CMS SOM App. A, Tag A-0630

practitioner responsible for the care of the patient, or by a qualified dietitian or qualified

nutrition professional as authorized by the medical staff and in accordance with State law

governing dietitians and nutrition professionals.

Interpretive Guidelines §482.28(b)(2)

Patient diets, including therapeutic diets, must be provided in accordance with orders from a

practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition

professional who is permitted to order diets under State law and authorized to do so by the

medical staff.

Diets must be based on an assessment of the patient’s nutritional and therapeutic needs and

documented in the patient’s medical record (including documentation about the patient’s

tolerance to any therapeutic diet ordered).

The hospital’s governing body may choose, when permitted under State law and upon

recommendation of the medical staff, to grant qualified dietitians or qualified nutrition

professionals diet-ordering privileges. In many cases State law determines what criteria an

individual must satisfy in order to be a “qualified dietician;” State law may define the term to

mean a “registered dietician” registered with a private organization, such as the Commission on

Dietetic Registration, or State law may impose different or additional requirements. Terms such

as “nutritionists,” “nutrition professionals,” “certified clinical nutritionists,” and “certified

nutrition specialists” are also used to refer to individuals who are not dieticians, but who may

also be qualified under State law to order patient diets. It is the responsibility of the hospital to

ensure that individuals are qualified under State law before appointing them to the medical staff

or granting them privileges to order diets.

If the hospital chooses not to grant diet-ordering privileges to dietitians or other nutrition

professionals, even when permitted under State law, the patient’s diet must be prescribed by a

practitioner responsible for the patient’s care. In this situation, a dietitian or nutrition

professional who does not have privileges to order diets may nevertheless assess a patient’s

nutritional needs and provide recommendations or consultations for patients to a practitioner

responsible for the care of the patient.

Survey Procedures §482.28(b)(2)

• Review patient records to verify that diet orders are provided as prescribed by the

practitioner(s) responsible for the care of the patient, a qualified dietitian, or

qualified nutrition professional.

• If diet orders are prescribed by a dietitian or other nutrition professional, review

their records to verify that he or she was appointed to the medical staff with diet-ordering privileges, or was granted diet-ordering privileges without being

appointed to the medical staff.

o Ask the hospital how it determines whether the dietician/nutrition professional

is qualified under state law. Review staff records to verify that

dieticians/nutrition professionals demonstrate the required qualifications.