California Welfare and Institutions Code

§ 14059.5

WIC § 14059.5 Effective Jul 27, 2021Div. 9 · Part 3 · Ch. 7 · Art. 2

Statute text

(a)For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.

(b)(1) For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.

(2)The department and its contractors shall update any model evidence of coverage documents, beneficiary handbooks, and related material to ensure the medical necessity standard for coverage for individuals under 21 years of age is accurately reflected in all materials.

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Legislative history

Amended by Stats. 2021, Ch. 143, Sec. 371. (AB 133) Effective July 27, 2021.