CMS Memo Regarding Hospital Food and Nutrition Service Obligations

On March 30, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to hospital and Critical Access Hospitals (CAHs) providers entitled "Hospital Nutrition Service Obligations in Light of Updated Federal Nutrition Guidelines."

The memorandum reiterates existing requirements for hospitals participating in Medicare and Medicaid related to food and nutrition services, underscores the integral role of registered dietitian nutritionists (RDNs) in patient care, and emphasizes the importance of continuity of care across settings. It further directs hospitals to review and update food and nutrition service policies, standard menus, therapeutic diet protocols, and food procurement practices to align with the 2025–2030 Dietary Guidelines for Americans (DGAs).

The memo offers examples of changes to be considered in the context of the new DGAs issued earlier this year. The memo states that hospitals "should" consider certain changes consistent with the DGAs, along with offering other examples of changes in diet and beverage.

While the memo encourages alignment with the DGAs, it does not change existing regulatory requirements. Hospitals are still obligated to provide individualized nutrition care based on patient-specific needs, consistent with recognized dietary practices under 42 CFR §482.28. This includes following clinically relevant dietary practices and condition-specific guidelines.

The memo acknowledges that hospitals should evaluate what is clinically appropriate and feasible while maintaining patient safety. The Academy recommends that decisions be guided by patient's specific clinical condition, current nutritional needs, and ability to safely and effectively consume and tolerate foods and liquids.

The Academy encourages RDNs to proactively partner with their hospital compliance and regulatory teams as organizations evaluate this guidance. As food and nutrition experts, RDNs and NDTRs' are critical in translating clinical guidelines and informing how policies, menus, and protocols are implemented in a clinically appropriate manner. Early collaboration can help ensure that recommended changes align with CMS expectations while preserving the ability to deliver individualized nutrition care.

The current memorandum is directed specifically to hospitals and CAHs. It does not directly apply to Skilled Nursing Facilities (SNFs) or long-term care (LTC) settings.

However, SNFs and LTC facilities are subject to their own regulatory requirements under 42 CFR §483.60 (Food and Nutrition Services), which similarly require the provision of individualized nutrition care based on resident-specific needs and recognized dietary practices.

While facilities may look to broader federal nutrition guidance, including the DGAs, to inform food service policies, SNFs and LTC providers should continue to operate within their own regulatory framework, which places strong emphasis on individualized care, clinical appropriateness, and resident preferences.

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