Rule 67:16:42:03 Enteral nutritional therapy for individual 21 years of age and older.
67:16:42:03. Enteral nutritional therapy for individual 21
years of age and older. Enteral nutritional therapy for an
individual who is 21 years of age or older is covered if all of 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;
individual has a permanently inoperative internal body organ or an inoperative
is a physician's order or prescription for the therapy and sufficient medical
documentation describing the medical necessity for the therapy;
provider has received prior approval from the department; and
nutritional therapy is the only means the individual has to receive nutrition.
nutritional therapy is covered if the individual has a functioning
gastrointestinal tract but cannot maintain weight and strength commensurate
with the individual's general condition because of pathology to or the
nonfunction of the structures that normally permit food to reach the digestive
Source: 22 SDR 32, effective September 11, 1995.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
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