§469.  Inherited metabolic diseases; coverage for food products

A.  Every self-insurer and self-insurance plan, as defined in this Subpart, which are subject to the jurisdiction of the commissioner under this Title shall provide coverage, 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 self-insurer or self-insurance plan, provided coverage will not be denied if the self-insurer or self-insurance plan 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. Such 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D.  Repealed by Acts 2009, No. 503, §2.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. 22:3018.1 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2009, No. 503, §§1, 2.