Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-26 - DMEPOS: nutrition products
Universal Citation: OH Admin Code 5160-10-26
Current through all regulations passed and filed through September 16, 2024
(A) Coverage.
(1) Enteral and parenteral nutrition.
(a) The default certificate of medical
necessity (CMN) form is the ODM 01907, "Certificate of Medical Necessity:
Enteral and Parenteral Nutrition" (rev.
7/2024). The
CMN
includes the following information:
(i) Attestation to one of the following
statements:
(a) The individual is able to
ingest food but cannot derive sufficient energy and nutrients from ordinary
food, even if the food is prepared in a liquefied, puréed, or blended
form;
(b) The individual is unable
to ingest food safely but can digest it; or
(c) The individual is unable to digest food
in the alimentary canal and must obtain nutrition parenterally.
(ii) For an individual who has
difficulty in maintaining weight, a current weight history; and
(iii) For an individual who
needs a daily intake of more than two thousand
calories, an explanation of the need.
(b) A new prescription is
needed for a change in the type or increase in the
quantity of an item.
(c)
Substitutions are permitted, so long as the substituted product is correctly
formulated to meet the needs of the individual and the prescriber is notified
before the supplier dispenses the product.
(d) Payment will not be made for quantities
that exceed one month's supply.
(e)
Suppliers
may dispense
items
up
to one week before the scheduled dispensing date.
(f) Payment includes dispensing and either
shipping or delivery.
(2)
Provision of donor human milk.
(a) Payment
can be made only to a medicaid-enrolled provider that is a member in good
standing of the human milk banking association of North America.
(b) The provider
keeps on
file the following documents:
(i) An
explanation by a prescriber of the medical necessity of human milk for the
recipient;
(ii) An attestation that
the prescriber has given the recipient's parent or guardian information about
human milk (e.g., nutrients, growth factors, shelf life, the effects of
pasteurization, the possibility of disease transmission) and the donation
process (e.g., donor screening, pasteurization, storage, transport), which may
be in the form of educational material obtained from the provider;
and
(iii) A consent form, signed
and dated by the recipient's parent or guardian, indicating that the parent or
guardian has been made aware of the benefits and risks of using banked donor
human milk.
(c)
Payment to a provider for supplying donor human
milk in a hospital setting is made in accordance with
Chapter 5160-2 of the Administrative Code.
(d)
For donor human
milk supplied in a non-hospital setting, payment includes processing, additives, and either shipping or delivery; no
payment is made for the milk itself.
(B) Constraints and limitations. Separate payment will not be made for the following items as medical supplies:
(1) Ordinary prepared food;
(2) Commercial products that serve as
ordinary food (e.g., shakes, smoothies, energy bars, vitamin or mineral
supplements, baby food);
(3) Food
products to be eaten as part of a diet related to diabetes, obesity, gastric
bypass, or bariatric surgery;
(4)
Food products for which a provider receives medicaid per diem payment;
and
(5) Standard infant formula
(not used to treat errors of metabolism) for which payment may be made through
a program other than medicaid.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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