Expanding Time Covered for Medical Nutrition Therapy: A Need for Clear Reporting on the Intensity of Nutrition Interventions

Medical Nutrition Therapy (MNT) is an evidence-based health care service that helps people improve their food and nutrition habits to positively influence health outcomes and quality of life, and is part of a suite of complementary interventions that can be implemented for effective disease prevention and management. However, the dose (ie, length and number of sessions) of MNT that is covered by health care payers in outpatient settings is highly variable and may not be adequate to achieve the desired clinical outcomes and cost savings. Interest in improving access to adequate doses of MNT provided by registered dietitian nutritionists (RDNs), through both new and existing coverage, has been growing as nutrition-related chronic diseases continue to take a toll on children and adults, health care costs continue to escalate, and health disparities widen. At the national level, advocacy work has focused on expanding both covered conditions and eligible individuals. For example, the Medical Nutrition Therapy Act of 2023 has support from more than 50 national organizations and the National Strategy for Hunger, Nutrition, and Health recommends expanding Medicare beneficiaries’ access to evidence-based nutrition counseling benefits for additional conditions. However, few advocacy efforts have focused on expanding the covered dose of MNT, which for Medicare-covered conditions remains at 3 hours in the first year and 2 hours in subsequent years, with an underutilized mechanism for additional hours. In this Commentary, evidence is reviewed demonstrating that currently covered doses of MNT may be inadequate to achieve desired nutrition outcomes and payer cost-savings goals, and how research reporting hinders determination of the optimal dose of MNT for nutrition-related chronic diseases is discussed. Specifically, three challenges to determining the optimal dose of MNT for nutrition-related chronic diseases are discussed: inconsistent/incomplete reporting of intervention characteristics, including interventionist and dose; dichotomization of behavior change interventions instead of dose-response treatment; and variety of doses tested. Recommended actions are provided to be taken by researchers and policy makers to fill these knowledge gaps in support of expanded access to adequate outpatient doses of MNT services provided by RDNs, through both new and existing coverage.