CurrentHealth NetPolicy N/A

MEDICALLY TAILORED MEALS/MEDICALLY SUPPORTIVE FOOD REFERRAL FORM

Defines eligibility, documentation, and referral process for providing up to two medically tailored meals per day or a weekly grocery box for up to 12 weeks to Medi-Cal members with nutrition-sensitive health conditions; includes required forms, required documentation, and limits on meal type selection.

Policy Summary

PayerHealth Net

PolicyMEDICALLY TAILORED MEALS/MEDICALLY SUPPORTIVE FOOD REFERRAL FORM

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionComplete and submit the Medically Tailored Meals/Medically Supportive Food referral form together with the Medi-Cal Prior Authorization Request Form Outpatient online or by fax (fax: 800-743-1655).

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes

Up to 12 weeksMaximum Duration

2/day or weekly boxService Limit

Multiple conditionsCovered Indications (examples)

Coverage Summary

Overview: Medically Tailored Meals / Medically Supportive Food provides up to two medically tailored meals per day or a weekly grocery box for up to 12 weeks to Medi‑Cal members with nutrition-sensitive health conditions. The program is intended to address chronic or serious nutrition-sensitive conditions to improve health outcomes and reduce avoidable medical costs and is not intended solely to address food insecurity. Coverage stance: covered_with_criteria. Eligibility, documentation, and the referral/prior authorization process are required to receive services.

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Provider Actions & Operational Requirements

Prior Authorization

Submit referral with prior authorization

Complete and submit the Medically Tailored Meals/Medically Supportive Food referral form together with the Medi-Cal Prior Authorization Request Form Outpatient either online (recommended) at provider healthnetcalifornia.com or by fax at 800-743-1655.

Documentation Required

Include nutritional assessment

Attach a nutritional assessment by a registered dietitian or other appropriate clinician, including the meal plan and standards to meet the member's dietary needs.

Documentation Required

Include provider order

Attach a provider order signed by an authorized clinician (physician, registered dietitian (RD), clinical nurse specialist (CNS), nurse practitioner (NP), pharmacist, or physician assistant (PA)).

Billing Rule

One meal type per authorization

Members may receive only one meal type at a time (prepared meals or grocery box). If the member wants to change meal type, a new authorization request is required.

Background & Definitions

Purpose and intent: Medically Tailored Meals/Medically Supportive Food services are intended to address members' chronic or serious health conditions that are nutrition-sensitive, with the goals of improving members' health outcomes and lowering unnecessary medical costs. These services are delivered as part of the member's clinical care and are not intended to respond solely to food insecurity.

Program scope: The service covers up to two meals per day or a weekly grocery box for up to 12 weeks. Members must meet specified eligibility criteria related to nutrition-sensitive health conditions and must complete the required referral and documentation process, including prior authorization, to receive services.

Medically Tailored Meals: Prepared meals delivered as part of the member's clinical care to address their nutrition-sensitive health condition. These meals are intended to meet dietary needs defined in the member's nutritional assessment and are not intended solely to address food insecurity.

Medically Supportive Food / Grocery Box: A weekly grocery box (medically supportive foods) provided to meet dietary requirements related to the member's nutrition-sensitive health condition. Members may receive only one meal type at a time (prepared meals or grocery box); changing meal type requires a new authorization request.