CurrentIndependent HealthPolicy N/A

Medically Tailored Meals Services

Defines a no-cost Medically Tailored Meals (MTM) program offered to Independent Health Medicaid members aged 18+ that provides dietitian support and home-delivered meals for eligible members.

Policy Summary

PayerIndependent Health

PolicyMedically Tailored Meals Services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2023

Next Review DateN/A

Key ActionVerify member is an Independent Health Medicaid member age 18+, has a secure place to store and heat meals, and meets the program's qualifying pathway before enrollment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

up to 2/daymeals delivered per day

6 monthsservice period per enrollment

18+member age eligibility

Medicaidpayer program

Coverage Criteria

Program Enrollment Criteria

Covered when ALL of the following are met:

Member eligibility: Member is an Independent Health Medicaid member age 18 years or older

Residence capability: Member has a secure place to store and heat meals

Qualifying pathway

Pathway A: Personal care services: Member receives personal care services and elects to replace some meal preparation and food shopping hours while receiving medically tailored meals (hours reduced depend on number of meals)
Pathway B: Diagnosis plus utilization:

Policy Summary

PayerIndependent Health

PolicyMedically Tailored Meals Services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2023

Next Review DateN/A

Key ActionVerify member is an Independent Health Medicaid member age 18+, has a secure place to store and heat meals, and meets the program's qualifying pathway before enrollment.

SourceLink

On This Page

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Provider Actions & Requirements

Documentation Required

Enrollment verification required

Verify member enrollment and eligibility before providing Medically Tailored Meals. Required verifications include Medicaid membership with Independent Health, member age (must be 18 years or older), confirmation the member has a secure place to store and heat meals, and clinical/utilization criteria (receipt of personal care services with reduction of meal-prep/shopping hours or diagnosis of cancer, diabetes, heart failure, or HIV/AIDS with qualifying inpatient/ER utilization in the prior 12 months).

Payer: Independent Health (Medicaid members only)
Age: 18 years or older
Storage/heat capability: Member must have a secure place to store and heat meals
Clinical/utilization verification: Either (a) member receives personal care services and will replace some meal-prep/food shopping hours, or (b) member has cancer, diabetes, heart failure, or HIV/AIDS plus qualifying inpatient hospital stays and/or ER visits in the last 12 months

Note

Providers must confirm and document eligibility elements in the member record and coordinate with Member Services for program enrollment. Notify members that participation is voluntary and will not affect Medicaid eligibility or other benefits. For questions or to enroll members, contact Member Services at (716) 250-7183 or 1-833-891-9372 (TTY 711).

Document Medicaid membership, age, storage/heat capability, and clinical/utilization evidence in the medical record
Ensure personal care service plans reflect any replaced meal-preparation or shopping hours when applicable
Contact Member Services for enrollment assistance and program details

Documentation Required

Required eligibility documentation

Acceptable documentation must be maintained to demonstrate program eligibility. Maintain copies in the member's chart and make available upon request for audit or utilization review.

Proof of Medicaid membership (Independent Health enrollment verification or eligibility file)
Proof of age (government ID or eligibility file showing date of birth)
Confirmation of storage/heat capability (attestation from member or caregiver, or care-plan note)
Clinical documentation: diagnosis of cancer, diabetes, heart failure, or HIV/AIDS when applicable (problem list, clinician note, or diagnosis code)
Utilization history: records showing qualifying inpatient hospital stays and/or ER visits in the prior 12 months (discharge summaries, encounter records)
Personal care services: care-plan or service authorization showing personal care services and documentation that some meal-prep/food shopping hours will be replaced

Denial Risk

Eligibility-based denial risk

Services may be denied if the member does not meet the eligibility requirements. Prior to providing meals, confirm all criteria to avoid claim denials or service interruptions.

Denial risk if member is not an Independent Health Medicaid enrollee or is under 18 years of age
Denial risk if member lacks a secure place to store and heat meals
Denial risk if clinical condition or required utilization history is not documented (no qualifying diagnosis or insufficient inpatient/ER visits)
Denial risk if personal care services documentation does not show replacement of meal-prep/shopping hours when that pathway is used

Definitions

Medically Tailored Meals (MTM) — program definition

Program descriptionNo-cost Medically Tailored Meals (MTM) program providing home delivery of meals tailored to members' specific health needs.

Nutrition supportAccess to a registered dietitian and nutritionist for guidance and support.

Service frequency and durationUp to two meals per day delivered to the member's home for six months per enrollment period; continuation available if member remains eligible.

Eligible populationIndependent Health Medicaid members age 18 years or older.

PurposeProvide healthy, nutritious meals targeted to members' clinical needs to support chronic condition management and reduce food insecurity.

Secure place to store and heat meals — member requirement

RequirementMember must have a secure place at their residence to store and heat delivered meals.

MeaningPhysical capability and space in the member's home to keep meals refrigerated or otherwise stored and to warm them as needed.

VerificationEligibility verification must confirm the member's residence has storage and heating capability before enrollment.

Exclusion implicationMembers without a secure place to store and heat meals are excluded from the MTM benefit.

OpenPayer

Medically Tailored Meals Services

Coverage Criteria

Coding

Provider Actions & Requirements

Definitions

Background