471 NAC 20-017. MEDICAL NECESSITY

017. MEDICAL NECESSITY. 017.01 NECESSARY TREATMENT INTERVENTIONS AND SUPPLIES. Biopsychosocially necessary treatment interventions and supplies are those which are: (A)Consistent with the behavioral health condition and conducted with the treatment of the beneficiary as the primary concern; (B)Supported by sufficient evidence to draw conclusions about the treatment intervention's effects of behavioral health outcomes; (C)Supported by evidence demonstrating the treatment intervention can be expected to produce its intended effects on behavioral health outcomes; (D)Supported by evidence demonstrating the intervention's intended beneficial effects on behavioral health outcomes outweigh its expected harmful effects; (E)Cost effective in addressing the behavioral health outcome; (F)Determined by the presentation of behavioral health conditions, not necessarily by the credentials of the service provider; (G)Not primarily for the convenience of the beneficiary or the provider; and (H)Delivered in the least restrictive setting that will produce the desired results in accordance with the needs of the beneficiary. 017.02 BEHAVIORAL HEALTH CONDITIONS. Behavioral health conditions are the diagnoses identified in diagnostic manuals commonly recognized in this field.