What is required to meet the condition of “medical necessity” for inpatient mental health treatment?
• The state of Washington defines medical necessity for inpatient care as “a requested service which is reasonably calculated to diagnose, correct, cure or alleviate a mental disorder or prevent the worsening of a mental condition that endanger life or cause suffering and pain or result in illness or infirmity or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction and there is no adequate less restrictive alternative available.” RCW 71.34.020 (12) • For publicly funded admissions, the RSN or the DMHP determines medical necessity for acute psychiatric care. • The CLIP Administration makes determination of medical necessity for voluntary long-term inpatient care regardless of whether the child has public or private insurance. • For both levels of care, adolescents committed for 180 days of involuntary inpatient treatment have been determined to meet medical necessity through the detention and commitment process as defined in RCW 71.34.750 • Federal requi
