§432:1-609  Medical foods and low-protein
modified food products; treatment of inborn error of metabolism; notice. 
(a)  All individual and group hospital and medical service plan contracts and
medical service corporation contracts under this chapter shall provide coverage
for medical foods and low-protein modified food products for the treatment of
an inborn error of metabolism for its members or dependents of the member in
this State; 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.



Coverage shall be for at least eighty per cent of
the cost of the medical food or low-protein modified food product prescribed
and administered pursuant to this subsection.



(b)  Every mutual benefit society shall provide
notice to its 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 during
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
inherited metabolic disease; 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, §3; am L 2009, c 11, §53]



 



Note



 



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