Rule 67:16:42:02 Enteral nutritional therapy and nutritional supplements for individual under 21 years of age.
67:16:42:02. Enteral nutritional
therapy and nutritional supplements for individual under 21 years of age.
Enteral nutritional therapy, oral nutritional supplements, and electrolyte
replacement for an individual who is under 21 years of age are covered when the
following conditions are met:
(1) The individual is not
institutionalized and services are delivered in the individual's residence. For
purposes of this rule, an individual's residence does not include an acute care
hospital, a nursing facility, an intermediate care facility for individuals
with intellectual disabilities, or an institution for individuals with a mental
(2) If eligible for the Supplemental
Nutrition Program for Women, Infants, and Children operated by the Department
of Health, the items and services are not available under that program or the
physician's order exceeds the amount allowed under that program; and
(3) The items are ordered by a
Enteral nutritional therapy is covered when the
individual has a functioning gastrointestinal tract but cannot maintain weight
and strength commensurate with the individual's general condition because of a
medical condition or illness or pathology to or the nonfunctioning of the
structures that normally permit food to reach the digestive tract.
Oral nutritional supplements are covered when a
child cannot maintain normal protein or caloric intake from a daily nutritional
plan or when a normal infant formula cannot be tolerated because of a condition
Source: 17 SDR 37, effective September 11,
1990; 17 SDR 184, effective June 6, 1991; 17 SDR 200, effective July 1, 1991;
18 SDR 209, effective June 23, 1992; transferred from § 67:16:11:03.05, 22
SDR 32, effective September 11, 1995; 40 SDR 122, effective January 8, 2014.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
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