CMS SOM App. PP, Tag F808

§483.60(e)(1) Therapeutic diets must be prescribed by the attending physician.

§483.60(e)(2) The attending physician may delegate to a registered or licensed

dietitian the task of prescribing a resident’s diet, including a therapeutic diet, to the

extent allowed by State law.

INTENT §483.60(e)(1)-(2) - To assure that residents receive and consume foods in the

appropriate form and/or the appropriate nutritive content as prescribed by a physician,

and/or assessed by the interdisciplinary team to support the resident’s treatment, plan of

care, in accordance with his her goals and preferences.

GUIDANCE §483.60(e)(1)-(2)

If the residents’ attending physician delegates this task he or she must supervise the

dietitian and remains responsible for the resident’s care even if the task is delegated. The

physician would be able to modify a diet order with a subsequent order, if necessary.

NOTE: The terms “attending physician” or “physician” also includes a non-physician

provider (physician assistant, nurse practitioner, or clinical nurse specialist) involved in

the management of the resident’s care.

DEFINITIONS §483.60(e)(1)-(2)

“Therapeutic Diet” means a diet ordered by a physician or delegated registered or

licensed dietitian as part of treatment for a disease or clinical condition, or to eliminate or

decrease specific nutrients in the diet, (e.g., sodium) or to increase specific nutrients in

the diet (e.g., potassium), or to provide food the resident is able to eat (e.g., a

mechanically altered diet).

“Mechanically altered diet” means one in which the texture of a diet is altered. When

the texture is modified, the type of texture modification must be specific and part of the

physicians’ or delegated registered or licensed dietitian order.

PROBES §483.60(e)(1)-(2)

• If a resident is receiving a therapeutic diet, is the diet prescribed by the attending

physician or delegated registered or licensed dietitian?

• If a registered or licensed dietitian has written the order, is this delegation by the

physician allowed by State law?

• If a resident has inadequate nutrition or nutritional deficits that manifest into

and/or are a product of weight loss or other medical problems, determine if there

is a therapeutic diet that is medically prescribed.

POTENTIAL TAGS FOR FURTHER INVESTIGATION §483.60(e)(1)-(2)

During the investigation of F808, the surveyor may have identified concerns with

additional requirements related to outcome, process, and/or structure requirements. The

surveyor is advised to investigate these related requirements before determining whether

non-compliance may be present at these other tags. Examples of some of the related

requirements that may be considered when non-compliance has been identified include,

but are not limited to, the following:

• §483.30(e)(2), F715, Physician Delegation to Dietitians

o Determine if concerns are identified with the physician delegation/supervision

of a registered or licensed dietitian

• §483.25(g)(1)-(3), F692, Assisted Nutrition and Hydration.

o Determine if concerns are identified regarding a resident’s nutritional status