the Health Risk Management Division of MMSA is the Medical
Advisory Committee (MAC) whose principle function is to consider all
requests for ex-gratia funds, high-cost excluded medicaton, new technology,
plastic surgery and any other request for treatment not covered under
normal routine benefits.
of MAC investigate all requests and motivations in depth looking at
past claims history and the clinical appropriatemess of the request.
This is then reported to the Committee twice a week for a decision and
recommendation. Each case is considered individually on its merits.
Factors taken into account when making decisions are whether the request
is clinically appropriate and one of genuine medical need. Other factors
are considered such as the member's policy choice where limits may apply,
whether the medication or treatment is excluded and length of membership.
must be motivated in writing with as much clinical detail as possible
in order for the Committee to evaluate the request.