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To the Editor: In their Special Communication on clinical practice guidelines (CPGs) for older patients, Dr Boyd and colleagues¹ correctly state that medical nutrition therapy for diabetes would be part of the treatment regimen for a hypothetical 79-year-old woman with diabetes and multiple chronic diseases. However, the list of clinician tasks that they provided does not include referral to a registered dietitian.

The US Congress created a Medicare benefit in section 105 of the Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Benefits Improvement and Protection Act² allowing for medical nutrition therapy for patients with diabetes or chronic renal disease (except for those receiving dialysis) that became effective January 1, 2002. Medical nutrition therapy services are defined in the statute as "nutritional diagnostic, therapy, and counseling services for the purpose of disease management which are furnished by a registered dietitian or nutrition professional . . . pursuant to a referral by a physician."²

. . . [Full Text of this Article]

Mary H. Hager, PhD, RD
mhager@eatright.org
American Dietetic Association
Washington, DC

Pam Michael, MBA, RD
American Dietetic Association
Chicago, Ill

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