Effective for dates of service on or after July 1, 2021, the Department of Health Care Services (DHCS) has updated the List of Enteral Nutrition Products. Providers may refer to the List of Enteral Nutrition Products in the List of Enteral Nutrition Products section of the appropriate Part 2 provider manual.
The manufacturers guarantee that Medi-Cal providers may purchase, upon request, the listed products at or below the maximum acquisition cost (MAC) for dispensing with an approved Treatment Authorization Request (TAR) or a Service Authorization Request (SAR) through the Medi-Cal fee-for-service pharmacy delivery system. Providers can locate MAC price suppliers by calling manufacturer phone numbers listed in the List of Enteral Nutrition Products.
Beneficiaries affected by changes to the list, should seek new prescriptions from their licensed prescriber, and new authorizations from their pharmacy provider for a comparable product on the list. Continuing care does not apply.
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.
The amount reimbursed to providers for enteral nutrition products shall not exceed the published estimated acquisition cost (EAC) plus a 23 percent markup.
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 1-855-795-0634 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
Durable Medical Equipment
|enteral (1, 3)