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      RS 22:246     


§246.  Inherited metabolic diseases; coverage for food products

A.  Every health maintenance organization granted a certificate of authority under this Subpart and every insurer licensed under the provisions of Subpart C of Part I of Chapter 2 of this Title that engages in health maintenance organization activities authorized and regulated pursuant to this Subpart shall provide coverage to each enrollee or family member of an enrollee, subject to applicable deductibles, coinsurance, and copayments, for low protein food products for treatment of inherited metabolic diseases, if the low protein food products are medically necessary and, if applicable, are obtained from a source approved by the health maintenance organization or health insurer, provided coverage will not be denied if the health maintenance organization or health insurer does not approve a source.

B.  As used in this Section, the following words shall have the following meanings:

(1)  "Inherited metabolic disease" shall mean a disease caused by an inherited abnormality of body chemistry.  These diseases shall be limited to:

(a)  Glutaric Acidemia.

(b)  Isovaleric Acidemia (IVA).

(c)  Maple Syrup Urine Disease (MSUD).

(d)  Methylmalonic Acidemia (MMA).

(e)  Phenylketonuria (PKU)

(f)  Propionic Acidemia.

(g)  Tyrosinemia.

(h)  Urea Cycle Defects.

(2)  "Low protein food products" shall mean a food product that is especially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease. Low protein food products shall not include a natural food that is naturally low in protein.

C.  Coverage provided pursuant to this Section shall not exceed eligible benefits of two hundred dollars per month.

D.  Repealed by Acts 2009, No. 503, §2.

Acts 2003, No. 829, §1; Redesignated from R.S. 22:2004.2 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2009, No. 503, §2.

NOTE:  Former R.S. 22:246 redesignated as R.S. 22:2243 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

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