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Insurance coverage for the cost of MNT is inconsistent across the United States. Some private insurance companies have policies that pay the cost for a person to receive medical nutrition therapy based on protocols developed by the American Dietetic Association. Other companies leave the coverage to the discretion of a case manager or physician, while some refuse to provide reimbursement for any nutrition therapy.

Some U.S. states have laws that mandate that insurance companies provide coverage for MNT. Some of these states limit coverage to diabetes, while others include a wider range of diseases. In January 2002, the Medicare program began providing MNT coverage for persons with diabetes and prerenal disease. (Medicare is a federal health insurance program for those over the age of sixty-five, those under sixty-live with certain disabilities, and for people with permanent kidney failure.) Congress is considering inclusion of other diagnoses, such as cardiovascular disease. This would expand the provision of MNT to those persons with coronary artery disease, congestive heart failure, and hypertension. Diabetes self-management training is a Medicare-covered benefit that includes MNT and education on issues such as blood glucose monitoring, disease complications, and prevention. Internationally, the cost of nutrition therapy is sometimes covered by a national health care system, or by a private system similar to that in the United States.

Medical Nutrition Therapy is physician directed. This means a person's primary care physician makes a referral to a registered dietitian for therapy. Many insurance carriers and state licensure laws require this referral to document the medical necessity of the therapy.

The expansion of insurance coverage for MNT by Medicare and private providers is vital to improving access to this type of care. Rising health pre-renal: kidney disease caused by change in the blood supply to the kidney cardiovascular: related to the heart and circulatory system artery: blood vessel that carry blood away from the heart toward the body tissues hypertension: high blood pressure glucose: a simple sugar; the most commonly used fuel in cells care costs and limited incomes often force choices between food and health care. Medical nutrition therapy has been shown to reduce health care cost for individuals, employers, hospitals, and insurance carriers. see also Dieti tian; Nutritional Assessment.

Mindy Benedict

Bibliography

American Dietetic Association (2000). Manual of Clinical Dietetics, 6th ed. Chicago, IL: Author.

Florida Dietetic Association (2002). The Florida Dietetic Association Handbook of Medical Nutrition Therapy: The Florida Diet Manual. Tallahassee, FL: Author.

Internet Resources

American Dietetic Association. "Medicare MNT Benefit Provider Information." Available from <http://www.eatright.org>

physiology: the group of biochemical and physical processes that combine to make a functioning organism, or the study of same rickets: disorder caused by vitamin D deficiency, marked by soft and misshapen bones and organ swelling diet: the total daily food intake, or the types of foods eaten vitamin D: nutrient needed for calcium uptake and therefore proper bone formation

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