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



 



Note



 



  The 2009 amendment is retroactive to April 3, 2008.  L 2009,
c 11, §76(2).