Medical Coverage Policy Oral Nutrition Mandate
Defines coverage criteria for non-prescription oral nutritional formulas, low-protein food products, and special medical formulas for home use for commercial products under Rhode Island mandate; describes prior authorization/reimbursement process and exclusions (donor breast milk, enteral tube feeding).
No material clinical or coverage changes to this policy at this time.
Coverage Summary
This policy implements Rhode Island General Law 27-20-56 and defines coverage for non-prescription oral nutritional formulas, low-protein food products, and special medical formulas for home use when ordered by a physician and medically necessary to treat listed causes of malabsorption. The policy applies to Commercial products only. Effective date: 2014-12-01; Policy last reviewed: 2023-02-01.
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