23 Miss. Code. R. 209-1.30 - Infusion Pump, Enteral/Parenteral/External

A. Medicaid defines an enteral pump as a device used to deliver nutritional requirements to the stomach or small bowel via a tube, including nasogastric, gastrostomy, jejunostomy and PEG tubes.

B. Medicaid covers enteral pumps for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity, for rental up to purchase amount, or for purchase when ordered by a physician and if the following criteria is met:

1. The beneficiary is tube fed, and

2. The enteral feedings are the sole source of nutrition.

C. Medicaid defines a parenteral pump as a device used to deliver nutritional requirements intravenously. Intravenous nutrition is also referred to as Total Parenteral Nutrition (TPN) or hyperalimentation therapy.

D. Medicaid covers parenteral pumps if prior authorized, for rental up to purchase amount, or for purchase if indicted for all beneficiaries when ordered by a physician for beneficiaries who cannot absorb nutrients by the gastrointestinal tract.

E. Medicaid defines an ambulatory infusion pump as a small portable electrical device that is used to deliver parenteral medication. It is designed to be carried by or worn by the beneficiary.

F. Medicaid defines a stationary infusion pump as an electrical device which serves the same purpose as an ambulatory pump, but is larger and typically mounted on a pole.

G. Medicaid covers ambulatory and stationary pumps when prior authorized, for rental up to purchase amount, or purchase if indicated when ordered by a physician for home use when the following criteria is met:

1. Parenteral administration of the medication in the home is reasonable and medically necessary; and

2. An infusion pump is necessary to safely administer the medication.

Notes

23 Miss. Code. R. 209-1.30

42U.S.C. § 1395m; Miss. Code Ann. §§ 43-13-117(17), 43-13-121.

Amended 9/1/2018