Tenn. Comp. R. & Regs. 1200-13-16-.02
The medical necessity standard set forth at Tennessee Code Annotated Section 71-5-144 and in these rules shall govern the delivery of all medical items and services to all enrollees or classes of beneficiaries in the TennCare program. The definition of medical necessity will be implemented consistent with federal law, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, and within the state's authority to define what constitutes a medically necessary Medicaid service. The state recognizes that current EPSDT requirements include coverage of "necessary health care, diagnostic services, treatment and other measures to correct or ameliorate defects and physical and mental illness and conditions discovered by screening services, whether or not such services are covered under the state plan".
Tenn. Comp. R. & Regs. 1200-13-16-.02
Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.