405 IAC 5-24-9 - Food supplements, nutritional supplements, and infant formulas
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 9.
(a) Food
supplements, nutritional supplements, and infant formulas are covered only when
no other means of nutrition is feasible or reasonable. Prior authorization for
these items is required. Approval is subject to the following criteria:
(1) The feasibility or reasonableness of
other means of nutrition, as documented by the requesting practitioner, and as
determined by the office's contractor on a case-by-case basis.
(2) Authorization will not be granted when
convenience of the member or the member's caretaker is the primary reason for
the request for the service.
(3)
Coverage is not available in cases of routine or ordinary nutritional
needs.
(4) Coverage is not
available in cases in which the item is to be used for other than nutritional
purposes.
(5) In a long term care
facility setting, costs for these products, when utilized either for
nutritional supplementation or as the sole source of nutrition for the
resident, are included in the facility's established per diem rate. When these
products are furnished to a long term care facility resident, they are not
separately reimbursable by Medicaid and are not to be billed separately to
Medicaid by either the long term care facility or another provider furnishing
the products.
(b)
Hyperalimentation and total parenteral nutritional products do not require
prior authorization. These products may be separately billed to Medicaid for
residents of long term care facilities.
Notes
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