SF 3613 Summary

• Medical assistance covers pediatric home-based enteral nutrition services for patients age 21 or younger who are dependent on feeding tubes for at least 75 percent of their nutritional needs and receive care in their home residence.

• Services include nutritional products (formula, feeding tubes, syringes, etc.), medical supplies and equipment, and clinical services such as patient intake, ordering, clinical setup, troubleshooting, and equipment maintenance.

• Two patient tiers establish different payment rates: tier one patients receive base rate of $862/month, and tier two patients (with multiple diagnoses or higher needs) receive $1,083/month, with age-based modifiers adding $233/month (ages 11-12) or $429/month (age 13+).

• Authorization by the commissioner is required within 20 working days of service start, based on medical necessity and cost-effectiveness; patients without sufficient information for tier assignment begin at the lowest tier.

• Quality metric reporting incentive program (2023-2025) and quality improvement incentive program (2026+) each receive annual funding equal to 3 percent of estimated state expenditures for pediatric home-based enteral nutrition services.