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

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

(b)  Every mutual benefit society shall providenotice to its members regarding the coverage required by this section.  Thenotice shall be in writing and prominently placed in any literature orcorrespondence sent to members and shall be transmitted to members duringcalendar 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 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 one gramof protein per serving;

(2)  Is prescribed or ordered by a physician orosteopathic physician as medically necessary for the dietary treatment of aninherited metabolic disease; 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, §3; am L 2009, c 11, §53]

 

Note

 

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