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016.06.21-214.000. Coverage of Enteral (Sole Source) Hyperalimentation Services/Benefit Limits.

AR ADC 016.06.21-214.000Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 21. Hyperalimentation Provider Manual (Refs & Annos)
Section 210.000. Program Coverage.
Ark. Admin. Code 016.06.21-214.000
016.06.21-214.000. Coverage of Enteral (Sole Source) Hyperalimentation Services/Benefit Limits.
Currentness
Coverage of sole source enteral therapy must be prior approved. Enteral (sole source) nutrition is considered medically necessary for a patient with a functioning gastrointestinal tract who cannot maintain weight and strength commensurate with his or her general condition due to pathology or non-function of the structures that normally permit food to reach the digestive tract. Enteral (sole source) therapy may be given by nasogastric, jejunostomy or gastrostomy tubes.
Coverage of enteral (sole source) nutrition therapy must be prior approved. Each request will be reviewed on a case by case basis. Typical examples of conditions that would qualify for coverage are:
A. Acute ulcerative colitis
B. Gastrointestinal cancer
C. Granulomatous colitis
D. Intestinal atresia (infants)
E. Ischemic bowel disease
F. Malabsorption syndrome
G. Short-gut syndrome
H. Head and neck cancer with reconstructive surgery
I. Central nervous system disease leading to interference with the neuromuscular mechanisms of ingestion of such severity that the patient cannot be maintained with oral feeding.
Enteral (sole source) hyperalimentation services include the provision and delivery of the prescribed therapy, equipment and supplies necessary for the administration of the prescribed therapy in the beneficiary's place of residence.
Enteral (sole source) hyperalimentation services are limited to 30 units of service per day. One unit of service equals 100 calories of covered nutritional therapy product resulting in a maximum of 3000 calories per day. Units may not be rounded up. Providers must bill a date span according to the prescribed daily volume. (Refer to Section 240.000 for billing instructions.)

Credits

Eff. Oct. 1, 2006.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.21-214.000, AR ADC 016.06.21-214.000
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