Limitations for TPN or EN Therapy. B. Enteral nutrients, IV diluents, injectable medications, and solutions are available as allowed in the pharmacy program with the limitations stipulated therein. C. Baby foods, such as Similac, Enfamil or Mull-Soy, are breast milk substitutes, and thus are not Medicaid benefits. D. Kits, bags and pumps are not benefits with nutritional supplements. E. A monthly supply kit containing all supplies except the catheter is a Medicaid benefit only for patients residing at home.
Prior authorization is required.
All parenteral and enteral solutions and equipment require prior approval. There must be a reasonable medical expectation that an improved quality of life will ensue from the parenteral, enteral or IV therapy. The licensed pharmacy must request a prior approval from Medicaid for the nutrients and supplies. The physician's prescription must be attached to the prior approval request. The attending physician must justify the use of a pump for metered dosage, continuous infusion, extremely small doses which cannot be measured accurately without a pump, or other special medical need.