(a) The following services shall not be covered:
- (1) Any service for which there is no medical necessity or for which the medical necessity has not been established;
- (2) Services which are not medical or dental in nature, except that transportation shall be covered in accordance with He-W 546.05(d);
- (3) Services that have not been proven to be safe or effective, as documented in medical peer review literature; and
- (4) Services which are more costly than other services which could be expected to provide the recipient with the same outcome.
- (b) Services listed in He-W 522 through He-W 589 as non-covered services shall not be covered unless the service is determined to be medically necessary for the recipient pursuant to He-W 546.06.
Source. (See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98 New. #6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35