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Enteral Nutrition Product-Specific Criteria Modified for Compleat Products

October 29, 2018

Effective for dates of service on or after October 22, 2018, the product-specific criteria restricting all Compleat products by Nestlé HealthCare Nutrition in the standard category are modified. To be considered for authorization of Compleat products, the beneficiary must meet the medical criteria for standard products and all of the following product-specific criteria:

  • Tube-feeding use only
  • Have sufficient clinical evidence of failure or medical intolerance to at least two (2) other age-appropriate and medically-appropriate standard products on the List of Enteral Nutrition Products
  • Not used as a convenience or alternative to blenderized food

The List of Enteral Nutrition Products will be updated with the policy change in a future Medi-Cal Update.

Note:

Listing of a product is not a guarantee of its availability. The product number approved on an authorization must be the same product number dispensed to the beneficiary and claimed for reimbursement by the provider.

Medi-Cal beneficiaries denied enteral nutrition products who believe the denial was in error may ask for a state hearing by contacting the California Department of Social Services at 1-800-743-8525 or (855) 795-0634, or by sending a written request to:

California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 9-17-37
Sacramento, CA  94244-2430