Medically_Tailored_Meals_Workflow.pdf

Final MTM Workflow 6-8-2026

Medically Tailored Meals (MTM) Workflow

This document outlines the minimum requirements AAAs and providers must abide by regarding the MTM workflow for both LTSS and non LTSS contracts. AAAs may choose to implement more stringent requirements for non LTSS contracts.

1. Individual indicates interest in MTM

a. Client has been informed of the benefit through one of a variety of pathways

2. AAA/HCS/DDCS/subcontractor performs eligibility evaluation

a. Eligible

i. Referring professional/caregiver/client indicates medical condition and associated diet requirements (if known), food allergies, and/or food preferences within diet requirements

• Provide a nutrition plan from RDN or PCP completed within the past 6 months, if available

ii. AAA/HCS/DDCS/subcontractor determines the maximum number of meals available to be authorized (LTSS 3 meals a day / non LTSS as determined by the AAA)

• Client chooses number of meals up to maximum allowance

iii. AAA/HCS/DDCS sends approval notification

iv. AAA/HCS/DDCS sends referral to MTM provider and include nutrition plan from RDN or PCP completed within the past 6 months, if available

• LTSS – Referral Packet

• Non LTSS – GetCare Authorization

v. MTM provider confirms receipt and accepts referral

• Response is required within 2 business days

• If MTM provider denies referral, AAA/HCS/DDCS contacts another

MTM provider, if available

For AAAs subcontracting eligibility evaluation, go to step 2.a.v.

If there is no willing and qualified provider available, go to step 2.d.iii.

vi. AAA/HCS/DDCS authorizes service. This step must take place between eligibility determination and service provision. If a subcontractor is providing eligibility determination, there must be separation of services to create a firewall between eligibility determination and service provision.

• LTSS – CARE

• Non LTSS – GetCare or another DSHS approved process that includes a step in which the AAA is authorizing services

b. MTM RDN/RD/PCP completes an initial assessment to develop a medically appropriate nutrition plan if there is no nutrition plan from outside RDN/RD/PCP available

i. Provide written nutrition plan to client or authorized representative

ii. For LTSS, provide written nutrition plan to HCS Imaging Unit

• HCS Imaging Unit then upload to BARCODE o Fax 855-635-8305

PO Box 45826 Olympia, WA 98504-5826

iii. For non LTSS, provide written nutrition plan or attestation of such to the AAA

• If AAA receives the nutrition plan, AAA uploads into the electronic file in GetCare

• If AAA receives contractor attestation, AAA maintains record

iv. MTM provider begins meal delivery following diet requirements, food allergies, and/or food preferences to the extent practicable

• For LTSS, within 10 calendar days of completion of a medically appropriate nutrition plan

• For non LTSS, within 21 calendar days of completion of a medically appropriate nutrition plan

c. If initial assessment to complete a medically appropriate nutrition plan is not possible prior to meal delivery NOTE: this should be an exception rather than standard practice

i. MTM provider will notify the case manager, including the reasoning

ii. Case manager may authorize meal delivery to begin if the client has a specific medical condition listed in CARE/GetCare for which there are known diet requirements that the MTM provider has available

iii. Case manager will provide verbal and written notification to client or authorized representative about the requirement/need to complete a nutrition plan for services to continue

iv. Case manager will enter a SER in CARE/progress note in GetCare

v. MTM services must be terminated/paused after 30 calendar days of meal delivery until a medically appropriate nutrition plan is completed by the MTM

RDN/RD/PCP

d. Denied

i. Individual ineligible for Medicaid

• Verbally inform the individual; no further action required

ii. Individual eligible for Medicaid but does not meet other requirements of

MTM

• Send a denial notification (PAN or notice)

iii. Individual is eligible but there are no available providers

• Send a denial notification (PAN or notice)

3. 6-month reassessment

a. AAA/HCS/DDCS/subcontractor performs eligibility evaluation

i. An eligibility reassessment is required if the client wishes to continue MTM services

4. Termination of services

a. If a client has been receiving services and becomes ineligible at some point during the service authorization period

• Send a termination notification (PAN or notice)

b. If, at the end of the service authorization period, a client no longer wishes to receive the service

• No action needed, as the original PAN or notice includes the authorization period for MTMs.

If eligible and services will continue, go to step 2.a.

If services are denied or will otherwise be terminated, got to step 2.d or 4.