67:16:42:02.  Enteral nutritional therapy and nutritional supplements for individual under 21 years of age. Enteral nutritional therapy, oral nutritional supplements, and electrolyte replacement for an individual who is under 21 years of age are covered when the following conditions are met:

          (1)  The individual is not institutionalized and services are delivered in the individual's residence. For purposes of this rule, an individual's residence does not include an acute care hospital, a nursing facility, an intermediate care facility for the mentally retarded, or an institution for individuals with a mental disease;

          (2)  If eligible for the Supplemental Nutrition Program for Women, Infants, and Children operated by the Department of Health, the items and services are not available under that program or the physician's order exceeds the amount allowed under that program; and

          (3)  The items are ordered by a physician.

          Enteral nutritional therapy is covered when the individual has a functioning gastrointestinal tract but cannot maintain weight and strength commensurate with the individual's general condition because of a medical condition or illness or pathology to or the nonfunctioning of the structures that normally permit food to reach the digestive tract.

          Oral nutritional supplements are covered when a child cannot maintain normal protein or caloric intake from a daily nutritional plan or when a normal infant formula cannot be tolerated because of a condition or illness.

          Source: 17 SDR 37, effective September 11, 1990; 17 SDR 184, effective June 6, 1991; 17 SDR 200, effective July 1, 1991; 18 SDR 209, effective June 23, 1992; transferred from § 67:16:11:03.05, 22 SDR 32, effective September 11, 1995.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.