Medically necessary hospital services

Medically necessary hospital services are services provided in a hospital which meet the following criteria: (1) Are consistent with the person's symptoms, diagnosis, condition, or injury; (2) Are recognized as the prevailing standard and are consistent with generally accepted professional medical standards of the provider's peer group; (3) Are provided in response to a life - threatening condition; to treat pain, injury, illness, or infection; to treat a condition which would result in physical or mental disability; or to achieve a level of physical or mental function consistent with prevailing standards for the diagnosis or condition; (4) Are not furnished primarily for the convenience of the person or the provider; and (5) There is no other equally effective course of treatment available or suitable for the person needing the services which is more conservative or substantially less costly. A county shall rely on the attending physician's determination as to medical necessity of hospital services unless evidence exists to the contrary. Source: SL 1997, ch 170 , § 5.