Wisconsin Chronic Disease Program

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Wisconsin Chronic Disease Program Policies Coverage of Enteral Nutrition Products

The Wisconsin Chronic Disease Program (WCDP) has been a critical source of payment for medical services for Wisconsin residents who have renal disease, cystic fibrosis or hemophilia. WCDP operates within a very limited budget and is funded only with Wisconsin taxpayer dollars. Within this limited budget WCDP must assure that it pays only for products and services that are medically necessary.

Thus, WCDP has established the following policies on coverage for enteral nutrition products:

• Enteral nutrition product claims need to include:
  • The completed Medicaid prior authorization forms (PA/RF and PA/ENPA), with documentation of the medical necessity of the product.
  • A prescription from the patient’s physician, nurse practitioner or physician assistant.
• WCDP will not pay for enteral nutrition products for which other payers have denied coverage. For example, if Medicaid has denied coverage of the product due to medical necessity or an error in claims submission, WCDP will not pay for the product.

Low-income individuals should consider obtaining nutritional products and vitamins from the following sources:

• The Food Share Program (formerly Food Stamp Program) covers nutritional products such as Ensure, Boost, and Compleat. For more information about Food Share see http://dhs.wisconsin.gov/foodshare/fsspending.htm
• The Medicaid program covers several brands of legend renal care vitamins when prescribed and medically necessary for renal patients.

Please contact WCDP with any questions regarding this policy update at (608) 221-3701.

Back to the WCDP Home Page.

Last Revised: July 07, 2008