MEDICAL NECESSITY
Care centered around you.
At LifeWays, we want to make sure every person receives the care that best fits their needs. One way we do that is by using medical necessity.
Medical necessity is a process that helps determine which services are the right fit for a person's mental health or substance use needs. It helps ensure people receive the right care, at the right time.
What does “medical necessity” mean?
Medical necessity means a service is considered appropriate because it is needed to evaluate, diagnose, treat, or improve a person's mental health or substance use condition.
Authorization decisions are based on established clinical criteria, including guidance from the Michigan Medicaid Provider Manual and other applicable requirements. Each request is evaluated using the individual's unique clinical information, including mental health symptoms, diagnoses, and any co-occurring conditions.
How decisions are made.
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Every person is different. When reviewing a request for services, we may look at things like:
Current symptoms
Mental health or substance use diagnosis
Safety concerns
Previous treatment and progress
Recommendations from providers
The type and amount of care needed
Our goal is to make sure each person receives the level of care that best meets their needs.
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Medical necessity decisions are not based on:
Income
Insurance coverage or who pays for services
Personal factors that are unrelated to clinical need
Our decisions are based on clinical information—not a person's financial situation.
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Sometimes a requested service may not meet medical necessity guidelines or may not be the best option for a person's current needs.
If that happens, the individual and their provider will receive a written explanation of the decision, along with information about how to appeal.
Whenever possible, we will also work with the person and their provider to identify other services that may better meet their needs.
Your privacy matters.
Any information shared during the review process is protected by federal privacy laws (HIPAA). Only authorized staff involved in the review have access to this information.
Our commitment.
Every person deserves care that is based on their unique needs. At LifeWays, we use medical necessity to help make fair, consistent, and clinically appropriate decisions so people can receive the care that is right for them.