Minnesota Administrative Rules
Agency 196 - Human Services Department
Chapter 9505 - HEALTH CARE PROGRAMS
MEDICAL ASSISTANCE PAYMENTS
Part 9505.0325 - NUTRITIONAL PRODUCTS
Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1. Definition.
"Nutritional product" means a commercially formulated substance that provides nourishment and affects the nutritive and metabolic processes of the body.
Subp. 2. Eligible provider.
To be eligible for medical assistance payment, a parenteral nutritional product must be prescribed by a physician and must be dispensed as a pharmacy service under part 9505.0340. To be eligible for medical assistance payment, an enteral nutritional product must be prescribed by a physician and supplied by a pharmacy or a medical supplier who has signed a medical supplies agreement with the department.
Subp. 3. Payment limitation; enteral nutritional products.
Except as provided in subparts 4 and 5, an enteral nutritional product must receive prior authorization to be eligible for medical assistance payment.
Subp. 4. Covered services; enteral nutritional products for designated health condition.
An enteral nutritional product is a covered service and does not require prior authorization if it is necessary to treat a condition listed in items A to D:
Subp. 5. Covered services; enteral nutritional product for recipient discharged from a hospital.
An enteral nutritional product provided for a recipient being discharged from a hospital to a residence other than a long-term care facility does not require prior authorization of an initial supply adequate for 30 days or less.
Subp. 6. Payment limitations; long-term care facilities and hospitals.
An enteral nutritional product for a recipient in a long-term care facility or hospital is not eligible for payment on a separate claim for payment. Payment must be made according to parts 9500.1090 to 9500.1140, 9549.0010 to 9549.0080, and 9553.0010 to 9553.0080.
Subp. 7. Payment limitation; parenteral nutritional products.
Parenteral nutritional products are subject to the payment limitations applicable to pharmacy services as provided in part 9505.0340.
Statutory Authority: MS s 256B.04
