TABLE 2

Replication of the Federal Pediatric Medical Necessity Standard in Reviewed State Documents

State (n = 33)State LawMCO ContractFirst MCO Provider ManualSecond MCO Provider Manual
ArizonaYesYesNo
CaliforniaYesNoYesNo
ColoradoYesYesNoNo
DelawareYesYesYes
FloridaYesNo
GeorgiaYesYesNoNo
HawaiiYesYesYes
IllinoisYesYesYesNo
IndianaYesYesNo
KansasYesYes
KentuckyYesNoNo
MarylandYesYesYes
MassachusettsYesYesNo
MichiganYesYesNoNo
MinnesotaYesYesNoNo
MissouriYesNo
NebraskaYesYesYes
NevadaYesYes
New JerseyYesYesYesYes
New MexicoYesYesNoNo
New YorkYesYesYesYes
OhioYesYesNo
OregonYesYesNo
PennsylvaniaYesYesYesYes
Rhode IslandYesYesYes
South CarolinaYesNoYesNo
TennesseeYesNoYesYes
TexasYesNoYesNo
UtahYesYesNo
VirginiaYesNo
WashingtonYesYesYesNo
West VirginiaYesYes
WisconsinYesYesNo
Total (%)33/33 (100%)13/18 (72%)22/28 (79%)8/28 (29%)
30/56 (54%)
  • —, not able to locate and download document from state or Medicaid MCO Web site or not able to access document because of requirements for providers to have an ID and a password.