As of Oct. 1, 2020, EmblemHealth covers medically tailored, home-delivered meals for Medicaid and HARP members under certain EmblemHealth value-based provider agreements.
The GLWD meal intervention program consists of a three-step approach to address social determinants of health such as food insecurity and malnutrition related to chronic health conditions. Patients in need of medically tailored meals (tailored diets designed to improve health conditions [e.g. members with COPD, CKD, and/or diabetes can improve their health condition (s) with a low sodium diet]) that are referred to the program will receive:
- A nutritional assessment by a Registered Dietitian Nutritionist (RDN).
- Evidence-based, medically tailored meals that address patients’ specific medical circumstances.
- Ongoing nutrition education and counseling.
Your patients may be eligible to receive medically tailored meals if they meet all necessary criteria, including but not limited to:
- Live in the five (5) boroughs of NYC, Westchester, Suffolk, or Nassau County
- Have access to a microwave, oven, or hotplate
- Have access to a refrigerator and freezer
- Do not have any of the following food allergies/restrictions: Beans, Celery, Gluten, Halal, Kosher, Onions, or Soy
- Have at least two (2) chronic medical conditions, and
- Have at least one (1) of these functional needs:
- Client exhibits impaired judgement
- Client is disoriented to person/place/time
- Client exhibits wandering
- Client cannot stand for more than 20 minutes
- Client has severely limited range of motion in arms and legs
- Client needs assistance ambulating outside
- Client uses assistive device
- Except for appointments, client’s mobility is restricted to the home
- Client is bedbound
If your patient is eligible and needs medically tailored meals, submit a Preauthorization Request using our secure provider portal at emblemhealth.com/providers. Click here to see the Clinical Criteria questions that will require your patient’s answer when submitting the Preauthorization Request. Additionally, please follow these recommended guidelines when filling in the online form:
|Prior Approval Request Type:||Office Services|
|Service Date:||Include a buffer of 3-5 days when making a Service Date selection.|
|Facility Code:||Office (11)|
|Service Type:||Medical Care (1)|
|Service Level:||Elective (01)|
|Servicing Provider PRIS # or NPI:||PRIS#: 846714P NPI: 1467646281|
|Procedure Code:||S5170 - Home-delivered meals, including preparation; per meal|
|Procedure Units - 1 Month of Service:||Option A - 2 Meals (Lunch and Dinner) a Day: 60 Units
Option B - 3 Meals (Breakfast, Lunch, and Dinner) a Day: 90 Units
|Procedure Units - 3 Months of Service:||Option A - 2 Meals (Lunch and Dinner) a Day: 180 Units
Option B - 3 Meals (Breakfast, Lunch, and Dinner) a Day: 270 Units