DAR File No. 37228

Human Services, Aging and Adult Services

Section R510-104-11

Liquid Meals

Notice of Proposed Rule

(Amendment)

DAR File No.: 37228
Filed: 01/24/2013 04:35:48 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment does two things: 1) the term "liquid meal" describing liquid nutritional supplement products such as Ensure is no longer used by the Administration on Community Living (ACL). This amendment updates the rule to use the ACL's new acceptable term, "medical meal"; and 2) the current version of the rule indicates federal reimbursement can be received for medical meals prescribed by a doctor, dietician, or nurse following a clinically-based assessment of the client. However, in reality, while a dietician or nurse needs to perform the assessment before a medical meal can receive federal reimbursement, a doctor can prescribe a reimbursable medical meal without the need to conduct the assessment. This amendment corrects both of these issues and makes the wording and practices associated with these meals conform to the ACL's policies.

Summary of the rule or change:

The amendment changes all instances of "liquid meal" in the rule to "medical meal." It also clarifies that a doctor can prescribe medical meals without conducting a clinically based assessment, and that the prescribed meals will still be federally reimbursable.

State statutory or constitutional authorization for this rule:

• 42 USC 3001
• Section 63A-3-104

Anticipated cost or savings to:

the state budget:

No savings or cost--This change is in rule language only and does not create savings or expenses for the Division of Aging and Adult Services.

local governments:

No savings or cost--This change is in rule language only and does not create savings or expenses for the local Area Agencies on Aging.

small businesses:

This change is in rule language only and does not create savings or expenses for providers or other small businesses.

persons other than small businesses, businesses, or local governmental entities:

This change is in rule language only and does not create savings or expenses for clients. The suggested donation will remain the same.

Compliance costs for affected persons:

These changes clarify the existing rule and do not create any compliance costs.

Comments by the department head on the fiscal impact the rule may have on businesses:

I have reviewed this wording changes and there are no fiscal impacts from this rule change.

Palmer DePaulis, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Aging and Adult Services
195 N 1950 W
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Nels Holmgren at the above address, by phone at 801-538-3921, by FAX at 801-538-4395, or by Internet E-mail at nholmgren@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/25/2013

This rule may become effective on:

04/01/2013

Authorized by:

Nels Holmgren, Director

R510. Human Services, Aging and Adult Services.

R510-104. Nutrition Programs for the Elderly (NPE).

R510-104-11. [Liquid]Medical Meals.

(1) In situations where nutritional considerations make solid foods inappropriate, the need for nutrient supplements to include [liquid supplemental feedings]medical meals (meeting the required RDI Guidelines) may be part of medical nutrition therapy recommended by a registered dietitian, registered nurse or physician, [with the concurrence of the local AAA,] primarily when the participant [can not]cannot tolerate or digest regular meals. [Exceptions to solid foods shall be documented by the nutrition case manager who shall record that other alternatives were tried but unsuccessful. All other sources of home-delivered meal modification should be exhausted before liquid supplemental feedings become the main nutritional regimen.]

(2) Only seniors are eligible for [liquid]medical meals purchased through the Nutrition Program for the Elderly (NPE) funding. Exceptions can be made for Alternatives clients under 60. Additionally, AAAs always have the discretion to use county dollars in any way they see fit.

(3) A [liquid]medical or secondary meal shall only be offered in place of regular food as the first meal[, if prescribed by a physician, dietitian, or nurse, or if an AAA makes an exception for a client who prefers a liquid meal, provided the AAA follows the process outlined below].[

(a)] In order to receive [liquid]medical meals through the Nutrition Programs for the Elderly ([NPE]NPS),[the participant must be a client and be determined to be at moderate to severe risk of malnutrition. The participant will fill out] the following [tools to arrive at a nutrition screening score if they would like an exception made to receive liquid meals without a health professional's prescription]requirements must be met:

(i) A demographic questionnaire must be completed (for the AAA records).

[(ii) The AAA's nutritional health screening tool.](ii) A physician must issue a prescription, or a clinically based assessment must be completed by a dietician or nurse.

(4) A [liquid]medical meal distributed through the AAAs' NPE Programs must meet the 33 1/3 DRI nutrient requirements. If the [liquid]medical meal is picked up by the client or client representative at a senior center, the meal will count as a congregate meal (C1) and if the [liquid]medical meal is delivered to the client's home by the AAA staff, the meal will be considered a home delivered meal (C2).

(5) The Participant may not be provided more than a one month supply of medical liquid supplement at one time.

(6) A confidential contribution system shall be in place with a suggested donation in order to qualify the [liquid]medical meal for the USDA cash-in-lieu reimbursement.

 

KEY: elderly, nutrition, home-delivered meals, congregate meals

Date of Enactment or Last Substantive Amendment: [July 21, 2009]2013

Notice of Continuation : October 8, 2009

Authorizing, and Implemented or Interpreted Law: 62A-3-104; 42 USC Section 3001