Medically Necessary (or Medical Necessities) per the Act are:

• Reasonably necessary to prevent illness or medical conditions, or provide early screening, interventions, and/or treatments for conditions that cause suffering or pain, cause physical deformity or limitations in function, threaten to cause or worsen a handicap, cause illness or infirmity of a recipient, or endanger life;

• Provided at appropriate locations and at the appropriate levels of care for the treatment of clients’ conditions;

• Consistent with health-care practice guidelines and standards that are issued by professionally-recognized health-care organizations or governmental agencies;

• Consistent with the diagnoses of the conditions; and

• No more intrusive or restrictive than necessary to provide a proper balance of safety, effectiveness, and efficiency.

Source: www.hhsc.state.tx.us

Post Footer automatically generated by Add Post Footer Plugin for wordpress.

In insurance and Medicaid/Medicare lingo, ADL is often used as an acronym for Activities of Daily Living. Activities of Daily Living are considered essential to daily personal duties of self maintenance. These duties including personal hygiene, getting dressed, using the restroom, and eating. Normally, these activities are placed on a checkbox style grid, and an applicable insurance policy will pay on an amount based upon the number of ADLs that a subscriber can or cannot perform on a daily basis.

Post Footer automatically generated by Add Post Footer Plugin for wordpress.

Both are federal programs that help pay for medical needs.

However, Medicare, which is applied for at the Social Security Office, is for: People 65 and over, people of any age who have kidney failure or long term kidney disease and/or people who are permanently disabled and cannot work. There is no income requirements for Medicare.

Medicaid is for low income individuals including: pregnant women, children under the age of 19, people 65 and over, the blind, disabled and/or who need nursing home care. There are strict financial and income guidelines that have to be adhered to in order to qualify for Medicaid assistance.

Post Footer automatically generated by Add Post Footer Plugin for wordpress.