Dietetic Association’s Latest Power Grab

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.