When I was completing clinical rotations at a community hospital as a dietetic intern, I remember entering a patient’s room as they had just received a life-altering diagnosis – diabetes, hypertension or cancer. I had 15 minutes to spend with them to talk about nutrition. They were already overwhelmed and in such a short amount of time, I could not address all their nutrition-related questions or concerns. In reality, I was adding another layer of confusion about what they “should” do to manage their condition. After discharge, when cancer patients and survivors must learn to manage their condition at home, referrals and insurance coverage for outpatient nutrition counseling through Medical Nutrition Therapy (MNT) are rare. This leaves patients with limited information and resources on what food and nutrition choices to make. It is time for that to change and recently introduced legislation may help make progress in increasing access to nutrition support for people with cancer.
What is Medical Nutrition Therapy?
MNT is defined by law as “nutritional diagnostic, therapy, and counseling services for the purpose of disease management, which are furnished by a Registered Dietitian or nutrition professional.” It is a specific application of the Nutrition Care Process used in clinical settings that focuses on the management of diseases and involves nutrition screening or referral, nutrition assessment, nutrition diagnosis, nutrition intervention and monitoring and evaluation. This individualized, in-depth approach is effective in both reducing costs and improving outcomes.
What is the Medical Nutrition Therapy Act?
The Medical Nutrition Therapy Act of 2020 (H.R. 6971; S.4504) was introduced by Representatives Eliot Engel (NY-16) and Pete King (NY-02) in May 2020 and by Senators Susan Collins (Maine) and Gary Peters (Michigan) in August 2020. This bicameral, bipartisan legislation would provide coverage for Medicare beneficiaries to obtain treatment from Registered Dietitian Nutritionists (RDN) and other qualified nutrition experts for many common and costly chronic diseases, including cancer.
The Medical Nutrition Therapy Act would increase access to MNT for Medicare beneficiaries beyond the limited number of currently covered conditions in the outpatient setting – diabetes, renal diseases and post-kidney transplant. It would allow MNT to be covered under Medicare Part B for a number of diet-related conditions including cancer, malnutrition, obesity, HIV/AIDS and more. The bill would also allow the U.S. Secretary of Health and Human Services to further expand access to MNT without additional action from Congress and would allow physician assistants, nurse practitioners, clinical nurse specialists and psychologists to refer their patients for MNT.
How Will the Medical Nutrition Therapy Act of 2020 Help Cancer Patients and Survivors?
A 2019 study examining nutrition services in outpatient cancer centers found that overall, the services were inadequate. Although 94 percent of outpatient cancer centers surveyed reported having at least one RDN on staff, the RDN-to-patient ratio was extremely high, with the mean caseload per RDN being well over 2,000 patients. The best practice ratio for RDNs in oncology care is 1 RDN per 120 patients. Additionally, due to lack of insurance coverage, 77 percent of these centers did not directly bill the patient for their nutrition services.
What Can You Do to Support Medical Nutrition Therapy for Cancer Patients and Survivors?
As part of a broader strategy to improve access to nutrition and physical activity for cancer survivors, AICR is working with other nutrition and health organizations, including the Academy of Nutrition and Dietetics, to advocate for the Medical Nutrition Therapy Act. You can send an email to your Senators and Representatives asking them to support the bill through the Academy of Nutrition and Dietetics’ website. It is important for Members of Congress to hear from constituents like you about how the proposed legislation would impact you and your families.
Additionally, if you or a family member are a cancer patient or survivor and you would like your insurance to cover MNT, you can contact your insurance company and request that they expand coverage of MNT. You can also speak with your health care provider about coverage of MNT and ask that they request expanded coverage as well.
To learn more about how AICR is working to increase access to nutrition and physical activity for cancer survivors, click here.
To learn more about the Medical Nutrition Therapy Act, click here.