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STATE OF NEVADA
DIVISION FOR AGING SERVICES

SERVICE SPECIFICATIONS

MEDICAL NUTRITION THERAPY
(Revised 1/02)  

Any exception to these Service Specifications must be requested in advance in writing and approved by the Administrator.  

SERVICE DEFINITION: 

Medical Nutrition Therapy (MNT) service begins by screening of referred seniors to determine if the seniors are nutritionally “at risk.”  Once seniors are identified as “at risk,” a nutritional assessment is conducted to ascertain if counseling/education, additional meals, nutrition supplements and/or case management may be required. 

SERVICE CATEGORIES AND UNIT MEASURES: 

The following service categories and unit measures established by the Division for Aging Services (DAS) must be used to document the amount of service provided: 

One unit equals completion of one client contact to screen, assess, intervene, counsel and/or provide education.  

SPECIFICATIONS: 

1.     Required Services: 

1.1             Clients are screened to determine if they are high risk for nutritional problems. The screening process identifies individuals who are at high risk of nutritional problems or who have poor nutritional status. Screening reveals the need for an in-depth nutritional assessment, which may require medical diagnosis and treatment as well as nutrition counseling, as a specific component in a comprehensive health care plan. 

Clients may be classified as high risk if they are low-income, are taking multiple medications, have multiple nutritionally related diseases (i.e. diabetes, hypertension, chronic heart conditions, cancer) and/or have physical disabilities or other functional impairments that result in increased dependence on others. 

1.2      Once a client is identified as high risk, an assessment will be completed to establish a nutrition plan. 

Nutrition assessment is the measurement of indicators of dietary or nutrition-related factors to identify the presence, nature, and extent of impaired nutritional status of any type, and to obtain the information needed for intervention to improve nutritional care. This includes developing a plan of care and reviewing it with the client. 

1.3      The nutrition plan can include: nutrition intervention, counseling or education, additional meals, nutrition supplements and/or case management. 

Nutrition intervention is an action taken to decrease the risk or to treat poor nutritional status. Nutrition interventions address the multiple causes of nutritional problems and therefore include actions that may be taken by many different health and social service professionals as well as family and community members. Intervention actions may include, but are not limited to: utilization of meal programs, home care services, dental services, pharmacist advice, nutrition counseling, and specialized medical and/or dietary treatment, e.g. eternal nutrition therapy. 

Nutrition counseling provides individualized guidance on appropriate food and nutrient intakes for those with special needs, taking into consideration health, cultural, socioeconomic, functional and psychological factors. Nutrition counseling may include advice to increase or decrease nutrients in the diet; to change the timing, size or composition of meals; to modify food textures; and, in extreme instances, to change the route of administration – from oral to feeding tube to intravenous. 

Nutrition education imparts information about foods and nutrients, diets, lifestyle factors, community nutrition resources and services to people to improve their nutritional status. 

1.4       Frozen meals, sack lunches, cold meals, supplements, and/or shelf stable meals can be used to provide supplemental meal service to clients. 

1.5       The availability of insurance or a third party payer to defray costs should be explored. 

2.     Nutrition Service Standards: 

2.1       Prior to providing services, programs are required to provide a background check of all persons providing services to clients in their home and document the results. 

2.2       Service providers cannot accept tips, gifts, loans or fees from MNT clients. Drivers may collect program donations from clients receiving meals or liquid meal supplements. 

2.3       A registered dietitian will provide nutrition assessment, counseling and education. 

2.4       Nutritionists or dietetic technicians may provide client counseling and education under the direction of a registered dietitian. Minimum qualifications include: 

2.4.a   At least a two-year associate’s degree in nutrition from a US regionally accredited college or university or a dietetic technician program approved by the Commission on Accreditation for Dietetics Education (CADE), or the American Dietetic Association (ADA). 

2.5       Grantees are required to establish a waiting list policy for MNT Services that will be activated in the event the demand for service exceeds the program’s capabilities. A waiting list is to be established only after all other measures for improving the efficiency of the service delivery system have been examined and, when feasible, implemented. Clients with the greatest needs are to receive priority consideration. The program must define in writing  “greatest need.”  The program must establish a procedure for updating the continued service needs of clients placed on the waiting list. 

3.     Quality Improvement: 

3.1       The program shall establish a method to determine consumer satisfaction that will be used to provide continuous quality improvement, develop acceptable intervention menus and address identified concerns. 

4.     Evaluation Documentation: 

4.1       All long-term recipients will be evaluated and certified as to the need for the service. The continued need for service should be periodically reviewed and documented by staff to assure program resources are being appropriately allocated. Documentation should include: 

4.1.a   The date service was started.

4.1.b   A copy of the screening tool identifying risk factors; the assessment, the care plan and documentation of follow-up. 

4.1.c   The estimated length of time the individual is expected to receive nutrition therapy. The length of certification must be based on the client’s health condition and cannot exceed 12 months. 

4.1.d   The date of certification and signature of certifying social worker or registered dietitian.

Questions or Comments for the Division for Aging?
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We look forward to speaking with you!

Last Updated: 09/05/08

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