CurrentHealth NetPolicy N/A

Medically Tailored Meals / Medically Supportive Food — Referral and Authorization Requirements

Governs referral and authorization requirements for providing medically tailored meals or medically supportive grocery boxes to Medi‑Cal members with nutrition‑sensitive chronic or serious health conditions in North Carolina.

Policy Summary

PayerHealth Net

PolicyMedically Tailored Meals / Medically Supportive Food — Referral and Authorization Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit the completed Medically Tailored Meals/Medically Supportive Food referral form with the Medi‑Cal Prior Authorization Request Form Outpatient and include a nutritional assessment and provider order.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

up to 2/dayservice quantity limit

≤ 12 wksauthorization duration

one at a timemeal type restriction

nutritional assessmentrequired docs

Coverage Criteria

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Medical necessity criteria

Covered when ALL of the following are met

Eligibility and documentation: Member has a nutrition-sensitive chronic or serious health condition (see eligible conditions). Referral form and Medi‑Cal Prior Authorization Request Form Outpatient are completed and submitted.

See list of eligible conditions in policy and submit required supporting documents described below.

Supporting clinical documentation: Required documents are submitted with the referral: a nutritional assessment by a registered dietitian or other appropriate clinician including the meal plan and standards, and a provider order signed by a licensed health care provider or other appropriate clinician.

Requests without these completed documents may be denied.

Service type: Request is for either up to two prepared medically tailored meals per day OR a weekly medically tailored grocery box (medically supportive foods).up to 2 meals/day or weekly grocery box

A member may receive only one meal type at a time; changing meal type requires a new authorization request.

Duration: Requested authorization period does not exceed 12 weeks per authorization (initial or extension requests accepted).<= 12 weeks

These services are not intended to respond solely to food insecurity. Medically tailored meals and medically supportive grocery boxes must be delivered as part of clinical care to address a member’s nutrition-sensitive chronic or serious health condition. Authorization and coverage depend on meeting clinical criteria and submission of the required referral and supporting documentation rather than being used as a standalone social service.

Provider Actions & Authorization

Prior Authorization

Prior authorization required — submit referral + Medi‑Cal PA form

Prior authorization is required for initial and extension requests. 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.

Step Therapy

One meal type at a time — new auth required to change

A member may only receive one meal type at a time (either prepared medically tailored meals or a medically tailored grocery box). If the member needs to change meal type, the provider must submit a new authorization request.

Documentation Required

Required submission documents — referral form, nutritional assessment, and provider order

Include the completed Medically Tailored Meals/Medically Supportive Food referral form with the Medi‑Cal Prior Authorization Request Form Outpatient and attach a nutritional assessment (including meal plan and standards) performed by a registered dietitian or other appropriate clinician, plus a provider order signed by a licensed healthcare provider or other appropriate clinician.

Denial Risk

Missing form or documentation may delay or result in denial

Requests submitted without a completed referral form and the required supporting documentation may be delayed or denied.

Required supporting documentation includes a nutritional assessment with meal plan and standards and a provider order signed by a licensed clinician.

Definitions

Medically Tailored Meals/Supportive Food — definition(s) for the benefit

Service typesPrepared medically tailored meals (up to two meals per day) OR a weekly medically tailored grocery box.

PurposeIntended to improve health outcomes and lower unnecessary medical costs by addressing nutrition-sensitive conditions; not intended solely to respond to food insecurity.

Quantity limitCovers up to two meals per day or a weekly grocery box.

Maximum authorization durationCovered for up to 12 weeks per authorization.

Background

Medically tailored meals and medically supportive foods are clinical interventions intended to improve health outcomes for members with nutrition-sensitive chronic or serious health conditions. Covered services include either up to two prepared medically tailored meals per day or a weekly medically tailored grocery box, delivered with a clinical goal and provided as part of the member’s overall treatment plan.

These services are time-limited and subject to authorization: coverage is available for up to 12 weeks per authorization. A member may receive only one meal type at a time (prepared meals or grocery box); any change in meal type requires a new authorization request. Prior authorization must be obtained by submitting the Medically Tailored Meals/Medically Supportive Food referral form together with the Medi‑Cal Prior Authorization Request Form Outpatient and the required supporting documentation (for example, a nutritional assessment with meal plan and standards and a provider order signed by an appropriate licensed clinician).