The US Academy of Nutrition and Dietetics calls for universal access to medical nutrition

16 Nov 2023 --- The Academy of Nutrition and Dietetics champions the MNT act — a bill to improve access to Medical Nutrition Therapy (MNT) and broader-reaching coverage for chronic conditions to facilitate the appropriate care for senior US Medicare beneficiaries. The proposed legislation was initially introduced in 2020 and is now championed by US senators Susan Collins and Gary Peters, along with US Reps. Robin Kelly and Jen Kiggans. It aims to extend coverage under Medicare Part B to individuals with a range of chronic conditions.

“Passage of this bill would allow Medicare beneficiaries to access the care they need from qualified practitioners by providing coverage for Medical Nutrition Therapy for various chronic conditions. Medicare currently only covers MNT for people with kidney disease and diabetes,” Jeanne Blankenship, VP of policy initiatives and advocacy at the academy, tells Nutrition Insight.

The MNT Act 
Blankenship outlines that scientific evidence has shown that MNT interventions for diet-related chronic diseases provided by a registered dietitian nutritionist improve health outcomes and nutrition status.

Passage of the MNT Bill would allow Medicare beneficiaries to access the care from qualified practitioners.“The bill would allow coverage of MNT to extend to seniors diagnosed with cancer; cardiovascular disease; dyslipidemia; eating disorders; gastrointestinal diseases including celiac disease; HIV/AIDS; hypertension; malnutrition; obesity; prediabetes; and unintentional weight loss.”

“Currently, those with these conditions do not receive comprehensive care even though lifestyle interventions such as MNT are included in the clinical guidelines because there is no Medicare coverage. MNT is a proven, low-cost, non-invasive option that is not accessible, but this act would change that,” she underscores.

The MNT Act would also increase access to nutrition care services. For example, equitable access to MNT provided by a registered dietitian nutritionist can help stop prediabetes from developing into type 2 diabetes, improving people’s health and cutting costs. 

Difficult access to MNT
Blankenship sees an important role for nutritionists in diagnosing and intervening in diet-related chronic diseases, explaining that eEvidence continues to show that “MNT provided by a registered dietitian nutritionist is clinically effective in treating or managing the new conditions included in the bill.”

She argues that even with coverage limited to patients with diagnosed diabetes, renal disease and post-kidney transplant, services are underutilized. Reasons for this include needing a referral from a physician, which may be refused, as well as time and scheduling issues.

“Other qualified nonphysician practitioners such as nurse practitioners, physician assistants, clinical nurse specialists and psychologists are statutorily barred from directly referring their patients who have Medicare Part B to MNT services.”

Blankenship highlights that this poses a barrier to beneficiaries who may be under the care of a nonphysician practitioner licensed to practice as an independent provider in their state but precluded from exercising their full referral scope of practice by the Centers for Medicare and Medicaid Services. “This especially impacts rural and medically underserved areas that rely more heavily on nonphysician practitioners.”

She further points out some of the reasons why a physician may not refer a patient to MNT services even when medically indicated. “Examples include a lack of awareness that MNT is a covered service, an inability to locate a registered dietitian nutritionist and communication barriers or cultural competence concerns.”Scientific evidence shows MNT interventions improve health outcomes and nutrition status.

“In some parts of the country, appropriate MNT services may not be available within the travel radius of the beneficiary and — outside of the flexibilities imparted during the COVID-19 public health emergency — antiquated telehealth requirements often limit remote access to MNT services.” 

Regarding the barriers to MNT access posed by time and scheduling, Blankenship points out that most physician practices do not directly employ a registered dietitian nutritionist, forcing patients to make an additional appointment, often at another site on another day, to receive MNT services.

“Transportation can pose a barrier for some older adults, making scheduling appointments over multiple days and locations challenging. Additionally, if the beneficiary has received a referral for both MNT services and Diabetes Self-Management Training, current coverage requires those services be received on different days.”

MNT health impact
Blankenship also details the MNT Act’s broader implications in advancing healthcare and promoting a healthier lifestyle for US citizens. 

“A healthful diet is essential to living a long, happy life. Increasing access to MNT provided by a registered dietitian nutritionist as part of a health care team can positively impact weight, blood pressure, blood lipids and blood sugar control.” 

“Medicare coverage and payment in the US sets the standard for other commercial payers and government-funded health plans. Coverage of MNT would have a trickle-down effect on the provision of health care services. Although Medicare is for seniors, passage of the MNT Act would open opportunities to influence policy for all adults.”

Advocacy efforts
The VP assures that the academy is working with allied health organizations to move the needle on the MNT Act. “As of November 14, 2023, 45 organizations have signed on in support of this bill. We advocate across party lines and feel MNT is a non-partisan issue.”

“Our members are engaging in grassroots efforts to communicate with policymakers and tell stories of how MNT can be successful as well as the negative effects on health when individuals don’t have access.”

“The Biden-Harris Administration released the National Strategy on Hunger, Nutrition and Health, which included policy recommendations to increase access to nutrition and obesity counseling. Thus, we feel we have support at the highest level of government to find a solution such as this bill,” Blankenship highlights. 

Experts say the MNT Act has broader implications in advancing healthcare in the US.Supporting legislation and initiatives
She details efforts related to the Food as Medicine initiative in the US, which would complement the MNT Act.

“Addressing access to healthy foods is part of the equation, but to help those with chronic disease, MNT must be built into the model. Medically tailored meals and teaching kitchens can help seniors improve their knowledge and dietary patterns that lead to improved health.”

She further points to the Treat and Reduce Obesity Act and Nutrition Care Act, which also include elements of MNT for obesity and eating disorders. The I CAN Act would allow more providers to refer for MNT, which could increase access in rural areas and communities with clinician shortages.

“We support their passage and discuss these bills when advocating for the MNT Act,” Blankenship asserts.

Lastly, she reveals that, as more medications are introduced for obesity treatment, the importance of access to MNT becomes more relevant.

“Use of medications for the treatment of obesity, as well as for diabetes, hypertension and cardiovascular disease, should be accompanied by lifestyle interventions to maximize health benefits,” she concludes. “Providing only access to medications misses an important tool in the provider’s toolbox that is needed for quality and comprehensive care.” 

By Milana Nikolova