Rule 67:16:42:02 Enteral nutritional therapy and nutritional supplements for individual under 21 years of age.
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:
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;
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
items are ordered by a physician.
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.
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.
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