§346-67 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice.

372 words·~2 min read·/hi/chapter-346/346-67

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(a)Public assistance recipients in this State who receive medical assistance pursuant to this chapter shall be allowed coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism; provided that the medical food or low-protein modified food product is:

(1)Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and

(2)Consumed or administered enterally under the supervision of a physician or osteopathic physician licensed under chapter 453.

The department shall adopt rules pursuant to chapter 91 to effectuate this subsection.

(b)All health maintenance organizations and prepaid health plans with which the department executes risk contracts for the provision of medical care to eligible public assistance recipients shall provide notice to their members regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to members and shall be transmitted to members within calendar year 2000 when annual information is made available to members, or in any other mailing to members, but in no case later than December 31, 2000.

(c)For the purposes of this section:

"Inborn error of metabolism" means a disease caused by an inherited abnormality of the body chemistry of a person that is characterized by deficient metabolism, originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate, or fat.

"Low-protein modified food product" means a food product that:

(1)Is specially formulated to have less than one gram of protein per serving;

(2)Is prescribed or ordered by a physician or osteopathic physician as medically necessary for the dietary treatment of an inborn error of metabolism; and

(3)Does not include a food that is naturally low in protein.

"Medical food" means a food that is formulated to be consumed or administered enterally under the supervision of a physician or osteopathic physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation. [L 1999, c 86, §1; am L 2009, c 11, §45]