Learn about the CMS Rules on Therapeutic Diet Orders

What is the new CMS rule on therapeutic diet orders?

The Centers for Medicare and Medicaid Services announced a final rule that, among other things, allows the resident's physician in long term care facilities to delegate the ability to order therapeutic diets to qualified RDNs, consistent with state laws. The Academy is committed to working with state affiliates to ensure state laws and LTC regulations facilitate this process of delegated order writing.

CMS previously announced a final rule for hospitals that, among other things, will allow registered dietitian nutritionists to become privileged to independently:

  • Order patient diets without requiring the supervision or approval of a physician or other practitioner; and
  • Order laboratory tests* to monitor the effectiveness of dietary plans and orders. Please note that ordering privileges for laboratory tests are determined by hospitals and their medical staffs in accordance with state law as well as any other requirements and/or incentives that CMS or other insurers might have.

CMS expects this rule to improve the efficiency and efficacy of nutrition care and save up to $459 million in annual hospital costs. The Academy supports this new rule that will provide patients with better health care and help hospitals function more efficiently.

Read the answers to frequently asked questions about the proposed rule.

Implementing the Rule in Your State

As a benefit to its members, the Academy has created resources to implement the new rule.

Since the hospital rule leaves it up to the hospital to make the decision of who can become privileged to independently order diets (in accordance with state law), all RDNs are encouraged to use the available state analysis and practice tips to initiate the process in hospitals. The Academy has developed tips for use in LTC facilities.

  1. Check out your state's ability to immediately implement the hospital rule. Review our initial compilation of your state's regulatory language governing ordering of therapeutic diets in the LTC setting.
  2. Work with your affiliate to identify strategies for taking advantage of the new rule.
  3. Review the practice tips to determine next steps for obtaining privileges in your hospital.
  4. Have additional questions? Check out our FAQs

This is an exciting time for the profession, Academy members and the health of Americans. The Academy is encouraging members to work with their affiliate to understand the rules and how they can be applied in their state.

*Please note that ordering privileges for laboratory tests are determined by hospitals and their medical staffs in accordance with state law as well as any other requirements and/or incentives that CMS or other insurers might have.