Section 1200-13-16-.07 - DEVELOPMENT OF EVIDENCE-BASED MEDICAL NECESSITY GUIDELINES(1) In recognition of the ever-evolving nature of the study and practice of medicine, the growing body of evidence-based medical practice guidelines, the opportunity to achieve cost-containment objectives consistent with quality care, and the existence of practice variability among health care practitioners, the Bureau of TennCare may, on occasion, endorse or establish medical necessity guidelines that shall guide determinations of medical necessity for specific items or services across all managed care contractors and State agencies performing the function of managed care contractors.(2) Such guidelines shall be established with input from managed care contractors, practicing physicians and other health care providers, shall be evidence-based and shall take into consideration all criteria of the statutory definition of medical necessity.(3) The Bureau of TennCare will disseminate approved evidence-based medical necessity guidelines to its contractors and the provider community.(4) The Bureau of TennCare will implement a continuous medical review process to ensure that approved evidence-based medical necessity guidelines are responsive to advances in medical knowledge and technology.Tenn. Comp. R. & Regs. 1200-13-16-.07
Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007.Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.