Medical necessity is the prerequisite for participation in the Medicaid (Title XIX) Long-term Care program. This section contains the general qualifications for a medical necessity determination. To verify that medical necessity exists, an individual must meet the conditions described in paragraphs (1) and (2) of this section.(1) The individual must demonstrate a medical condition that:(A) is of sufficient seriousness that the individual's needs exceed the routine care which may be given by an untrained person; and(B) requires licensed nurses' supervision, assessment, planning, and intervention that are available only in an institution.(2) The individual must require medical or nursing services that:(A) are ordered by a physician;(B) are dependent upon the individual's documented medical conditions;(C) require the skills of a registered or licensed vocational nurse;(D) are provided either directly by or under the supervision of a licensed nurse in an institutional setting; and(E) are required on a regular basis.