Medical necessity

Medical necessity

Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. Other countries may have medical doctrines or legal rules covering broadly similar grounds. The term clinical medical necessity is also used.


Implementations of the 'medical necessity' doctrine

USA (Medicare)

Medicare pays for medical items and services that are "reasonable and necessary" for a variety of purposes. By statute, Medicare may only pay for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member", unless there is another statutory authorization for payment.[1]

Medicare has a number of policies, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), formerly known as Local Medical Review Policies (LMRP), that describe coverage criteria.[2]

In a small number of cases, Medicare may determine if a method of treating a patient should be covered on a case-by-case basis. Even if a service is medically determined to be "reasonable and necessary," coverage may be limited if the service is provided more frequently than allowed under Medicare coverage policies.[3]

Specific instances

Medical use of marijuana

The use of cannabis (also known as marijuana) for medical purposes is a notable 'medical necessity' case. Cannabis is a plant whose active ingredients are widely reported by sufferers to be effective in pain control for various conditions, usually neuropathic in nature, where common painkillers have not had great benefit; however as a Schedule I drug under the Controlled Substance Act, it is illegal and is targeted by government, police, and anti-drug campaigners: in some states, possession is decriminalized for even non-medical purposes, wherein other states possession is a felony offense. In this case the doctrine of medical necessity would be used by a patient who believed marijuana was beneficial to them if charged with use or growing/production of illegal controlled substance relating to marijuana.

In several medical marijuana cases, the patients' physician has been willing to state to the court that the patient's condition requires this medicine and thus that the Court should not interfere. However, the Supreme Court of United States has outrightly rejected this defense in the landmark case United States v. Oakland Cannabis Buyers' Cooperative, in which the Court ruled that there was no medical necessity exception to drug laws, and federal government is free to raid, arrest, prosecute, and imprison patients who are using medical marijuana no matter if the medicine is crucially necessary to them. On the other hand, in Gonzales v. Raich, the Ninth Circuit Court of Appeals told a sufferer in extreme pain that they could not rely on state law allowing medical use, but if arrested they could seek to use medical necessity as a defence.

In the state of Maryland, a bill signed by former governor Robert Ehrlich became law in 2003 permitting patients to use medical necessity defense to marijuana possession in the state. The maximum penalty for these users cannot exceed $100. However, this law does not prevent federal prosecution of patients, as the federal law does not recognize medical necessity. [3]

See also


  1. ^ See 42 U.S.C. § 1395y(a)(1)(A)
  2. ^ See
  3. ^ For more information, see Certificate of medical necessity, [1], or [2].

External links

Wikimedia Foundation. 2010.

Игры ⚽ Поможем сделать НИР

Look at other dictionaries:

  • Certificate of medical necessity — Generally, a Certificate of Medical Necessity is a piece of paper required by Centers for Medicare and Medicaid Services to substantiate the medical necessity of an item of durable medical equipment furnished to a Medicare beneficiary. It is… …   Wikipedia

  • Medical billing (United States) — Medical billing Coding is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they… …   Wikipedia

  • Necessity in English law — For the discussion on general principles and policy, see necessity In English law, the defence of necessity recognises that there may be situations of such overwhelming urgency that a person must be allowed to respond by breaking the law. There… …   Wikipedia

  • Medical cannabis in the United States — Main articles: Cannabis in the United States and Medical cannabis United States cannabis laws.   States with medical …   Wikipedia

  • Medical underwriting — is an insurance term referring to the use of medical or health status information in the evaluation of an applicant for coverage (typically for life or health insurance). As part of the underwriting process, health information may be used in… …   Wikipedia

  • Medical Banking — involves the use banking systems to improve healthcare industry. It is the involvement of banks into the Healthcare value chain to reduce costs,increase access and simplify delivery of healthcare.Medical banking integrates various stakeholders… …   Wikipedia

  • Medical Arts Building (Knoxville, Tennessee) — Medical Arts Building U.S. National Register of Historic Places …   Wikipedia

  • medical examiner — med·i·cal examiner n: a public officer who determines the necessity of and conducts autopsies to find the cause of death Merriam Webster’s Dictionary of Law. Merriam Webster. 1996. medical examiner …   Law dictionary

  • Necessity — This article is about the definition of necessity according to domestic law. For the concept of necessity in international law, see Military necessity. For logical meanings, see Necessary (disambiguation) and Modal logic …   Wikipedia

  • Necessity (tort) — Tort law Part of the …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”