28-13-27.1. 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.
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