Michele Wood MS RD LDN
PADA MNT Reimbursement Chair
ADA members have been asking if Medicare medical nutrition therapy (MNT) coverage has been expanded to conditions other than diabetes and kidney disease. The answer, unfortunately, is not yet. In this month’s Medicare MNT Provider “question corner,” we ask ADA’s director of Government Relations, Ron Smith, if we can expect any good news soon.
In 2006, will we see any expansion or new diseases/conditions for Medicare MNT?
In 2005 ADA spent considerable time and resources supporting Congressional initiatives to expand Medicare MNT coverage. Those efforts will carry over into 2006. However, at best, any expansion of MNT would not be effective until 2007 or 2008.
What is ADA doing on Capitol Hill to gain support to expand Medicare MNT services?
ADA has been working closely with members of key Congressional Committees, and their staff, to build support for expanding the Medicare MNT benefit. This includes numerous one-on-one meetings with Representatives and Senators asking them to co-sponsor the Medicare Medical Nutrition Therapy Act of 2005. That bill would give the Centers for Medicare & Medicaid Services (CMS) the authority to use the National Coverage Determination Process to determine when and how to expand the benefit.
How is ADA looking for creative ways to expand MNT services within Medicare?
There is no single approach. The legislative situation (meaning what may or may not pass) is driven largely by budget considerations. As a result, ADA has had to draft and re-draft several proposals to expand the MNT benefit in order to overcome some budgetary obstacles. This may very well happen again in 2006. One creative suggestion ADA gave Congress was to first operate a demonstration pilot program for four years in five sites before giving CMS the authority to permanently expand the benefit.
What do the MNT demonstration projects entail?
ADA drafted and recommended a demonstration program that would allow Medicare to expand MNT services in certain sites and for certain conditions to determine its effectiveness on reducing health care costs, improving quality of life and overall health status. ADA recommended that several diseases or conditions be covered in the demonstration program, including hypertension, dyslipidemia, HIV/AIDS, unintentional weight loss, and oncology.
ADA's primary focus will continue to be the passage of the Medicare Medical Nutrition Therapy Act of 2005, which would give CMS the authority to expand the MNT benefit. Nevertheless, ADA remains open to alternatives or compromises in the event they are required to overcome budget constraints or other legislative roadblocks.
How might the demonstration project affect my practice?
If the demonstration project is supported by Congress, some RDs may be involved in the project if their facility is one of the selected sites included in the demonstration. However, it is up to the Secretary of the Department of Health and Human Services to determine what constitutes a site. A site could be an Indian Reservation, a hospital, a state, or some other geographic area.
How can I participate in or support ADA's legislative work?
The best way to stay up-to-date on a regular basis on ADA's lobbying efforts, whether for MNT or any issue, is to subscribe to "On the Pulse". Also, consider attending the March 14-17 Public Policy Workshop. More information on this year’s PPW can be found at www.eatright.org under Conferences and Events.
As registered dietitians around the country anxiously wait to see expanded coverage of Medical Nutrition Therapy for conditions such as cardiovascular disease, the Medicare MNT Provider newsletter is documenting Medicare’s every move. With the Provider, RDs can get the inside scoop on everything from billing codes to patient privacy rules. This article was just an example of the type of easy to understand, informative articles the Provider publishes each month. For more information about the Provider newsletter, or to view a list of previous issues for topics of interest, go to ADA’s Web page at www.eatright.org and search for “ADA Medicare MNT Provider.”
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