[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR440.230]



[Page 249]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 440_SERVICES: GENERAL PROVISIONS--Table of Contents

 

      Subpart B_Requirements and Limits Applicable to All Services

 

Sec. 440.230  Sufficiency of amount, duration, and scope.



    (a) The plan must specify the amount, duration, and scope of each 

service that it provides for--

    (1) The categorically needy; and

    (2) Each covered group of medically needy.

    (b) Each service must be sufficient in amount, duration, and scope 

to reasonably achieve its purpose.

    (c) The Medicaid agency may not arbitrarily deny or reduce the 

amount, duration, or scope of a required service under Sec. Sec. 

440.210 and 440.220 to an otherwise eligible recipient solely because of 

the diagnosis, type of illness, or condition.

    (d) The agency may place appropriate limits on a service based on 

such criteria as medical necessity or on utilization control procedures.



[46 FR 47993, Sept. 30, 1981]