To all American Dietetic Association members:
Seven years after passing legislation to make Registered Dietitians Medicare providers of Medical Nutrition Therapy, Congress has sent the President a proposal which should allow for a major expansion of the benefit. Originally Congress limited MNT only to beneficiaries with diabetes and renal diseases.
The bill passed by the Senate Wednesday, July 9, and earlier by the House of Representatives contains language that should allow MNT to be expanded to cover therapy considered reasonable and necessary for the prevention of an illness or disability.
The Medicare bill was considered one of Congress' "must pass" pieces of legislation because it overrides a scheduled reduction in physician reimbursement rates of 10.6 percent set to go into effect July 1. Virtually no member of Congress supported reducing reimbursement rates; however, there has been considerable disagreement over how to pay for preventing the reductions.
Last August, the House of Representatives passed a bill that not only dealt with the reimbursement issue, but contained a title expanding preventive services covered by Medicare. That title contained a list of preventive services to be covered which specifically included MNT.
According to ADA President Martin Yadrick, MS, MBA, RD, FADA, inclusion of MNT as a preventive service was the direct result of years of work by ADA members to expand MNT coverage.
Yadrick said that according to the United States Preventive Services Task Force, there is strong evidence that proper nutrition intervention can help prevent hyperlipidemia, high blood pressure, obesity, and diabetes. "Covering nutrition therapy for Medicare beneficiaries with diabetes while not covering beneficiaries diagnosed as pre-diabetic is counter to everything we know about saving lives and saving money." The Centers for Disease Control now estimates that 57 million people are pre-diabetic.
The Medicare bill sent to the President does not contain a list of specific preventive services to be covered. Instead, the bill establishes a procedure by which new services will be considered and evaluated. To be covered, preventive services must be proven to be necessary and reasonable and receive a recommendation from the United States Preventive Services Task Force. Yadrick said that expanding MNT to conditions such as pre-diabetes should be approved by Medicare relatively quickly since the evidence is so strong that proper nutrition intervention can prevent the progression of the disease. He indicated that other conditions recommended by the USPSTF also would be evaluated by ADA and submitted to Medicare for consideration.
"Approval of new preventive services is a major achievement and helps make Medicare more responsive to the patient's needs. MNT is an example of one critically important service to patients that heretofore prevented Medicare from being a comprehensive health care delivery system." Yadrick said "Expanding Medicare coverage of MNT has been a high priority of ADA and its members for years.
"ADA members have made hundreds of visits to Capitol Hill, written thousands of letters, and lobbied nearly every member of Congress over the last few years trying to convince them that nutrition therapy could was an essential element of any comprehensive health care plan. While more work needs to be done to ensure Medicare correctly interprets the intent of Congress to cover expanded MNT services, passage of the Medicare bill still represents a major step forward in providing seniors on Medicare access to critical services that can improve their lives."