Abstract
Vulnerable adult populations’ access to cost-effective medical nutrition therapy (MNT)
for improving outcomes in chronic disease is poor or unquantifiable in most Health
Resources & Services Association (HRSA)-funded health centers. Nearly 50% of the patients
served at Federally Qualified Health Centers are enrolled in Medicaid; the lack of
benefits and coverage for MNT is a barrier to care. Because the delivery of MNT provided
by registered dietitian nutritionists is largely uncompensated, health centers are
less likely to offer these evidence-based services and strengthen team-based care.
The expected outcomes of MNT for adults with diabetes, obesity, hypertension, and
other conditions align with the intent of several clinical quality measures of the
Uniform Data System and quality improvement goals of multiple stakeholders. HRSA should
designate MNT as an expanded service in primary care, require reporting of MNT and
registered dietitian nutritionists in utilization and staffing data, and evaluate
outcomes. Modification to the Centers for Medicare & Medicaid Services Prospective
Payment System rules are needed to put patients over paperwork: HRSA health centers
should be compensated for MNT provided on the same day as other qualifying visits.
Facilitating the routine delivery of care by qualified providers will require coordinated
action by multiple stakeholders. State Medicaid programs, Medicaid Managed Care Organizations,
and other payers should expand benefits and coverage of MNT for chronic conditions,
factor the cost of providing MNT into adequate and predictable payment streams and
payment models, and consider these actions as part of an overall strategy for achieving
value-based care.
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Biography
N. Braunstein is an assistant professor and dietetic internship director, California State University Sacramento, Family and Consumer Sciences Department, Sacramento, CA.
Biography
M. Shrum-Guerrero is a business analyst, White Salmon, WA.
Biography
S. Liles is the director of nutrition services/WIC, Santa Barbara, CA.
Biography
A. Germann is the clinical medical director, Salud Medical Clinic, Woodburn, OR.
Biography
M. Kuppich is senior manager, Nutrition Services Integration, Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL.
Biography
H. Martin is the director, Legislative and Government Affairs, Academy of Nutrition and Dietetics, Washington, DC.
Biography
M. Schofield is the senior director, Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago IL.
Biography
K. Yoder Latortue is the executive director, Miami Beach, FL.
Article info
Publication history
Published online: December 16, 2020
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.
AUTHOR CONTRIBUTIONS N. Braunstein, M. Guerrero, S. Liles wrote and revised drafts with the support of Academy staff member M. Kuppich. All authors reviewed and commented on subsequent drafts of the manuscript.
Identification
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© 2021 by the Academy of Nutrition and Dietetics.
