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Course Description:

The Catalyst Center and the National Coordinating Center for the Regional Genetics Networks, two programs supported by the Health Resources and Services Administration, are pleased to announce a three-part webinar series to help the genetics community better understand how they can navigate medical necessity. This webinar series will provide information about medical necessity through the lens of genetic cases.

Target Audience:

Healthcare Providers, Public Health Professionals, Individuals/Families

Medical Necessity Webinar Series Part 1 - Define and Discuss the Use of Evidence to Form Medical Necessity Criteria and Policy

Date of Release: May 12, 2022

Expiration Date: May 31, 2024

Credits offered: CME

Estimate time of completion: 1 hour

Course must be completed by the expiration date

Learning Objectives:

At the conclusion of this session, participants should be able to:

• Define what is medical necessity.
• Describe how evidence is evaluated to determine whether a test or service is deemed medically necessary.
• Explain how the evaluation of benefits and costs to families and to payers are considered when determining medical necessity policy.

Medical Necessity Webinar Series Part 2 - Medicaid and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)- The Title V and Medicaid Relationship

Date of Release: May 25, 2022

Expiration Date: May 31, 2024

Credits offered: CME

Estimate time of completion: 1 hour 

Course must be completed by the expiration date

Learning Objectives:

At the conclusion of this session, participants should be able to:

• Explain how EPSDT sets a standard for care for children and youth and its relationship to medical necessity
• Compare the relationship of Title V and Medicaid for supporting coverage and access to services in states.
• Define the first steps in the process of getting prior authorization for medically necessary services

Medical Necessity Webinar Series Part 3- Practical Application of Medical Necessity: Understanding Prior Authorization Process, Requesting Authorizations, and Denials and Appeals

Date of Release: June 27, 2022

Expiration Date: May 31, 2024

Credits offered: CME

Estimate time of completion: 1 hour 

Course must be completed by the expiration date

The Catalyst Center (Grant U1TMC31757) is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $500,000, with no financing by nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

The National Coordinating Center for the Regional Genetics Networks is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Cooperative Agreement #UH9MC30770 from 6/2020-5/2024 for $800,000 per award year. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Contributors:  

Accredited Continuing Education Information:

Continuing Medical Education (CME AMA & CME Other)

Accreditation

The American College of Medical Genetics and Genomics is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

The American College of Medical Genetics and Genomics designates this enduring activity for a maximum of 3 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claiming your Educational Credits

This activity consists of: View content, take a post-test, the test may be taken as often as necessary to achieve a passing score of 80% or better is required to receive credit.  If you do not achieve a passing score, the program will identify which questions you answered incorrectly so that you can review the module and try again. Complete the evaluation form.

Accredited Continuing Education Financial Disclosure

The American College of Medical Genetics and Genomics (ACMG) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Accredited Continuing Education (ACE) for physicians. ACMG is an organization committed to improvement of patient care and general health by the incorporation of genetics and genomics into clinical practice.

ACMG has implemented the following procedures to ensure the independence of ACE activities from commercial influence/promotional bias, the Accreditation Council for Continuing Medical Education (ACCME) requires that providers (ACMG) must be able to demonstrate that: 1) everyone in a position to control the content of an ACE activity has disclosed all financial relationships that they have had in the past 24 months with ineligible* companies; 2) ACMG has implemented a mechanism to mitigate relevant financial relationships; and 3) all relevant financial relationships with ineligible companies are disclosed to the learners before the beginning of the educational activity. The learners must also be informed if no relevant financial relationships exist.
*Ineligible companies are defined as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

ACMG Education Policies

Please review the policies below regarding the ACMG Education program

• Financial Disclosures and Mitigation Procedure
• ACMG Content Validation Policy
• ACMG Content Branding Policy

All of the relevant financial relationships listed for these individuals have been mitigated.