MA H4937

Requires all Massachusetts health insurance plans to cover enteral formulas (specialized medical nutrition) for home use, whether administered orally or via tube feeding, when ordered by a physician

Coverage applies to the Group Insurance Commission (state employees), individual and group accident/sickness policies, hospital service plans, medical service agreements, and HMOs

Physician's written order must certify the formula is medically necessary and proven effective for treating conditions that would otherwise cause malnourishment, chronic disability, or death

Covered conditions include inherited metabolic diseases, eosinophilic gastrointestinal disorders, Crohn's Disease, gastroesophageal reflux with failure to thrive, chronic intestinal pseudo-obstruction, and severe food allergies

Medically necessary enteral formulas prescribed for disease treatment must be distinguished from elective nutritional supplements, which are not covered