R590. Insurance, Administration.R590-194. Coverage of Dietary Products for Inborn Errors of Amino Acid or Urea Cycle Metabolism.
R590-194-1. Authority.
This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-623.
R590-194-2. Purpose and Scope.
(1) The purpose of this rule is to:
(a) establish minimum standards of coverage for dietary products, including formulas and low protein modified food products, used for the treatment of inborn errors of amino acid or urea cycle metabolism; and
(b) identify a uniform billing code standard to be used for processing claims for dietary formulas in conjunction with the treatment of specific inborn metabolic errors.
(2) This rule applies to an insurer offering an accident and health insurance policy that contains major medical benefits.
R590-194-3. Definitions.
Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-623.
R590-194-4. Minimum Standards and General Provisions.
(1) Preauthorization for dietary products may be required if it is stated in the policy.
(2) Each insurer shall provide direct access to a designated person familiar with dietary products to facilitate the processing of claims.
(3) Dietary products shall be paid under the major medical benefit as any other illness and not under any limited benefit, such as durable medical equipment (DME).
(4) An insurer may request additional information required to determine the eligibility of the claim under the terms of the policy.
(5)(a) "Coverage for Metabolic Dietary Products Standard version 2.1," adopted by the Utah Health Information Network (UHIN), is incorporated by reference and is available on the department's website, https://insurance.utah.gov.
(b) This uniform billing standard shall be utilized for billing and processing claims for dietary products.
R590-194-5. Severability.
If any provision of this rule, Rule R590-194, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.
KEY: insurance law
Date of Last Change: January 10, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-614.5; 31A-22-623
