Nutrition in-lieu-of-services prior authorization (Medically Tailored Meals and Produce Prescription)
Form and criteria for referring UnitedHealthcare Community Plan of Michigan members to Medically Tailored Home-Delivered Meals (MTM) or a Produce Prescription (PP) program in select Michigan counties; applies to providers referring members for these nutrition services.
No material clinical or coverage changes in this revision.
Coverage Criteria for Nutrition Services
Program eligibility criteria (MTM and Produce Prescription)
Covered when ALL of the following are met for the selected program
MTM eligibility
- Clinical risk factor: Member has at least one listed clinical risk factor (examples include hypertension, renal disease, diabetes, HIV, gestational diabetes, CHF including cancer with malnutrition, COPD, sickle cell disease, other nutrition-sensitive conditions)>=1
See form for full list
- Social risk factor and limitations: Member has at least one social risk factor (e.g., at risk for nutritional deficiency due to food insecurity) AND lacks current capacity to shop and cook for themselves or lacks adequate social support>=1
Member must not be receiving duplicative support from federal, state, or locally funded programs and must not be eligible for a substantively similar Medicaid-covered service
- Service limitations and geography: Member resides in an eligible listed county and requested service fits program limits (up to 2 meals/day; service duration up to 12 weeks) and member is not receiving other funded meal delivery servicesN/A
County list provided on form; meals/food are not provided solely for food insecurity
Produce Prescription eligibility
- Clinical risk factor: Member has at least one listed clinical risk factor (examples include cancer with malnutrition, high-risk pregnancy history including gestational diabetes, HIV, COPD, hypertension, CHF, diabetes, renal disease, sickle cell disease, child elevated lead or childhood obesity, CSHCS-eligible)>=1
See form for full list
- Social risk factor and limitations: Member has at least one social risk factor (e.g., at risk for nutritional deficiency due to food insecurity) AND is not receiving duplicative support>=1
Produce Prescription items must align with specified eligible produce programs and member must reside in an eligible county
- Service limitations and geography: Member resides in an eligible listed county and service follows program voucher/transaction rules; service duration up to 12 weeks and not provided solely for food insecurityN/A
County list provided on form
Exclusions apply when the member is already receiving similar services from other funded programs or can meet their needs without this benefit. Specifically, services are excluded for members who are receiving other meal delivery services from local, state, or federally funded programs. Providers must confirm the member is not enrolled in duplicative support through federal, state, or locally funded programs and that the member is not eligible for a Medicaid-covered service that is substantively the same.
The member must also lack the ability to meet nutrition needs through their own capacity or available supports. Coverage is not intended for members who have current capacity to shop and cook for themselves or who have adequate social support to meet these needs. The referral form includes explicit questions about the member’s ability to shop and cook and their social supports; responses should be documented and submitted with the request.
Meals and Produce Prescription vouchers are intended to address nutrition needs tied to medical conditions and related social risk factors, not to serve as a sole response to food insecurity. The policy states that meals/food are not provided to respond solely to food insecurity, and requests that document only food insecurity without the required clinical and functional criteria will not meet medical necessity.
Additionally, services are not medically necessary when the member can independently shop and cook or has sufficient social supports. The prior authorization process requires documentation that the member lacks capacity to shop/cook or lacks adequate support; if the member can shop and prepare food, the service is not covered.
Coding and Diagnosis
| Requested ICD-10 code(s) | Field provided for applicable diagnosis codes supporting medical necessity |
Provider Submission, Documentation, and Review
Form submission and approval process
Submit the completed prior authorization request form by email to uhcmimedicaidnutrition@uhc.com. All fields on the form are required; incomplete forms will be returned for lack of information. If the criteria are met the request is approved; if not met the request will be reviewed by a medical director.
- Email: uhcmimedicaidnutrition@uhc.com
- All fields required — incomplete forms returned
- Medical director review when criteria not met
Duplication and alternative services check
Verify the member is not currently receiving duplicative support through other federal, state, or locally funded programs and confirm they are not eligible for a Medicaid-covered service that is substantively the same before approving enrollment.
- Confirm member is not receiving duplicative support from SNAP/WIC or other funded meal programs
- Confirm member is not eligible for a Medicaid-covered service that is substantively the same
Required supporting documentation
Include supporting clinical and transition documentation to substantiate medical necessity. Recommended documents to attach with the request include office visit notes with diagnosis, skilled nursing discharge plans, emergency department/inpatient discharge paperwork, documentation from support agencies, and medication or treatment orders. Note: services provide up to 2 meals per day and/or Produce Prescription vouchers for up to 12 weeks when medically necessary; meals/food provided only when tied to medical necessity, not solely for food insecurity.
- Documentation/office visit notes with diagnosis or identification of chronic illness requiring a special diet
- Skilled nursing discharge plan
- Emergency department, inpatient, or skilled nursing discharge paperwork
- Documentation from support agencies indicating services/supports member needs or receives
- Medication/treatment orders
- Service limits: up to 2 meals/day and/or Produce Prescription for up to 12 weeks when medically necessary
Triggers for denial or return
Requests will be returned if the form is incomplete. A medical director will review requests that do not meet stated clinical or social risk criteria. Meals/food provided only when medically necessary; requests may be denied if the member has the capacity to shop and cook or adequate social support, or is already receiving excluded services.
- Incomplete forms returned
- Medical director review when criteria not met
- Meals/food not covered when not medically necessary
- Exclusions: members already receiving other funded meal delivery services or who can shop/cook or have adequate social support
Background
Medically Tailored Home-Delivered Meals (MTM) and Produce Prescription (PP) programs are intended to address nutrition needs that are directly linked to specific medical conditions and associated social risk factors. These programs target members with nutrition-sensitive clinical conditions (examples on the referral form include diabetes, renal disease, CHF, cancer with malnutrition, COPD, HIV, high-risk pregnancy, sickle cell disease, childhood obesity, and others) and who also have a relevant social risk such as limited ability to shop or prepare meals.
The programs are designed to fill gaps where clinical need and functional limitations intersect: MTM provides medically tailored fresh or frozen meals, and Produce Prescription provides vouchers for eligible fruits and vegetables. Both services require documentation of clinical risk factors and social risk factors, verification that the member is not receiving duplicative funded services, and residency in an eligible county. Service limits are up to 2 meals per day and/or Produce Prescription benefits for up to 12 weeks, when medically necessary.
Definitions
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