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Medicare Ruling Levels Playing Field Among Nutrition Professionals and Registered Dietitians in Hospitals


June 11, 2014

CHICAGO, IL—A landmark federal ruling that all qualified nutrition professionals—not just Registered Dietitians—may order therapeutic diets in hospitals, has leveled the playing field between nutrition professionals and Registered Dietitians.

The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid (CMS) ruled [i] that:

“all patient diets, including therapeutic diets, must be ordered by a practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition professional as authorized by the medical staff and in accordance with State law.” [emphasis added]

The ruling adopts the Board for Certification of Nutrition Specialists’ (BCNS) formal recommendation to CMS that qualified nutrition professionals obtain any privileges granted to Registered Dietitians.

The ruling goes on to state:

“We agree with commenters that the regulatory language for § 482.28 should be inclusive of all qualified nutrition professionals. We do not agree with commenters who requested that we use the term “registered dietitian” or define “qualified dietitian” as an individual specifically registered with the Commission on Dietetic Registration. We agree that a more flexible approach would be the best way to ensure that patients benefit from the improved quality of care that these professionals can bring to hospital food and dietetic services.” [ii] [emphasis added]

“This ruling has vast implications for the nutrition profession,” said BCNS President Sidney Stohs, PhD, CNS, FACN, ATS. “It embraces the right of a variety of highly qualified nutrition professionals—such as Certified Nutrition Specialists—to practice in hospitals, and rejects the assertion that Registered Dietitians should have an exclusive right to provide medical nutrition therapy.”

“Most importantly,” said Dr. Stohs, “this ruling is a victory for patients, giving hospitals flexibility in determining which type of nutrition provider will best serve its patients’ health.”

The Board for Certification of Nutrition Specialists (BCNS) is the foremost credentialing body for advanced nutrition professionals. Its Certified Nutrition Specialist® certifying program is accredited by the National Commission for Certifying Agencies (NCCA), the preeminent standard of excellence for certifying bodies, and is featured in the U.S. Department of Labor’s Definition of the Nutritionist Profession. The BCNS’ Center for Nutrition Advocacy is the leading advocate ensuring public access to a range of nutrition professionals.

More detail on the final rule and implications are available at BCNS’ advocacy initiative, the Center for Nutrition Advocacy: NutritionAdvocacy.org/recent-rulings

[i] Final Ruling on Regulatory Provisions to Promote Program Efficiency Transparency, Efficiency and Burden Reduction. May 12, 2014.
[ii] Centers for Medicare & Medicaid Services
42 CFR Parts 413, 416, 440, 442, 482, 483, 485, 486, 488, 491, and 493
RIN 0938-AR49
Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Part II p 45