CurrentHealth NetPolicy N/A

Medically Tailored Meals / Medically Supportive Food — Referral and Authorization

Defines the referral, required documentation, eligibility conditions, and service limits for Medically Tailored Meals (prepared meals) or Medically Supportive Food (grocery box) for Medi‑Cal members; applies to providers submitting authorization requests to Health Net in North Carolina.

Policy Summary

PayerHealth Net

PolicyMedically Tailored Meals / Medically Supportive Food — Referral and Authorization

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit a completed referral form with the Medi‑Cal Prior Authorization Request Form and attach a nutritional assessment and provider order.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Up to 2 meals/day or weekly boxservice offering

Up to 12 weeksmax duration

Single type at a timemeal type

Nutritional assessment + orderrequired docs

Coverage criteria

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Coverage criteria

Covered when ALL of the following are met

Clinical condition: Member has one or more nutrition-sensitive health conditions selected from the provided list (examples: cancer, dyslipidemia, hypertension, cardiovascular disorders, elevated lead levels, liver disease, chronic kidney disease/end-stage renal disease, malnutrition, chronic lung disorders (eg, asthma/COPD), fatty liver, obesity, gastrointestinal disorders, stroke, gestational diabetes, chronic or disabling mental/behavioral health disorders, heart failure, high cholesterol, diabetes or other metabolic conditions, high-risk perinatal conditions, HIV, or other listed conditions).select at least one

See referral form condition list

Documentation: Required documents are submitted with the referral for new authorization requests or extensions: (1) a nutritional assessment by a registered dietitian or other appropriate clinician that includes the meal plan and standards to meet the member's dietary needs for the nutrition-sensitive condition; and (2) a provider order signed by a licensed health care provider or other appropriate clinician (eg, physician, RD, CNS, NP, pharmacist, PA).document attached

Missing these documents may trigger denial

Service limits and type: Requested service is limited to either up to two prepared medically tailored meals per day OR a weekly grocery box (medically supportive food), for a maximum authorization period of up to 12 weeks; a member may receive only one meal type at a time (prepared meals or grocery box).up to 12 weeks

If changing meal type, submit a new authorization request

Services described as Medically Tailored Meals or Medically Supportive Food are intended to be delivered as part of the member's clinical care to address chronic or serious nutrition‑sensitive health conditions. They are not intended to be used solely to respond to food insecurity without clinical justification. Coverage therefore requires that the service is ordered and documented to treat a nutrition‑sensitive health condition rather than functioning only as a general food assistance benefit.

Provider actions, prior authorization, and documentation

Prior Authorization

Prior Authorization Required

Prior authorization is required for initial requests and extensions. Service covers up to two meals per day or a weekly grocery box for up to 12 weeks. Complete and submit the Medically Tailored Meals/Medically Supportive Food referral form together with the Medi‑Cal Prior Authorization Request (Outpatient) — online at provider.healthnetcalifornia.com (recommended) or by fax at 800‑743‑1655.

Initial requests and extension requests require prior authorization
Service limits: up to two meals/day OR one weekly grocery box; maximum authorization duration up to 12 weeks
Submit referral form with Medi‑Cal Prior Authorization Request (Outpatient) online or by fax

Note

Meal-type Change Requires New Authorization

If the member wishes to change the meal type (prepared meals vs grocery box), a new authorization request must be submitted; prior authorization rules apply to the new request.

A member may receive only one meal type at a time (prepared meal OR grocery box)
To switch meal type submit a new authorization request

Documentation Required

Required Documents for Authorization

Required documentation must be submitted with initial or extension authorization requests. Include a nutritional assessment performed by a registered dietitian (RD) or other appropriate clinician that contains the meal plan and standards demonstrating how the dietary needs of the member's nutrition‑sensitive health condition will be met. Also include a provider order signed by a licensed health care provider or other appropriate clinician (examples: physician, RD, clinical nurse specialist, nurse practitioner, pharmacist, physician assistant).

Nutritional assessment by RD or appropriate clinician, including meal plan and standards to meet dietary needs
Provider order signed by a licensed health care provider or appropriate clinician (physician, RD, CNS, NP, pharmacist, PA)

Denial Risk

Documentation-related Denial Risk

Missing required documentation (nutritional assessment and provider order) may result in denial of the authorization request. Ensure all required fields on the referral and Prior Authorization Request are complete and member consent is documented.

Incomplete or missing nutritional assessment or meal plan may lead to denial
Missing provider order signed by an appropriate licensed clinician may lead to denial
Member consent for the referral should be documented to avoid processing delays

Note

How to Submit Referral

Complete and submit the Medically Tailored Meals/M edically Supportive Food referral form with the Medi‑Cal Prior Authorization Request (Outpatient). Recommended submission is online at provider.healthnetcalifornia.com; fax submissions accepted at 800‑743‑1655. Include all required supporting documents listed above when requesting initial authorization or an extension.

Submit referral form + Medi‑Cal Prior Authorization Request (Outpatient) together
Online submission recommended: provider.healthnetcalifornia.com
Fax submission: 800‑743‑1655
Include nutritional assessment and signed provider order with submission

Key definitions

Medically Tailored Meals / Medically Supportive Food — definition and scope

DefinitionPrepared meals or a weekly grocery box provided to members to address nutrition-sensitive health conditions as part of clinical care.

Scope of useIntended to address members' chronic or serious nutrition-sensitive health conditions to improve health outcomes and lower unnecessary medical costs; not intended solely to respond to food insecurity.

Service formatsTwo formats: prepared medically tailored meals (delivered) or a weekly grocery box (medically supportive food).

Service frequency and durationCovers up to two meals per day (prepared meals) or a weekly grocery box for up to 12 weeks.

Meal-type restrictionA member may receive only one meal type at a time (either prepared meals or grocery box).

How to requestComplete and submit the Medically Tailored Meals/Medically Supportive Food referral form with the Medi‑Cal Prior Authorization Request Form Outpatient online or by fax (see referral form for details).

OpenPayer

Medically Tailored Meals / Medically Supportive Food — Referral and Authorization

Coverage criteria

Provider actions, prior authorization, and documentation

Key definitions

Background