NEW YORK—The New York State Department of Health announced it has increased calorie limits for fee-for-service (FFS) Medicaid beneficiaries who receive enteral nutrition, with 25% increases for both oral- and tube-fed patients. The department said the new guidance is effective immediately.
"Effective Feb. 11, 2026, the regulatory amendment Section 505.5 of Title 18 NYCRR for enteral nutrition defined benefit changes will be implemented for Fee-for-Service (FFS) Medicaid members," the department said. "The changes will take effect with new prior authorizations and prior approval requests for enteral formula therapy initiated on or after this date."
The department's updates state calorie limits approved through the Enteral Web Portal and Interactive Voice Response (IVR) prior authorization systems will be increased from 1,000 calories per day to 1,250 calories per day for oral-fed members. Calorie limits for tube-fed members will increase from 2,000 calories per day to 2,500 calories per day.
The Association of Academic Health Centers said the increase in NY Medicaid’s calorie limits for enteral products is a result of a collaborative effort between American Association for Homecare (AAHomecare), Northeast Medical Equipment Providers Association and other stakeholders that began in 2023 when Medicaid transitioned enteral and other medical supplies back to FFS.
Updates also include that members with a body mass index under 18.5 are now allowed five refills per authorization approved through the Enteral Web Portal and IVR prior authorization systems.
"Medicaid recipients facing complex conditions including amyotrophic lateral sclerosis (ALS) and cancer often exceeded the prior calorie limitations which required a slow/labor intensive manual override process to obtain approval," the department said. "These changes will reduce administrative costs for suppliers and strengthen access to medically necessary enteral products and services."
See the Feb. 11 update from the NYS Dept. of Health for more details. Resources for enteral nutrition prior authorizations have been updated to reflect the changes noted above and can be found on the DME Manual homepage.