CMS SOM App. A, Tag A-0618

The hospital must have organized dietary services that are directed and staffed by

adequate qualified personnel. However, a hospital that has a contract with an outside food

management company may be found to meet this Condition of Participation if the company

has a dietician who serves the hospital on a full-time, part-time, or consultant basis, and if

the company maintains at least the minimum standards specified in this section and

provides for constant liaison with the hospital medical staff for recommendations on

dietetic policies affecting patient treatment.

Interpretative Guidelines §482.28

The hospital’s food and dietetic services must be organized, directed and staffed in such a

manner to ensure that the nutritional needs of the patients are met in accordance with

practitioners’ orders and acceptable standards of practice.

The hospital should have written policies and procedures that address at least the following:

• Availability of a diet manual and therapeutic diet menus to meet patients’ nutritional

needs;

• Frequency of meals served;

• System for diet ordering and patient trays delivery;

• Accommodation of non-routine occurrences (e.g., parenteral nutrition (tube feeding),

total parenteral nutrition, peripheral parenteral nutrition, change in diet orders, early/late

trays, nutritional supplements, etc);

• Integration of the food and dietetic service into the hospital-wide QAPI and Infection

Control programs;

• Guidelines for acceptable hygiene practices of food service personnel; and

• Guidelines for kitchen sanitation.

The same standards apply whether the food and dietetic services are provided by the hospital

directly, through a contractual agreement, or by off-site vendor.

The hospital must be in compliance with Federal and State licensure requirements for food and

dietary personnel as well as food service standards, laws and regulations.