Medicare's enduring struggle to define "reasonable and necessary" care

N Engl J Med. 2012 Nov 8;367(19):1775-7. doi: 10.1056/NEJMp1208386. Epub 2012 Oct 31.

Abstract

Medicare legislation mandates that the program not pay for items and services that are not "reasonable and necessary" - terms that are open to interpretation and easily politicized. In today's fiscal environment, "reasonable and necessary" warrants a closer look.

MeSH terms

  • Centers for Medicare and Medicaid Services, U.S.
  • Cost-Benefit Analysis
  • Eligibility Determination*
  • Evidence-Based Medicine
  • Government Regulation*
  • Health Care Rationing
  • Health Policy
  • Humans
  • Insurance Benefits / legislation & jurisprudence
  • Medicare* / legislation & jurisprudence
  • United States