"Medical necessity" determinations--a continuing healthcare policy problem.

Abstract

To promote an understanding of the implications of current structures and processes for medical necessity determinations that affect everyone, directly or indirectly, the American Health Lawyers Association will devote its biannual Public Interest Colloquium (to be held in February 2005) to the topic. In preparation for the colloquium, the author summarizes the history and current importance of the topic, identifies stakeholders in the system and their interests, and sets forth a preliminary list of issues to be considered by the colloquium participants, focusing on potential elements of an ideal system for making medical necessity determinations.