C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-13, subsec. 144-101-II-13.04
Each eligible member may receive covered services that are medically necessary within the limitations of this section. The Department reserves the right to request additional information to evaluate medical necessity and review utilization of services. The Department will require prior authorization (PA) for some targeted case management services reimbursed under this section (refer to 13.07-2). The Department may require utilization review for all services reimbursed under this section. Providers must work with the Department or its Authorized Agent to provide this information.
Members may receive case management services for as long as they meet the general criteria for eligibility described above and the specific criteria in the appropriate sections, below.
Case management services will discontinue if:
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-13, subsec. 144-101-II-13.04