Medical Nutrition Therapy (MNT)
| Date: | May 08, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Providers |
| Type: | Regulatory |
| Subject: | Medical Nutrition Therapy (MNT) |
| Business: | Medi-Cal Managed Care |
Health Plan provides Medical Nutrition Therapy (MNT) to our members in accordance with Department of Health Care Services (DHCS) and our Medical Nutrition Therapy guidelines.
MNT that is provided within the Medi-Cal frequency guidelines does not require prior authorization. Frequency is limited to three hours for the first calendar year and two hours per calendar year in each subsequent year.
Prior authorization is required for MNT services outside of the Medi-Cal frequency guidelines. Please follow Health Plan’s prior authorization process and include documentation supporting the need outside of the frequency guidelines, as outlined in our Provider Manual: January 2024, Section 8 “Utilization Management”– Page 7 titled “Submitting Requests for Authorizations”. This can be accessed online at https://www.hpsj.com/wp-content/uploads/2023/11/Section-8-Utilization-Management.pdf.
For more information on the DHCS MNT guidelines, please refer to “Medical Nutrition Therapy (MNT)” on page 17 of the Medi-Cal Provider Manual titled “Medicine” at https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/A4A4CF11-DFAE-4958-B95F-4DB14D2CEB18/medne.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
