Attention Long Term Care Dietitians
DATE: July 3, 2019
SUBJECT: Long Term Care Provider Bulletin No. 2019-07-03
Clarification of Dietitians Issuing Dietary Orders in Long Term Care
TO: Nursing Home Administrators
FROM: Susan Y Williamson, Director
Division of Nursing Care Facilities
Bureau of Facility Licensure and Certification
In 2017, the Centers for Medicare and Medicaid Services updated the regulations related to Long Term Care Facilities. Part of that update included language at CFR 483.30(e)(2). The update included language delegating the task of writing dietary orders to a qualified dietitian as long as they are acting within their scope of practice as defined by State law.
In F715, the physician may delegate the task of writing dietary orders, consistent with 483.60, to a qualified dietitian or other clinically qualified nutrition professional who…
i (i) Is acting within the scope of practice as defined by State law
ii (ii) Is under the supervision of the physician.
The question was posed to Department of State if this was within the scope of practice in PA.
Discussion between The Department of State’s Nursing Board and The Department of Health, Division of Nursing Care Facilities, clarified that if the physician writes an order delegating the task to the dietitian, then they are permitted to proceed with writing dietary orders.
Please note that:
• The physician shall have ultimate responsibility for the resident’s care.
• A physician must first order the resident’s diet. Only after the physician orders the resident’s diet may the physician then delegate dietary orders to a registered dietitian who can, under this delegation, alter, modify, or change the physician’s original order. The physician shall specifically note in the medical record the delegation to the dietitian to alter/modify/change the original order.
• A registered dietitian issuing an order for a resident’s diet must act under the direction or supervision of a physician.
• The facility’s policies and procedures must outline, qualifications, status, clinical duties and responsibilities of registered dietitians and delineate the responsibilities of the physician in relation to registered dietitians
• The registered dietitian issuing an order for a resident’s diet shall act only in accordance with regulatory requirements and policies and procedures.
Pennsylvania Department of Health Page 1 of 1 Division of Nursing Care Facilities Provider Bulletin No. 2019-07-03 Implemented: July 3, 2019 Clarification of Dietitians Issuing Dietary Orders in LTC
CMS Long-Term Care Rule Change
The PA Academy of Nutrition and Dietetics is pleased to announce that the CMS Long Term Rule Change regarding delegated dietitian diet order writing has been approved for implementation in LTC facilities in Pennsylvania. Our partners, The Pennsylvania Board of Nursing, PA Medical Society, Hospital and Health System Association of Pennsylvania, and the Department of Health, Division of Nursing Care Facilities are in support of the rule change. You can learn the specifics of the rule change by reading our Newsletter, or by downloading the FAQ: CMS-LTC-Rule-Change-FAQ-November-2017.pdf
The Pennsylvania Academy of Nutrition and Dietetics and the CMS Long Term Care Task Force developed a rule change implementation tool kit to assist LTC facilities with implementing the new rule. The toolkit is free to PA Academy Members or $25 for non-members. Non-members may order the toolkit using the form below. If you have any questions or difficulties with the form for purchasing the toolkit, please contact us at firstname.lastname@example.org
Thank you to the CMS Long-Term Care Task Force for their hard work on this valuable resource for Pennsylvania RDNs.
If you have specific questions about the CMS Long-Term Care rule change or implementation process, please contact:
Meg Rowe, MS, RD, LDN, FAND
CMS Long-Term Care Task Force Chair & Delegate of the Pennsylvania Academy of Nutrition & Dietetics email@example.com
This tool kit and the information regarding the CMS LTC rule change of 2016 on the PAND website are specific to Pennsylvania. Other states may have different regulations. Although accurate as of 2018, please check the interpretative guidelines and Division of Nursing Care Facilities Provider Bulletin for updated information and changes.