"Medical necessity" determinations--a continuing healthcare policy problem.
To promote an understanding of the implications of current structures and processes for medical necessity determinations that affect everyone, directly or indirectly, the American Health Lawyers Association will devote its biannual Public Interest Colloquium (to be held in February 2005) to the topic. In preparation for the colloquium, the author summarizes the history and current importance of the topic, identifies stakeholders in the system and their interests, and sets forth a preliminary list of issues to be considered by the colloquium participants, focusing on potential elements of an ideal system for making medical necessity determinations.
Blanchard
Timothy P
TP
McDermott Will & Emery LLP, Los Angeles, CA, USA.
D003954:Diagnostic Services / Q000191:economics; D033161:Government Regulation; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000331:legislation & jurisprudence; D008329:Managed Care Programs / Q000331:legislation & jurisprudence; D008484:Medicaid / Q000331:legislation & jurisprudence; D006278:Medicare / Q000331:legislation & jurisprudence; D020380:Needs Assessment / Q000331:legislation & jurisprudence*; D011315:Preventive Medicine / Q000191:economics; D013812:Therapeutics / Q000191:economics; D014481:United States