They want to make sure that only Registered Dietitians, not certified nutritionists with Master’s degrees and PhDs, will be eligible for insurance reimbursements!
We’ve reported previously on how the Academy of Nutrition and Dietetics, formerly the American Dietetic Association (AND/ADA), is attempting to create a monopoly on the practice of nutrition services and counseling, cornering the market by excluding other qualified professionals by law relying on a state-by-state, restrictive licensure scheme. (They’re not the only profession that uses licensure as a means to eliminate competition, but this is one of the most egregious examples we have seen, and one that could affect your health!)
What we haven’t mentioned before is that AND/ADA is also using licensure to make sure insurance reimbursement is available only to RDs.
Medical Nutrition Therapy (MNT) is covered under Medicare Part B for people with diabetes or kidney disease and is therefore reimbursable. The federal regulations state that “only a Registered Dietitian or nutrition professional may provide [nutrition] services” provided the nutrition professional meets certain education and supervised practice requirements—which most certified nutritionists would meet. Many private insurers benchmark their coverage based on Medicare, and therefore also cover MNT.
The AND/ADA is getting state licensing boards to make sure MNT reimbursement is allowed only for Registered Dietitians, excluding other nutrition professionals, no matter how qualified. A bill in West Virginia, for example—which fortunately did not pass—would have made it unlawful to practice “dietetics” (which specifically included “medical nutrition therapy”) without a license.
We expect the AND/ADA will only become more aggressive in their licensure efforts now that the Supreme Court has upheld the administration’s Patient Protection and Affordable Care Act (PPACA). MNT for renal problems and diabetes is currently considered “preventive care” under the PPACA, and therefore would not be subject to deductibles or co-payment under private insurance—making AND/ADA especially determined to make sure this lucrative market is theirs alone. PPACA allows the Centers for Medicare and Medicaid Services to determine where and how to expand preventive services—and MNT is specifically included in its list of services that might get expanded.
An AND/ADA internal document reveals that the organization “is stepping up its policy making efforts as health reform is implemented through state and federal rulemaking and state legislation.” They also acknowledge as a problem that “the Affordable Care Act’s inclusion of nutrition does not equate to the specific inclusion of RDs or DTRs, and it remains unclear at this time whether the provision of these services will be from RDs or from other health professionals” (i.e., the competition).
Monopolistic AND/ADA-sponsored legislation is still pending in Illinois, New Jersey and New York. If you’re a resident of one of those states and haven’t yet contacted your legislators, please take action now!
Similar laws in Wyoming and Nevada passed in 2011. Wyoming recently had a comment period for their regulations, and ANH-USA submitted formal comments, requesting that they revoke the law altogether. Nevada is currently in the process of drafting regulations, and we will submit our formal comments there as well once the comment period opens.
We previously reported that Michigan’s Office of Regulatory Reinventions had recommended repealing the state’s monopolistic licensure law. Now the legislature will need to introduce legislation to make sure that happens.
Last but not least, the North Carolina Board of Dietetics/Nutrition is being sued because the board wouldn’t let a blogger, Steve Cooksey, offer free nutrition advice based on personal experience—not even to his friends over the phone! Just this week, Forbes magazine reported that they had received internal documents—leaked by outraged members within the AND/ADA, the professional association behind the NC State Board of Dietetics/Nutrition—which show that the AND/ADA has been using state legislatures to block alternative nutrition providers and restrict free speech. This power exposé demonstrates both the power and the underhanded manipulation of the organization. Don’t miss it.
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I am glad that they are finally getting to doing insurance reimbursement for nutrition professionals but to exclude Master’s and PhD’s is a little ridiculous. RD’s have very little knowledge. I have both an RD and MS, and have learned so much more than school ever taught.
I quit licensure here because they weren’t even enforcing their own rules letting everyone practice nutrition without a license even nurses, fitness trainers, and everyone under the sun.
I am so fed up with the ADA and all the so called nutrition want to be’s. There are too many people graduating. Control the supply, then there will be demand.
A Pediactrics nutritionist helped me raise healthy children.
I am a diabetic , however you do not represent me , please stay out of my healthycare decisions , I don’t want or need your drugs because I watch my diet and take natural supplements . Because of you people I have to buy them myself even though I buy and pay for my own insurance and even have government insurance .
