Change the Definition of Medical Necessity
Dohn Hoyle, Partners in Policymaking Faculty Member, Activist and Organizer
27. Change the Definition of Medical Necessity
We ran into people, so the next problem that was brought to me was, brought to us, was people saying, yeah, you know, you got this stuff in there about people building plans for what they want to do and being included in their, et cetera. But, these people are saying it's not medically necessary. Administrative law judges even are saying it's not medically necessary that you take this person to the library or that they get the chance to go to this community center. Nobody, or to a movie, whatever it is. Nobody's saying that, it's not medically necessary.
So we said, okay, how do we solve that problem? So it turns out, that medical necessity is something your state tells the feds is what your medical necessity criteria are. And they're typically preventing the spread of, or preventing the, getting worse, or to maintain current funding, this, that and the other. So we said, okay, we'll write this. So, we put it, what we wrote was, whatever is necessary to attain or maintain community inclusion, productivity.