What is Reasonable and Necessary care?

In an article written by Peter J. Neumann, Sc.D., and James D. Chambers, Ph.D. titled Medicare's Enduring Struggle to Define "Reasonble and Necessary" Care both Drs. Neumann and Chambers say that, Medicare has always covered medical services that are “reasonable and necessary.” As new approaches, drugs and medical technologies have been released, you would think coverage would be based on an objective analysis of outcomes and cost effectiveness. Thats not exactly the case.

Not that Centers for Medicare and Medicaid Services or CMS haven’t tried to be reasonable about “reasonable and necessary.” According to the article, in 1989 CMS specifically proposed that the words “cost effective” could be used to assess new technology. That proved to be too controversial. It later tried “least costly alternative language” for coverage of durable medical equipment and Part B medications.  This too was dismantled by the courts when plaintiffs argued that the term “reasonable and necessary” could only be applied to medical services, not to the costs of those services.

So what does fall under "reasonable and necessary health care? Reasonable and necessary health care costs of each supported child not covered by insurance, including medical, pharmaceutical, vision, dental, orthodontic and mental health costs, shall be shared equally by the parents (unless a different allocation is set forth below), and each parent shall reimburse the other for his or her share of such expenses paid by the other.