Type: Medicaid- Food as Medicine
Program Goal:
To evaluate whether a patient qualifies for medically tailored meals/grocery boxes, and if they do coach them on how to effectively use the benefit once they receive the food while addressing their nutrition, SDOH, and medical needs. We receive members from partnered food vendors and from CalOptima directly.
The goals of RD visits paired with medically tailored meals is to see improvements in
HbA1c
Weight
Diet quality (assessed in NQ data)
Secondary Outcomes and Measures:
Improvements in food insecurity (collected via NQ)
Engagement with telenutrition
States Served: CA
RD Requirements
Health Plan Credentialing
| State Medicaid Enrollment | Foodsmart Credentialing Requirements |
None | None
In California, Registered Dietitians and the CalOptima program are part of Cal-Aim (Ancillary/Social Services) so Medicaid Provider Enrollment isn't required at this time | Medallion Credentialing Application Copies of CDR, license in home state and where pt resides*, CV |
Benefits Overview:
Video Required | # of Allowed Visits | # of Allowed Units per Visit | Schedule Cadence
| Billing Codes |
No | Low Risk: NO VISITS (after the initial) or FOOD
Medium Risk: 5 visits (1 initial and 4 follow ups) Will be recommended for 4 weeks of food at a time with up to 8 weeks in total
High Risk: 7 visits (1 initial and 6 follow ups). Will be recommended for 4 weeks of food at a time with up to 12 weeks in total
| Initial: up to 6 units
Follow Up: up to 4 units | Medium and High Risk:
Visits every 2 weeks, which includes reassessment monthly
| Initial: 97802
Follow Up: 97803
|
MNT visits do renew each year, however the meals do not once they’ve reached the lifetime maximum
If a patient is not eligible for meals emphasize the benefits of MNT to help them maximize what they have now. Help them enroll in SNAP. If their situation changes, we can reassess them three weeks (or more) later, and see if the risk score changes.
RD Assessments:
NutriQuiz | SNAP | Risk Assessment |
Recommended before the 2nd visit and monthly for retesting | Required
Eligibility should be checked frequently
| Yes- see below
|
Food Benefits:
Foodsmart Bucks | Foodboxes/MTM | Food Selection Instructions |
NONE | YES | CalOptima has a maximum lifetime benefit limit of 8 weeks for Medium risk and 12 weeks for High risk
If members have already hit that threshold, no more food can be given- even if they are assessed as “high risk.”
If receiving MTM the patient will receive 2 meals per day for 7 days of the week.
Estimated turnaround time after the RA is submitted is 1-3 weeks
|
Risk Assessment Details:
Once the Risk Assessment is finalized, the responses cannot be modified. However, patients will be eligible for a follow-up appointment to retake the Risk Assessment after three weeks.
Please note that the type of food benefit a patient receives (e.g., medically tailored meals vs. grocery boxes) is determined programmatically based on clinical need and mobility.
How MTM or Produce Boxes are Decided:
Food box selection is based on 3 categories and if there is a recent inpatient visit:
Limitations to activities of daily living (primarily if they can cook and if they have a caretaker at home)
Medical Risk (medical conditions, medications a patient is on)
Food/Nutrition insecurity
If patient has one DHCS qualifying conditions, then patient is medium risk
If patient has one DHCS qualifying condition, and also has recent hospitalization or a second DHCS qualifying condition, then patient is high risk high risk.
If a member flags as medium or high risk, the member qualifies for food.
DHCS Qualifying Conditions
cancer(s)
cardiovascular disorders
chronic kidney disease
chronic lung disorders or other pulmonary conditions such as asthma/COPD
heart failure
diabetes or other metabolic conditions
elevated lead levels
end-stage renal disease
high cholesterol
human immunodeficiency virus
hypertension
liver disease
dyslipidemia
fatty liver
malnutrition
obesity
stroke
gastrointestinal disorders
gestational diabetes
high risk perinatal conditions
chronic or disabling mental/behavioral health disorders
More MTM Details:
If the patient has a preference for a vendor that matches the food benefit type that is determined then they will receive food from that vendor (or at least Foodsmart will send a referral out to that food vendor).
Preferences are considered, but not guaranteed.
Grocery box or MTM provider referrals will be dispatched automatically based on the assigned tier.
Example: if a patient prefers a vendor that can only provide medically tailored/pre-prepared meals, but they are only qualified for grocery/produce boxes, their vendor preference would not be considered.
Please only add the member preferred diet type in the "RD Recommendation" field in the RA and note that retaking the RA does consider grocery vs MTM.
CalOptima FAQs:
How long does it take for the member to be contacted and receive food?
Our system sends food referrals to food vendors at the end of each day. Most vendors typically reach out within 72 business hours. However, during periods of high referral volume, we kindly ask that patients allow up to two weeks before inquiring about their status. If it has been over two weeks, submit a ticket.
What if my member doesn’t know how many weeks they have used, or how many they have left, for food box delivery, since the limit is 8 or 12 weeks with CalOptima?
Have your patient call CalOptima, using the phone number on their healthcare card, to inquire how many claims have been submitted for food boxes of the 8 or 12 week limit.
What should I do if my member received a food box but needs meals (or vice versa)?
It is CalOptima policy that all members must retain the initial food benefit for FOUR weeks before submitting for a change. If your patient received the wrong type of food (e.g., a food box instead of meals or vice versa), please submit a request for the correct type of food preference by completing the CalOptima Member Food Change Request
How to change vendors for a food referral?
First confirm with the member that they have received four weeks of food from the initial vendor to which they were referred, as this is a requirement and policy set by CalOptima. If the member has received four weeks of food from the initial vendor and is classified as high risk (with eight weeks remaining), the RD can submit a ticket. If a member was categorized as medium risk based on the Risk Assessment, they may retake the assessment in the FFD portal, after which a new referral, if eligible, will be made based on the updated answers.
How To Explain Food Benefit To Patients:
Initial talking point with your member:
Before taking the risk assessment, it is the RD’s responsibility to assess factors (current medical conditions, access to food support) that your member may or may not be eligible to receive MNT visits and/or food benefits.
Please do not use the word “denial” when discussing your member's food support. We are not their health plan.
RDs should not tell members they are “low, medium or high risk." Instead say whether they are or are not eligible for services.
Use the word “recommend” when discussing the results of our risk assessment (i.e., “I recommend 12 weeks of food be provided based on this assessment. Ultimately, your health plan will review this recommendation for final approval.”)
See the CalOptima Food Vendors
Helpful Programs
Sample Visit Topics
See visit cadence above as each risk level is different.
Visit Number | Topic | To-Dos |
Visit 1 (Last Visit for Low Risk) | Get to Know, NutriQuiz (baseline measurements + reminder to get lab work done), Food Insecurity Screening, Introduction to Wallet Wellness | Risk Assessment
Nutri-Quiz
|
Visit 2 | SNAP application (if applicable). Shopping on a budget and maximizing grocery dollars MNT |
|
Visit 3
| Meal planning and future planning for self monitoring Foodsmart Program MNT | Risk Assessment (medium and high risk)
Nutri-Quiz |
Visit 4 (Last Visit Medium Risk) | Meal planning and future planning for self monitoring Foodsmart Program MNT |
|
Visit 5 | Foodsmart Program MNT |
|
Visit 6 (Last Visit High Risk) | MNT, Future planning for self monitoring (medium risk). Foodsmart Program | Risk Assessment (high risk)
Nutri-Quiz |
Please see the following link of Overview of Health Plans for info on all health plans.