QUESTION:
We’ve had some debate over who can order therapeutic diets. Can you help explain the rules on this issue?

ANSWER FROM HORTYSPRINGER ATTORNEY IAN DONALDSON:
Historically, CMS has restricted the ability to order therapeutic diets to “practitioners responsible for the care of the patient.”  This generally meant physicians.  However, in 2014, CMS changed its position on this matter, and revised 42 C.F.R. §482.28(b)(2) to read “All patient diets, including therapeutic diets, must be ordered by a practitioner responsible for the care of the patient, or by a qualified dietician or qualified nutrition professional as authorized by the medical staff and in accordance with State law governing dieticians and nutrition professionals.”  (Emphasis added.)

This change came about largely in recognition of the fact that registered dietitians and other types of nutritionists are trained to assess the nutritional and therapeutic needs of patients.  As such, CMS notes in its Interpretive Guidelines that “[t]he hospital’s governing body may choose, when permitted under State law and upon recommendation of the medical staff, to grant qualified dietitians or qualified nutrition professionals diet-ordering privileges.”

As indicated above, your state law may still limit a dietitian’s scope of practice, so be aware of any restrictions at the state law level.

If you have a quick question about this, e-mail us at info@hortyspringer.com.