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Elizabeth M. Whitehorn, Director

Provider Notice Issued 04/13/2021

 

Date:   April 13,2021

 

To:       Enrolled Durable Medical Equipment andSupplies Providers; Hospitals; and Pharmacies

 

Re:      Chapter M-200, Handbook for Providers ofMedical Equipment and Supplies

            New Topic M-213.4 - Medical Foods

 

 

 

 

This bulletinannounces coverage of medical foods for persons from birth through age 20 withinborn errors of metabolism. This coverage policy applies to participantscovered under Medicaid fee-for-service as well as participants enrolled in aHealthChoice Illinois managed care plan. Contact the applicable managed careplan for specific approval and billing requirements.  

 

Effective retroactively to November 25,2020, medical foods may be requested for participants age 0-20 affected by thefollowing inborn errors of metabolism:

 

  1. ​Phenylketonuria
  2. MapleSyrup Urine Disease
  3. Homocystinuria

 

 

FormHFS1313, Medical Food Nutrition Review Questionnaire, must becompleted by the prescribing practitioner and submitted with the HFS1409 - Prior Approval Request, a copy of the prescription, andother supporting material as noted in the HFS 1313.

 

TheHandbookfor Providers of Medical Equipment and Supplieshas been updated with Topic M-213.4 – Medical Foods and is available on the Department’swebsite. Questions regarding this bulletin may be directed to a DME medicalassistance consultant in the Bureau of Professional and Ancillary Services at877-782-5565.

 

Instructions for updating theHandbook for Providers of Medical Equipment and Supplies:

 

Topic M-213.4

Removepage HFS M-213 (1) and replace with pages HFS M-213 (1) and (2).

 

 

 

 

 

 

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