Clinical Requirements: Introduction

Any deviation from the following clinical requirements must be justified through the submission of clear and objective data supporting therapeutic intervention. This data must originate from recognized medical journals and demonstrate statistically significant and generally accepted results. Documentation of medical necessity must be submitted with the prior- authorization request (see 130 CMR 427.409). For services that do not require prior authorization, this documentation must be kept in the recipient record for review pursuant to 130 CMR 450.205. In addition, all services must meet Division regulations regarding cost and alternative available treatment at 130 CMR 427.407 through 427.411 and 427.420 through 427.422.