TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER C - MEDICAL ASSISTANCE PROGRAMS

PART 440 - SERVICES: GENERAL PROVISIONS

subpart b - REQUIREMENTS AND LIMITS APPLICABLE TO ALL SERVICES

440.230 - Sufficiency of amount, duration, and scope.

  (a) The plan must specify the amount, duration, and scope of each service that it provides for (1) The categorically needy; and (2) Each covered group of medically needy.

  (b) Each service must be sufficient in amount, duration, and scope to reasonably achieve its purpose.

  (c) The Medicaid agency may not arbitrarily deny or reduce the amount, duration, or scope of a required service under 440.210 and 440.220 to an otherwise eligible recipient solely because of the diagnosis, type of illness, or condition.

  (d) The agency may place appropriate limits on a service based on such criteria as medical necessity or on utilization control procedures.

[46 FR 47993, Sept. 30, 1981]