Changes to Medicare CoPs Liberalizing Practice by Registered Dietitians Won’t Impact Nebraska or Iowa Hospitals Yet
Although the Centers for Medicare & Medicaid Services (CMS) recently relaxed Medicare hospital staffing requirements to allow qualified dietitians and nutritionists to order patient diets, state law still prevents these practitioners from practicing independently in Nebraska and Iowa hospitals.
Medicare Conditions of Participation (CoPs) previously permitted only the physician or qualified non-physician practitioner responsible for a patient’s hospital care to order therapeutic diets. CMS’s revisions, which took effect July 11, 2014, give hospitals flexibility to grant limited ordering privileges to “qualified nutrition professionals” such as registered dietitians (RDs). The CoP authority is, however, subject to state law and authorization by a hospital’s medical staff.
In Nebraska, RDs are regulated as “medical nutrition therapists” and state law expressly defines the scope of practice of a licensee to the practice of medical nutrition therapy “under the consultation of a licensed physician.” Hospital licensing regulations distinguish ordering diets—permitted by physicians and certain non-physician practitioners like PAs and nurse practitioners—from assessing the nutritional status of patients, which can only be done by a medical nutrition therapist. Taken together, these laws do not appear to allow a hospital to grant independent clinical privileges to RDs.
The Iowa hospital regulations similarly differentiate nutritional assessment and counseling by an RD from the prescribing of a diet by a “qualified health care practitioner.” The RD’s role is limited to supervision and consultation with respect to the planning, preparation, and service of therapeutic diets.
Thus, while both require some level of involvement by an RD in a hospital’s food and dietary services, at this time neither state has explicitly extended the authority of a dietitian beyond practicing in collaboration with a physician or non-physician member of the medical staff who has ordering privileges.