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DHS raises rates, adds codes for specialized tube‑feeding formula; expected spend rises about 22%
Summary
DHS proposed rate changes for specialized enteral formulas and supplies used by tube‑fed patients — including two new billing codes — and estimated the changes would raise expected spending about 22 percent, roughly $1.9 million.
The Department of Human Services presented provider‑manual rate changes for specialized enteral formulas and associated supplies used by tube‑fed patients, citing provider shortages and rising production costs.
Veil Smith, deputy director for the Division of Medical Services, said rate review found problems with providers supplying specialized formula, which contributed to “children … being hospitalized for insufficient nutrition.” DHS proposed setting rates at the lesser of the Medicare rate or 80 percent of Blue Cross Blue Shield rates and said the Blue Cross rate was used in most cases.
The department also proposed adding two new billing codes — for a bolus syringe and gravity bags — that had previously been bundled into another kit code, allowing separate billing for those items. DHS told the committee both inpatient and outpatient settings will be covered under the rate changes.
DHS estimated the package of rate changes would produce a 22 percent increase in expected spending, an increase the agency quantified as about $1,900,000 in total, with roughly $555,000 identified as state funds.
Representative Bentley asked whether other barriers — such as prior authorization requirements — might impede provider participation. Veil Smith said DHS had focused primarily on rates but agreed to look into whether prior authorization or other administrative hurdles also contributed to provider shortages.
The chair closed the item, recording the rule as reviewed.
