What is the test of permanence for HEN coverage guidelines under Medicare?

• A. Permanence is defined solely by 6 months of non-improvement
• B. Based on the judgement of the attending physician and is substantiated in the medical record; Permanence means indefinite duration, 90 days or greater
• C. It is determined by the patient’s age
• D. It requires a formal multi-disciplinary committee approval

Answer: (B)

The key idea is that Medicare looks at whether there is a long-term, not temporary, need for home enteral nutrition based on the clinician’s judgment and how it’s documented. For permanence in HEN coverage, the attending physician must determine and record that the patient will require tube feeding for an extended, essentially indefinite period. In practice, this is described as permanence lasting 90 days or longer, which signals a long-term or permanent need rather than a short-term or trial period. The physician’s clinical reasoning and plan must be in the medical record to support this determination.

This isn’t based on the patient’s age, nor does it require a formal multi-disciplinary committee approval. It also isn’t defined by a fixed non-improvement timeframe like six months. The essential point is the physician’s professional judgment, backed by documentation, that the tube feeding will be needed for an indefinite or very long duration, typically 90 days or more.