§346-67  Medical foods and low-proteinmodified food products; treatment of inborn error of metabolism; notice.  (a) Public assistance recipients in this State who receive medical assistancepursuant to this chapter shall be allowed coverage for medical foods andlow-protein modified food products for the treatment of an inborn error ofmetabolism; provided that the medical food or low-protein modified food productis:

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

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

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

(b)  All health maintenance organizations andprepaid health plans with which the department executes risk contracts for theprovision of medical care to eligible public assistance recipients shallprovide notice to their members regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature orcorrespondence sent to members and shall be transmitted to members withincalendar year 2000 when annual information is made available to members, or inany 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 diseasecaused by an inherited abnormality of the body chemistry of a person that ischaracterized by deficient metabolism, originating from congenital defects ordefects arising shortly after birth, of amino acid, organic acid, carbohydrate,or fat.

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

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

(2)  Isprescribed or ordered by a physician or osteopathic physician as medicallynecessary for the dietary treatment of an inborn error of metabolism; and

(3)  Doesnot include a food that is naturally low in protein.

"Medical food" means a food that isformulated to be consumed or administered enterally under the supervision of aphysician or osteopathic physician and is intended for the specific dietarymanagement of a disease or condition for which distinctive nutritionalrequirements, based on recognized scientific principles, are established bymedical evaluation.(c)  For the purposes of this section:

"Inborn error of metabolism" means adisease caused by an inherited abnormality of the body chemistry of a personthat is characterized by deficient metabolism, originating from congenitaldefects 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 onegram of protein per serving;

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

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

"Medical food" means a food that isformulated to be consumed or administered enterally under the supervision of aphysician or osteopathic physician and is intended for the specific dietarymanagement of a disease or condition for which distinctive nutritionalrequirements, based on recognized scientific principles, are established bymedical 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).