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'''Medical necessity''' (or '''clinical medical necessity''') is largely a U.S.-based term and legal framework that broadly refers to "reasonable and necessary" or "appropriate" medical services based on evidence-based clinical standards of care.<ref name="MillerMN">{{cite web |url=http://www.physiciansnews.com/law/802.miller.html |archiveurl=https://web.archive.org/web/20120413123747/http://www.physiciansnews.com/law/802.miller.html |title=What is medical necessity? |work=Physician's News Digest |author=Miller, Nancy W |date=August 2002 |archivedate=13 April 2012 |accessdate=09 August 2014}}</ref>

Other countries may have medical doctrines or legal rules covering similar grounds. For example, Canada's Canada Health Act places restrictions and penalties on "extra-billing" of services and tries to ensure "services are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness or disability."<ref name="CHA">{{cite web |url=http://laws-lois.justice.gc.ca/eng/acts/c-6/fulltext.html |title=Canada Health Act: R.S.C., 1985, c. C-6 |work=Justice Laws Website |publisher=Government of Canada |date=1985 |accessdate=09 August 2014}}</ref>

==Medical necessity in the U.S.==

===Medicare===

Medicare may by law 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 another legal authorization for payment exists.<ref name="SSExc">{{cite web |url=http://www.ssa.gov/OP_Home/ssact/title18/1862.htm |title=Exclusions from Coverage and Medicare as Secondary Payer |work=Compilation of the Social Security Laws |publisher=Social Security Administration |accessdate=09 August 2014}}</ref> Coverage criteria is determined by several policies, including National and Local Coverage Determinations. Some exceptions may be made on a case-by-case basis. However, 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.<ref name="MedCovGuide">{{cite web |url=https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_Part3.pdf |format=PDF |title=Chapter 1, Part 3 (Sections 170 – 190.34) Coverage Determinations |work=Medicare National Coverage Determinations Manual |publisher=Centers for Medicare and Medicaid Services |date=23 February 2011 |accessdate=09 August 2014}}</ref>

===Medical cannabis===

As a Schedule I drug under the Controlled Substance Act, possession of cannabis is illegal as considered by the Federal government, though some states have decriminalized it. However, some chronically ill people who have used cannabis have reported benefits to their medical health, especially as a neuropathic for pain control. As such, the doctrine of medical necessity has been used by patients charged with the possession or growth of cannabis. However, cases such as ''United States v. Oakland Cannabis Buyers' Cooperative'' have led to a refusal to recognize a medical necessity exemption for cannabis regardless of any state law suggesting otherwise<ref name="USOCBC">{{cite web |url=http://www.law.cornell.edu/supct/html/00-151.ZS.html |title=United States v. Oakland Cannabis Buyers' Cooperative (00-151) 532 U.S. 483 (2001) 190 F.3d 1109, reversed and remanded |work=Legal Information Institute |publisher=Cornell University Law School |accessdate=09 August 2014}}</ref>; other cases like ''Gonzales v. Raich'' have led to decisions recognizing the use of a medical necessity defense on an individual basis.<ref name="GonRaich">{{cite web |url=http://www.law.cornell.edu/supremecourt/text/03-1454 |title=Gonzales v. Raich (No. 03-1454) 352 F. 3d 1222, vacated and remanded |work=Legal Information Institute |publisher=Cornell University Law School |accessdate=09 August 2014}}</ref> Some states like Maryland have gone on to pass medical cannabis laws to prevent State-level criminal prosecution and imprisonment of medical cannabis users.<ref name="HB811Maryland">{{cite web |url=http://mgaleg.maryland.gov/webmga/frmMain.aspx?pid=billpage&stab=01&id=hb0881&tab=subject3&ys=2014RS |title=Medical Marijuana - Natalie M. LaPrade Medical Marijuana Commission |publisher=General Assembly of Maryland |date=14 May 2014 |accessdate=09 August 2014}}</ref>

==Further reading==

* {{cite journal |url=https://www.academia.edu/3522907/Defining_Medical_Necessity_under_the_Patient_Protection_and_Affordable_Care_Act |journal=Public Administration Review |title=Defining Medical Necessity under the Patient Protection and Affordable Care Act |author=Skinner, Daniel R |volume=73 |issue=s1 |pages=s49–s59 |date=September/October 2013 |doi=10.1111/puar.12068}}

==Notes==

A few elements of this article are reused from [http://en.wikipedia.org/wiki/Medical_necessity the Wikipedia article].

==References==
<references />


[[Category:Regulatory terms]]

Medical necessity - Revision history

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