MN HF4059

Establishes pediatric home-based enteral nutrition services as a covered service under medical assistance for patients 21 years of age or younger who are dependent on feeding tubes for at least 75 percent of their nutritional needs.

Creates two service tiers with different payment rates: Tier One at $862 per patient per month and Tier Two at $1,083 per patient per month, with additional age-based modifiers of $233 for ages 11-12 and $429 for ages 13 and older.

Includes covered services such as enteral nutrition formula, feeding tubes, supplies, equipment, patient intake, clinical setup, troubleshooting, and delivery; Tier Two patients also receive clinical dietitian assessments and skilled nursing support.

Requires commissioner authorization of all pediatric home-based enteral nutrition services based on medical necessity and cost-effectiveness, with requests due within 20 working days of service start and monthly authorization units allowed.

Establishes quality metric reporting incentive programs (2023-2025) and quality improvement incentive programs (2026 onward) with annual funding pools equal to three percent of estimated state expenditures.