Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 40 - Division of Maternal, Child and Family Health › Chapter 7 - Metabolic Formula Program › Section 19 CSR 40-7.050 - Program Eligibility

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The Department of Health and Senior Services
				  (DHSS) provides low-protein formula, a special dietary product, to individuals
				  diagnosed as having phenylketonuria (PKU), maple syrup urine disease (MSUD) and
				  other metabolic conditions as approved by the Newborn Screening Standing
				  Committee, a subcommittee of the Missouri Genetic Advisory Committee which
				  makes recommendations to the department on newborn screening issues. This rule
				  establishes the criteria by which the Metabolic Formula Program accepts clients
				  for service.
(1) Conditions
				of eligibility for the Metabolic Formula Program (MFP) include:
(A) An applicant must be diagnosed as having
				phenylketonuria (PKU), maple syrup urine disease (MSUD) or other metabolic
				conditions as approved by the Newborn Screening Standing Committee and
				recommended to the department. The diagnosis must be made by a physician who
				practices at a metabolic treatment center;
(B) An applicant must be a resident of
				Missouri and cannot reside in a state facility. Proof of residency will consist
				of submitting a copy of the previous month's utility bill with the applicant's
				home address clearly printed;
(C)
				The physician treating the applicant must submit the following information to
				the department:
1. A letter requesting the
				applicant be placed on the MFP;
2.
				The name and address of the applicant; and
3. A prescription, signed by the treating
				physician, stating the name of the low-protein formula, a special dietary
				product the individual will be using; and
(D) Financial eligibility guidelines for
				enrollment in the MFP shall be based upon the Poverty Income Guidelines as
				established by the United States Department of Health and Human Services.
				Determination of individual applicant eligibility shall be based upon the
				following:
1. Applicants five (5) years or
				under shall have no income qualification requirements;
2. Applicants six (6) through eighteen (18)
				years whose family income is below three hundred percent (300%) of the federal
				poverty level shall be eligible for enrollment in the MFP;
3. Applicants six (6) through eighteen (18)
				years whose family income is at three hundred percent (300%) of the federal
				poverty level or above shall be eligible based on a sliding fee scale for
				enrollment in the MFP;
4.
				Applicants nineteen (19) years and above whose income does not exceed one
				hundred eighty-five percent (185%) of the federal poverty level shall be
				eligible for enrollment in the MFP;
5. Size of family unit shall be the number of
				persons in the household, including the responsible party(ies) and dependents
				allowable by the Internal Revenue Service as federal income tax exemptions. The
				family size may be increased by two (2) additional family members per affected
				individual nineteen (19) years and above for the cost of low-protein formula;
				and
6. Funding to eligible
				applicants may be adjusted by the department based on available
				funding.