Medical Nutrition Therapy

Service Standard

Medical Nutrition Therapy Service Standard Print Version

Texas Department of State Health Services, HIV Care Services Group – HIV/STD Program | Texas DSHS

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Subcategories Service Units Medical Nutrition Therapy Per 15 minutes Medical Nutrition Therapy – Counseling Per 15 minutes Medical Nutrition Therapy – Supplements Per transaction

Health Resources and Services Administration (HRSA) Description

Medical Nutrition Therapy (MNT) includes:

• Nutrition assessment and screening
• Dietary/nutritional evaluation
• Food, nutritional supplements, or both per a medical provider’s recommendation
• Nutrition education, counseling, or both

These services can be provided in individual and/or group settings and outside of HIV Outpatient/Ambulatory Health Services (OAHS).

Program Guidance

In Texas, only licensed dieticians (LDs) may provide MNT services.

Limitations

A licensed dietician must provide services pursuant to a medical provider’s written referral. Agencies may consider nutritional counseling not provided by an LD a support service under Psychosocial Support Services. Agencies should fund food provisions and nutritional supplements under Food Bank/Home-Delivered Meals if they are not provided pursuant to a physician’s recommendation and a nutritional plan developed by an LD.

Services

MNT is individualized dietary instruction that incorporates dietary counseling for a nutrition-related problem. This level of specialized instruction is above basic nutrition counseling and includes an individualized dietary assessment performed by an LD. Services also may include providing nutritional supplements and food provisions based on the medical care provider’s recommendation(s).

Universal Standards

Services providers for Medical Nutrition Therapy must follow HRSA and DSHS Universal Standards 1-52 and 104-109.

Service Standards and Measures

The following standards and measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.

Standard Measure

Referral by Licensed Medical Provider: A medical provider must provider a referral for clients receiving MNT services.

1. Percentage of clients with documentation of the medical provider’s referral to MNT.

Medical Nutrition Therapy Assessment: An LD will conduct an initial MNT assessment. A comprehensive nutritional assessment includes the following components: clinical history, physical examination, anthropometric measurements, diagnostic tests, and functional and dietary assessments.

2. Percentage of clients with documentation of a completed assessment conducted by an LD that includes the following components at a minimum: (Pilot Measure)

a. Clinical history

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b. Physical examination

c. Anthropometric measurements

d. Diagnostic tests as applicable

e. Functional assessment

f. Dietary assessment

Nutrition Plan: The LD will develop a nutritional plan that is appropriate for the client’s health status, financial status, and individual preference.

Staff should complete the plan within 10 business days of the nutrition assessment and the plan must include, but is not limited to:

• Nutritional diagnosis
• Client-centered nutrition education
• Measurable goal(s)
• Date service is to be initiated
• Recommended services and course of medical nutrition therapy to be provided to include the planned number and frequency of sessions
• Types and amounts of nutritional supplements and food provisions (if applicable)
• Signature of LD who developed the plan.

The LD will update the nutrition plan will be updated as necessary, but no less than twice per year, and will share the plan with the client, the client’s primary care provider, and other authorized personnel involved in the client’s care.

3. Percentage of clients with a documented nutrition plan that includes the following components: (Pilot Measure)

a. Nutritional diagnosis

b. Client-centered nutrition education

c. Measurable goal(s)

d. Date service is to be initiated

e. Recommended services to be provided

f. Planned number and frequency of sessions

g. Type, frequency, and amount of food or nutritional supplements to be provided if this service is part of the plan

h. LD signature

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4. Percentage of clients with documentation of a nutrition plan updated at least twice per year if the client has been receiving services for over 12 months.

Provision of Nutritional Supplements and Food Provisions: The agency may provide nutritional supplements and food provisions deemed medically necessary per written orders from a prescribing provider.

5. Percentage of clients that are prescribed nutritional supplements or food provisions that have written orders from the referring prescribing provider.

Discharge: When an agency discharges a client from services, staff must document the date of discharge, reason, and any recommendations in the client’s record and provide this documentation to the prescribing provider and other multidisciplinary team members as applicable.

6. Percentage of clients discharged from services during the measurement period with the following documentation components: (Pilot Measure)

a. Date of discharge

b. Reason for discharge

c. Recommendations for follow-up

d. Prescribing provider notified of discharge

e. Other multidisciplinary team members notified of the discharge, as applicable

References

Academy of Nutrition and Dietetics, HIV/AIDS, Nutrition Tips to Keep the Immune System Strong for People with HIV/AIDS, December 2021. Nutrition Tips to Keep the Immune System Strong for People with HIV AIDS (eatright.org)

Division of Metropolitan HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part A Recipients. Health Resources and Services Administration, June 2023.

Division of State HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part B Recipients. Health Resources and Services Administration, June 2023.

Licensed Dietitian Act. September 2015. OCCUPATIONS CODE CHAPTER 701. DIETITIANS (texas.gov)

National Institute of Health, HIVinfo.gov, HIV and Nutrition, and Food Safety, August 2021. HIV and Nutrition and Food Safety | NIH

National Institute of Health, National Library of Medicine, National Center for Biotechnology Information, Nutritional Assessment, April 2022. Nutritional Assessment – StatPearls – NCBI Bookshelf (nih.gov)

Ryan White HIV/AIDS Program. Policy Notice 16-02: Eligible Individuals & Allowable Uses of Funds. Health Resources & Services Administration, 22 Oct. 2018.

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