Enteral and Oral Nutrition Therapy in the Outpatient Setting
Summary
Effective October 1, 2026, enteral nutrition formulas, supplies and infusion pumps in the home setting may be considered medically necessary when the individual has severe intestinal malabsorption, permanent nonfunction or disease of the structures that normally permit food to reach the small bowel, a neuromuscular or central nervous system disorder or prematurity with a risk of aspiration, or malnutrition or risk of malnutrition with inadequate oral intake, failure to thrive, or faltering weight in a child. Specialized formulas for inborn errors of metabolism, in-line digestive enzyme cartridges for exocrine pancreatic insufficiency due to cystic fibrosis, and specialized formulas for eosinophilic gastrointestinal associated disorders under Washington House Bill 2153 member contracts may also be considered medically necessary when their listed criteria are met. Food thickeners, fluid and electrolyte replacements, fiber additives, blenderized foods and oral nutrition supplements are considered not medically necessary.
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