Selective medicine.. That’s what the big frogs want and while the people aren’t looking, that’s exactly what they will get. I can’t help but wonder why the people allow the very same frogs who benefits from their decisions to be the one’s who votes on their decisions.. Sounds like a loaded gun and it’s pointed at us. Healing comes in many titles.. Physician. specialist.. Registered Dietitians. Why deny certified nutritionists? Their not witch doctors.. They went through extensive training from reputable universities, received authentic documentation.. Spent years honing their profession. This stinks of selectness (probably because they refuse to ‘pay’ off these controlling toads). If I trust a doctor then I will trust them all else trust none of them if they agree with this selective disqualification in order to eliminate competition.
I’m not surprised at this action by the Medical Industry! They must feel threatened by how people are so much wiser about nutrition now and the increase of nutrtional supplements sold. But the outragious action here is the restriction of free speech.
I would have gone on from my BS in home economics in 1953 to become a dietician, except for the fact that I found out that I, a life-long vegetarian, would be forced to cook meat to qualify. They were adamant that vegetarianism and and veganism were not healthy. There are people in all camps that have terrible diets, but people can live longer, and get well easier on a vegan diet. Now, the ADA stance may be a little better, but it is impossible that they do not know that it has been proved that a high protein diet, especially a diet high in cow’s milk, is not the core for osteoporosis, but one of the foremost causes, yet they ignore this. They also ignore the problems with prion diseases, and the terrible consequences of CJD. I became a vegan in 1996, when I found out that I had breast cancer. Since the ADA is so behind the times, in all health prevention diets, giving diets for heart patients guaranteeing their clients short, miserable lives, with repeated heart surgeries if they survive the first one, for instance. There have to be viable alternative sources of information, and these sources need to be compensated in order to survive.Those who refuse to change should have the choice to die early, but they need to know that they do not have to. Cutting down on colas and sodas may be a first step, as a friend facing bypass surgery was told, but it will not do what is needed, and she did not know that.
Dorothy Skadsheim (retired RN, MLS, ART, etc.)
I have worked in the field of health care for 45 years. It has been my experience that most dieticians are simple pawns of the pharmaceutical industry and the refined food industry. Certified Nutritionists are better educated, with a broader and more extensive education in health and nutrition than dieticians. Taking away their right to practice the science they have studied and mastered would be detrimental to the well-being of this Country. It would only benefit the industries that have trained the dieticians.
I think that maybe access to license exam by “other” nutritionist would close the gap??? Piotr
Soooo ~ now we have to sneak of to some back road somewhere to find nutritional advice? LOL how totally stupid that would be ! These people need to step back a minute and think about the rights they are trampling on. Every right that is taken from us is also taken from them as individuals. Stop being such lemmings and join us in the fight for freedom from oppression.
How is it that they justify poisoning (ie: with excessive pesticides) us on one hand and then claim they are safeguarding us by preventing us from exercising our freedom of speech when we simply discus our nutritional habits with each other?
How is it that they have such a high level of confidence in their ability to trample our basic human rights?
Hmmm….maybe it is because we are complacent?
Time to wake up.
It’s no secret that the American Dietetic Association is backed by (and is strongly influenced by) many big food & beverage manufacturers. In my opinion, they are incapable of giving unbiased nutritional recommendations. A true nutritionist who is not indebted to these big companies is much better able to help with proper and unbiased advice and certainly deserves insurance compensation.
In my experience dietitians know about food, esp like is advocated by the FDA.
But nutritionists know so much more about health & nutrition. They should be getting the reimbursements, not the dietitians. Seems the health world is just upside down!
please be FAIR WITH EVERYONE! CONCERNED!
Greetings,
I live in Nevada. I heard about this liscensure idea back in school. I only became a RD to protect myself, not because I wanted to. I wanted to quit my internship after the 1st week. My 26 yo daughter reminded me how proud I was to graduate college at 50.. I am so far away of what the organizations stands for. I usually tell people I’m a Nutritionist. We’re all not bad. LOL If you need someone who cares about you as a whole person, well then look me up in Las Vegas or call.
Im appalled by these associations; obviously they feel threaten by wholistic nUtritionist, naturopaths, herbalogists etc. We have the right of speech as anyone and I would be ashamed to be called a dietician and offer a high glycemic and acidic menu to a pancreatic patient in a rehab facility as I ve observed few years back.
