Community-Based Services Manual (CBSM)

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Community-Based Services Manual (CBSM)

CBSM Waiver programs

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Waiver oral and enteral nutritional products

Page posted: 10/1/03		Page reviewed: 12/16/20	Page updated: 12/16/20
Legal authority	Federally approved BI, CAC, CADI and EW waiver plans, 42 C.F.R. 441.310, Minn. Stat. §256B.0625, subd. 32, Minn. Stat. §256B.0913, Minn. R. 9525.1800, subp. 22, Minn. R. 9525.1860, subp. 4
Definitions	Enteral nutritional product: Commercially formulated substance administered via feeding tube that provides a person with nourishment. Oral nutritional product: Commercially formulated substance taken by mouth that provides a person with nourishment.
Enteral nutritional products	When a person’s need exceeds the limits set for Medical Assistance (MA) state plan in the Medical Supply Coverage Guide (PDF), the lead agency can authorize additional units through specialized equipment and supplies to cover enteral nutritional products.
Oral nutritional products	AC and EW For AC and EW, oral nutritional products can be approved if all of the following are true: · MA will not pay for the product (EW only) · The product addresses a documented chronic care need and is not reimbursable through other payment options · The product is necessary to meet the person’s nutritional needs and maintain their strength to live in the community · The order from the physician/physician’s assistant includes why the person cannot obtain their caloric intake without the product · The person’s needs and goals related to the product are documented in their support plan. AC and EW do not cover: · Foods including organic or special diet needs · Organ extracts · Over-the-counter food supplement products, including vitamins, not covered by the MA state plan. BI, CAC and CADI The BI, CAC and CADI waivers do not cover: · Any oral nutritional products (e.g., Boost, Ensure) · Electrolyte products · Foods including organic or special diet needs · Organ extracts · Over-the-counter food supplement products, including vitamins, not covered by MA state plan sources.
Provider standards and qualifications	A provider must meet the standards and qualifications of specialized equipment and supplies providers.
Authorization process	The lead agency must: · Document the person’s need for the product(s) in excess of the MA state plan coverage in their support plan · Authorize the oral or enteral nutritional product(s) on the service agreement.
Additional resources	CBSM – Waiver, AC and ECS process and procedures CBSM – Specialized equipment and supplies Medical Supply Coverage Guide (PDF) MHCP Provider Manual – Nutritional products and related supplies MHCP Provider Manual – Specialized equipment and supplies authorization and billing responsibilities

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