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<section article="ghg" article_name="Health - General" number="19-705.5" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>“Inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry.</text>
      </level>
      <level label="ii">
        <text>“Inherited metabolic disease” includes a disease for which the State screens newborn babies.</text>
      </level>
    </level>
    <level label="3">
      <level label="i">
        <text>“Low protein modified food product” means a food product that is:</text>
        <level label="1">
          <text>Specially formulated to have less than 1 gram of protein per serving; and</text>
        </level>
        <level label="2">
          <text>Intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.</text>
        </level>
      </level>
      <level label="ii">
        <text>“Low protein modified food product” does not include a natural food that is naturally low in protein.</text>
      </level>
    </level>
    <level label="4">
      <text>“Medical food” means a food that is:</text>
      <level label="i">
        <text>Intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation; and</text>
      </level>
      <level label="ii">
        <text>Formulated to be consumed or administered enterally under the direction of a physician.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>A health maintenance organization shall include as part of its benefit package of health care services to be provided to members and subscribers coverage for medical foods and low protein modified food products for the treatment of inherited metabolic diseases if the medical foods and low protein modified food products are:</text>
    <level label="1">
      <text>Prescribed as medically necessary for the therapeutic treatment of inherited metabolic diseases; and</text>
    </level>
    <level label="2">
      <text>Administered under the direction of a physician.</text>
    </level>
  </level>
</section>
