What Kidney Patients Need to Know About Medical Nutrition Therapy

By Jim Myers, NKF patient-advocate

Medical Nutrition Therapy (MNT) is an evidence-based medical approach to treating certain chronic conditions through the use of an individually-tailored nutrition plan based on a comprehensive nutrition assessment conducted by a Registered Dietitian (RD). A physician may refer an individual to a RD for this service. The goal of Medical Nutrition Therapy is to prevent, delay or manage diseases or conditions like Chronic Kidney Disease (CKD).

Kidney advocacy's best kept secret: No cost RDN consultation

If you are covered by Medicare, you can see an RD for free since all cost-sharing (deductible, copays) are waived for MNT services. According to the Academy of Nutrition and Dietetics, MNT "is covered by Medicare for diagnoses of diabetes, non-dialysis kidney disease, and 36 months post kidney transplant when a Medicare beneficiary has been referred by a physician, and when provided by an RDN who is enrolled as a Medicare Provider. Medicare covers 3 hours of MNT the initial year of referral and up to 2 hours of MNT for subsequent years. Hours are based on calendar year and cannot be carried over from year to year.

Additional coverage is available in the same calendar year with a second referral when more MNT is medically necessary. There could be many reasons why individuals may need more care, including but not limited to a change in diagnosis, medical condition or treatment regimen. Medicare Advantage (Medicare Part C) plans may also offer additional benefits, including coverage beyond these diagnoses covered by traditional Medicare. Registered dietitian nutritionists must become credentialed with each Medicare Advantage plan in order to provide and get paid for MNT to patients enrolled in Medicare Advantage."

Current legislation supported by NKF and the Academy of Nutrition and Dietetics

The Medical Nutrition Therapy Act (H.R. 6971 / S. 4504 in the previous Congress) amends the Social Security Act to:

• Provide Medicare Part B coverage of outpatient MNT for prediabetes, obesity, high blood pressure, high cholesterol, malnutrition, eating disorders, cancer, celiac disease, HIV/AIDS and any other disease or condition causing unintentional weight loss;
• Authorize the Secretary of Health to include other diseases based on medical necessity; and
• Allow nurse practitioners, physician’s assistants, clinical nurse specialists and psychologists to refer their patients for MNT.

This would increase the types of professionals who can make referrals to RDNs under Medicare Part B (currently only physicians can make such a referral) and expand the Chronic Diseases covered beyond CKD and Diabetes.

Those wishing to advocate in favor of this bill should be sure to explain to their lawmakers that MNT includes a nutritional diagnostic, therapy, and counseling services furnished by a registered dietitian for the purpose of disease prevention, management, or treatment; that MNT is an evidence-based, cost-effective component of treatment that can help combat many of the nation’s most prevalent and costly chronic conditions, including conditions that are contributing to poor COVID-19 outcomes; and that access to MNT is especially critical for communities of color that suffer from chronic disease health disparities driven by reduced access to care, healthy foods and safe places to be active.

The National Kidney Foundation plans to continue finding ways to advocate for expansion of the MNT and looks forward to working with patients and providers alike to help federal lawmakers understand the urgency in doing so this Congress.