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Defining the delivery of nutrition services in Medicare MNT versus Medicare DSMT programs
October 2008

Executive Summary
Registered dietitians (RDs) have a defined and unique role in diabetes care that differs depending on whether the service is for Medical Nutrition Therapy (MNT) or part of a diabetes self-management training ¹ (DSMT) program (Appendix A).

The purpose of this paper is to describe the current regulatory and practice framework that supports nutrition care under Medicare Part B for people with diabetes. A description of MNT and DSMT provided under Medicare Part B is included. The role of the RD and other healthcare professionals involved as program instructors in DSMT programs is also addressed. Revisions to the National Standards for Diabetes Self-Management Education ² (DSME) are discussed to clarify the RD’s involvement in DSME programs.

All health care professionals, including RDs, must be accountable for upholding Medicare and other regulations for diabetes care. Medicare regulations define the unique program requirements that qualified providers must follow for MNT and DSMT program compliance. Medicare MNT involves comprehensive clinical care provided by licensed/certified (as applicable) RDs and nutrition professionals. Nationally recognized protocols are required for the delivery of MNT services. Under Medicare, DSMT includes a nutrition education component based on the National Standards for DSME. All DSMT programs must be accredited as meeting quality standards by a Centers for Medicare & Medicaid Services (CMS) approved national accreditation organization. Currently, CMS recognizes the American Diabetes Association and the Indian Health Service as approved national accreditation organizations (1).

CMS has described the features of MNT and DSMT, and determined that provision of both benefits may be more medically effective for some beneficiaries than receipt of just one of the benefits. Thus, the healthcare professional must recognize and respect the unique components that distinguish the education and training curriculum included in Medicare DSMT programs, and the nutritional diagnostic, therapy, and counseling
services provided through Medicare MNT.

The Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Diabetes Care describe levels of performance for RDs in diabetes care (2). In addition, the patient-focused Nutrition Care Process (NCP) for RDs also provides insight and language to distinguish nutrition education and nutrition counseling interventions (3).

MNT and DSMT services are well defined by Medicare, but their coverage is not comprehensive relative to patient access and need. The American Dietetic Association (ADA) continuously seeks to strengthen the coverage and delivery of diabetes services provided by RDs ³.

¹ For the purpose of this review, DSMT and diabetes self-management education (DSME) are used interchangeably.

² To promote quality education for people with diabetes, the American Diabetes Association (ADiabA) endorses the National Standards for Diabetes Self-Management Education. The ADiabA Education Recognition Program (ERP) assesses whether DSMT applicants meet the National Standards for Diabetes Self Management Education. Source: Education Recognition Program. American Diabetes Association Web page. http://professional.diabetes.org/recognition.aspx?cid=57995.

³ Principles to guide ADA policy work in diabetes care:

  • Medicare MNT and DSMT are complementary but distinct programs in which RDs provide unique nutrition services, consistent with the specific missions of those programs.
  • The registered dietitian is a key member of the multi-disciplinary health care team that provides DSMT.
  • RDs provide the highest quality nutrition care and services following ADA’s Nutrition Care Process and evidence-based nutrition practice guidelines for medical nutrition therapy. American Dietetic Association


  1. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual. Section 300—Diabetes Self-Management Training Services. Centers for Medicare & Medicaid Services Web site. http://www.cms.hhs.gov/Manuals/downloads/bp102c15.pdf.
    Accessed September 22,2004.
  2. Kulkarni K, Boucher JL, Daly A, Shwide-Slavin C, Silvers BT, O'Sullivan Maillet J, Pritchett E, American Dietetic Association. American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Diabetes Care. J Am Diet Assoc. 2005;105(5):819-824. Journal of the American Dietetic Association Web site. Standards_of_Practice_and_Professional_Performance_in_Diabetes_Care.pdf Accessed August 12, 2010.
  3. Lacey K, Pritchett E. Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management. J Am Diet Assoc. 2003;103(8):1061-72. Journal of the American Dietetic Association Web site. http://www.adajournal.org/article/S0002-8223%2803%2900971-4/fulltext. Accessed August 12, 2010.

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