VNS Health MLTC: Medical Equipment, Surgical Supplies, Respiratory Therapy, and Oxygen

Both acute and chronic conditions may require additional therapies for symptom management and treatment of the condition itself. These additional therapies may be temporary or they may be needed long-term. The Care Manager will coordinate with appropriate healthcare professionals and suppliers on required medical equipment, supplies, respiratory therapy, and oxygen.

Sometimes supplemental nutrition may be required and is part of this benefit.

In the event that supplemental oral or enteral (feeding tube) nutrition is needed, the provider will identify the mixture and route and the Care Manager will request enteral or oral supplements based on the following Medicaid Criteria:

• A documented diagnostic condition where caloric and dietary nutrients cannot be absorbed or metabolized.

• Clinical findings related to malnutrition.

• The condition requires supplemental nutrition.

• Demonstrates documented compliance with an appropriate medical and nutritional Person Centered Service Plan.

• Laboratory data related to malnutrition.

• A failure to increase or maintain body weight with usual solid or oral liquid intake.

• Already on tube feedings.

Medicaid coverage of enteral formula and nutritional supplements is limited to individuals who cannot obtain nutrition through any other means, as well as limited to the following three conditions:

1. Individuals who are fed via nasogastric (NG tube), jejunostomy (J-tube), or gastrostomy tube (G-tube or PEG tube);

2. Individuals with rare inborn metabolic disorders;

3. Children up to age 21 who require liquid oral enteral nutritional formula when there is a documented diagnostic condition where caloric and dietary nutrients from food cannot be absorbed or metabolized.

Coverage of certain inherited diseases of amino acid and organic acid metabolism shall include modified solid food products that are low protein or that contain modified protein.