency. When the UMC sends the white DHS-2.FRM, along with the Notice of Decision letter, medical necessity is presumed to be determined. The Worker has responsibility in this process to obtain the letter from the UMC as verification of medical eligibility at application and redetermination. The BMS, UMC, or case manager notifies the Worker when a client no longer has a medical necessity for Traumatic Brain Injury (TBI) waiver services.