Sec. 1.8. As used in this chapter, "clinical criteria" means: (1) written policies; (2) written screen procedures; (3) drug formularies or lists of covered drugs; (4) determination rules; (5) determination abstracts; (6) clinical protocols; (7) practice guidelines; (8) medical protocols; and (9) any other criteria or rationale; used by the utilization review entity to determine the medical necessity of a health care service.
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