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| Medical
Necessity under EPSDT |
In
a report prepared for the federal Health Care Financing
Administration (HCFA, now known as Center for Medicare
and Medicaid Services – CMS), Rosenbaum and
Sonosky described the EPSDT medical necessity standard
as follows:
"While
there is no federal definition of preventive medical
necessity, federal amount, duration and scope rules
require that coverage limits must be sufficient to
ensure that the purpose of a benefit can be reasonably
achieved.... Since the purpose of EPSDT is to prevent
the onset of worsening of disability and illness and
children, the standard of coverage is necessarily
broad... the standard of medical necessity used by
a state must be one that ensures a sufficient level
of coverage to not merely treat an already-existing
illness or injury but also, to prevent the development
or worsening of conditions, illnesses, and disabilities."
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