I have never met a dietition that was aware that soybeans were NOT food, but in reality just an industrial oil. As far as I am concerned, they are badly educated, and ignorant. Their education consists of brainwashing by the food industry. Any biochemist will tell you that soy is not catabolized in the cells as our bodies do not recognize the foriegn protein. It sits there, adding weight and interfering with cell function.
Making MNT reimbursement only for a Dietician would mean a
sad, a very sad decline in health care. Who rationizes
this restriction- and why? Cost effective (aka profit enhancer) …. or possibly a back room deal with the dieticians’ AND/ADA organization?
Sounds like dirty money at the publics expense and health!
Life. Liberty, and the Pursuit of Happiness! There is a lot of gray area in who really knows better. Does one place their life in believing that a person with a degree has absolute knowledge of every person’s unique chemistry? Does their knowledge make people do what they do not want to do? If believing every professional with their pile, higher degrees, sometimes be suspicious of their ultimate outcome, and their true intention. What is really BIG for one person, may be a disaster for others.
There is legislation that allows acupuncturists, chiropracters etc to practice in the SPECIFIC areas in which they are experts, most doctors do not object to it if it will help their patients and not cause harm (e.g. might not be for someone with a non-healing fracture may not be a good choice)
The same principle could apply to certified nutritionists with Master’s degrees and PhDs. Although having a masters or PhD does not automatically translate as expertise in all areas such as the clinical nutrition fields of pediatrics, parenteral feeding, gastrointestinal nutrition or nutrition during oncology treatment…Let’s just prove that certified nutritionists with Master’s degrees and PhDs are as competent in their ability to give counselling and help in SPECIFIC areas and the legistlation will change.
As yoru article states, there is no reason that Registered Dietitians should be the only ones allowed to provide MNT for Medicare Part B for people with diabetes or kidney disease when the certified nutritionists are equally qualified on knowledgable on insulin regimes and medications for glucose control and counselling for progressive renal failure.
So with proof of ability, the legislation will change. Then registered dietititans can stick to areas where certified nutritionists and Phds are not experts – clincial nutrition of pediatrics, oncology, gastrointestinal disorders, feeds, parenteral nutrition and stop scaring the public.
The Steve Cooksey story in Forbes is written by the husband of a “nutritionist” and the comments to it show more warmongering… again it does not bode well for the reputation of “nutritionists”.
Better to prove ability as the registered dietitians have, then it will be all good for everyone.
Personally I would not want to be a Steve Cooksey and apply my food experience to my friends, since I have no idea of their health status and each of us is genetically different in food asismilation and tolerance.
When I have an issue with health, my first line of defense is nutrition. It is not diet. There may or may not be foods, supplements that I can use because of bio-individuality. Nutrition honors this premise. Diet, which keeps RDA’s at abysmally low levels for the population at large, does not.
The dietician approach of clinically measured, one-size-fits-all regimens of foods and dosages of vitamins based upon science (actually corporate-funded science) is nonsensical. Nature is diverse, and so are the health needs of her people.
I don’t want my health decisions made by a dietician monopoly that is corporate-science driven. The witch hunt against nutritionists needs to stop.
I have been studying nutrition for over 35 years. I have worked at three different hospitals and two different physicians offices, both traditional and holistic. I am not a nutritionist and I am not an RD, but I am extremely knowledgable about nutrition and have helped myself to stay healthy because of it. I only have to look at hospital food to know that Registered Dieticians don’t have all of the information they need to help people get and stay healthy. I have heard from friends and family and many people I talk to about nutrition that their dietician and their physician who were traditionally trained were unable to help them. One diebetic recently called me for information and told me that his RD did not help him with his diabetes and that traditional medical practices almost destroyed his kidneys. Because of his very poor health, I referred him to a holistic physician. The only reason I am mentioning this is that throughout the many, many years that the “Registered Dieticians” have been in charge, people have gotten sicker and sicker in this country. It is time for other voices to be heard. We are not getting well in this country and it is not because there are not enough RDs and Medical Doctors. We are about 47th in World Health; that is truly a disgrace considering all the power and money in the U.S. and the amount of money spent on medical treatment. If traditional medicine would actually cooperate with the holistic/alternative medical community instead of competing with them, we would truly have the best health care system in the world. There is room for both.