CMS Proposes Expanded Hospital Dietitian Privileges for Ordering Diets

February 11th, 2013

As you know, the Academy has been engaged in conversations with the Centers for Medicare & Medicaid Services (CMS) for approximately two years regarding therapeutic diet order regulations. These regulations preclude RDs from ordering patients’ diets and result in costly and harmful delays in patient care. We have met and communicated frequently with CMS on this issue and offered letters evidencing the Academy’s rationale for allowing RDs to be able to independently change and order patient diets. Ensuring that RDs are able to practice at the fullest extent of our scopes of practice remains one of the Academy’s highest priorities.

This week (February 4, 2013), CMS announced in the attached press release that it is proposing a rule change that would, among other things, “Save hospitals significant resources by permitting registered dietitians to order patient diets independently, which they are trained to do, without requiring the supervision or approval of a physician or other practitioner. This frees up time for physicians and other practitioners to care for patients.” This exciting development is designed to help health care providers to operate more efficiently by getting rid of regulations that are out of date or no longer needed. Many of the rule’s provisions streamline the standards health care providers must meet in order to participate in the Medicare and Medicaid programs without jeopardizing beneficiary safety.

The proposed rule ( is open for public comment until April 8, 2013. The Academy’s Policy Initiatives & Advocacy team and Quality Management team will collaborate to prepare comments in support of this rule change as it is significant for Academy members and for the patients they serve. Several particulars about the proposed rule change are important to note:

  • The proposed rule, if adopted, would not take effect until later this year. RD practice in hospitals should not change until the final rule is published;
  • The proposed rule would apply only to RDs privileged by hospitals. The Academy will continue to work with CMS to urge a separate regulatory change that would apply to RDs practicing in long term care or other facilities;
  • CMS proposes to allow “licensed dietitians” to order patient diets. The Academy will work to ensure that only the qualified nutrition professional, with expertise mirroring that of the RD gold standard specified in the Social Security Act, will be able to order diets independently, thereby protecting patient health and realizing the cost savings associated with RD-ordered diets; and
  • CMS has adopted the Academy-approved “therapeutic diet” definition and interpretive guidance for the Resident Assessment Instrument Manual 3.0. The Academy will work with CMS to encourage adoption of the definition for hospitals and across the continuum of care.

You can be assured that we will continue to provide all relevant data, information, and experiences resulting from the proposed rule in our communication and will encourage ongoing input from DPGs and affiliates on the impact of the rule and its implementation. The Academy will also coordinate with members to solicit support for the proposed rule from physician and non-physician providers, hospitals, and congressional champions.


Policy Initiatives and Advocacy Team and
Quality Management Team

Academy of Nutrition and Dietetics
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606

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