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Minnesota Administrative Rules

9505.0325 NUTRITIONAL PRODUCTS.

Subpart 1.

Definition.

"Nutritional product" means a commercially formulated substance that provides nourishment and affects the nutritive and metabolic processes of the body.

Subp. 2.

Eligible provider.

To be eligible for medical assistance payment, a parenteral nutritional product must be prescribed by a physician and must be dispensed as a pharmacy service under part 9505.0340. To be eligible for medical assistance payment, an enteral nutritional product must be prescribed by a physician and supplied by a pharmacy or a medical supplier who has signed a medical supplies agreement with the department.

Subp. 3.

Payment limitation; enteral nutritional products.

Except as provided in subparts 4 and 5, an enteral nutritional product must receive prior authorization to be eligible for medical assistance payment.

Subp. 4.

Covered services; enteral nutritional products for designated health condition.

An enteral nutritional product is a covered service and does not require prior authorization if it is necessary to treat a condition listed in items A to D:

A.

phenylketonuria;

B.

hyperlysinemia;

C.

maple syrup urine disease; or

D.

a combined allergy to human milk, cow milk, and soy formula.

Subp. 5.

Covered services; enteral nutritional product for recipient discharged from a hospital.

An enteral nutritional product provided for a recipient being discharged from a hospital to a residence other than a long-term care facility does not require prior authorization of an initial supply adequate for 30 days or less.

Subp. 6.

Payment limitations; long-term care facilities and hospitals.

An enteral nutritional product for a recipient in a long-term care facility or hospital is not eligible for payment on a separate claim for payment. Payment must be made according to parts 9500.1090 to 9500.1140, 9549.0010 to 9549.0080, and 9553.0010 to 9553.0080.

Subp. 7.

Payment limitation; parenteral nutritional products.

Parenteral nutritional products are subject to the payment limitations applicable to pharmacy services as provided in part 9505.0340.

Statutory Authority:

MS s 256B.04

History:

12 SR 624

Published Electronically:

December 2, 2013

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