California Health and Safety Code Section 1374.56
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California Laws > Health and Safety Code > California Health and Safety Code Section 1374.56
1374.56. (a) On and after July 1, 2000, every health care service
plan contract, except a specialized health care service plan
contract, issued, amended, delivered, or renewed in this state that
provides coverage for hospital, medical, or surgical expenses shall
provide coverage for the testing and treatment of phenylketonuria
(PKU) under the terms and conditions of the plan contract.
(b) Coverage for treatment of phenylketonuria (PKU) shall include
those formulas and special food products that are part of a diet
prescribed by a licensed physician and managed by a health care
professional in consultation with a physician who specializes in the
treatment of metabolic disease and who participates in or is
authorized by the plan, provided that the diet is deemed medically
necessary to avert the development of serious physical or mental
disabilities or to promote normal development or function as a
consequence of phenylketonuria (PKU).
(c) Coverage pursuant to this section is not required except to
the extent that the cost of the necessary formulas and special food
products exceeds the cost of a normal diet.
(d) For purposes of this section, the following definitions shall
(1) "Formula" means an enteral product or enteral products for use
at home that are prescribed by a physician or nurse practitioner, or
ordered by a registered dietician upon referral by a health care
provider authorized to prescribe dietary treatments, as medically
necessary for the treatment of phenylketonuria (PKU).
(2) "Special food product" means a food product that is both of
(A) Prescribed by a physician or nurse practitioner for the
treatment of phenylketonuria (PKU) and is consistent with the
recommendations and best practices of qualified health professionals
with expertise germane to, and experience in the treatment and care
of, phenylketonuria (PKU). It does not include a food that is
naturally low in protein, but may include a food product that is
specially formulated to have less than one gram of protein per
(B) Used in place of normal food products, such as grocery store
foods, used by the general population.
Last modified: February 22, 2013