AGING AND DISABILITY SERVICES ADMINISTRATION
2005 BH "Dear Provider" Letters
May 3, 2005
ADSA: BH #2005-003
Resident Eligibility for Enteral Nutrition
Dear Boarding Home Provider:
The Medical Assistance Administration (MAA) has adopted new Washington Administrative Code (WAC) to address eligibility requirements for nutritional products. These are liquid formulas such as Ensure or Resource that can be taken by mouth. The new eligibility requirements may affect some Medicaid residents who have been receiving orally administered enteral nutrition products purchased using the resident’s Medicaid card. These changes will not affect any of your private paying residents, nor will they affect residents receiving enteral nutrition through a tube into the stomach or small intestine.
Effective July 1, 2005 , in order to continue to receive nutrition products, a resident’s physician (MD), advanced registered nurse practitioner (ARNP) or physician assistant (PA-C) must document that the nutrition products are medically necessary. Additionally, MAA must provide “prior authorization” before the resident may receive the nutrition products. This means that all BH residents currently receiving oral nutritional products must be assessed by their MD, ARNP or PA-C to be able to continue to receive the products. Supply vendors will not be able to deliver these products without a prescription from the MD, ARNP or PA-C and the approval of MAA. You may start having your residents who are currently taking this product assessed now by their MD, ARNP or PA-C, and begin the authorization process.
Department case managers are currently reviewing the assessments and service agreements for residents who may have received nutrition products within the last year. Case managers will update the service plans to reflect alternative means of meeting the nutritional needs for those residents who are determined to be no longer eligible for nutrition products, and review appropriate actions with the facility. The department case manager may need to be in contact with BH providers to confirm the client’s current nutritional plan.
A MAA update with additional background information regarding changes to the enteral nutrition program is enclosed for your information. The revised requirements for the enteral nutrition program are found in chapter 388-554 WAC and can be accessed on the internet at: http://www.leg.wa.gov/WAC/index.cfm?fuseaction=chapterdigest&chapter=388-554.
If you have any questions regarding either the process to determine a resident’s eligibility to continue to receive nutrition products or appropriate plans for nutritional support for residents who may no longer be eligible for nutrition products, please contact the resident’s case manager.
Sincerely,
Joyce Pashley Stockwell, Acting Director
Residential Care Services
