Janet Feinstein, RD, LD, CNSC, Dieticians on Demand


The Centers for Medicare & Medicaid Services updated and finalized their mega-rule regulations last year. Some of the new regulations pertaining to registered dietitians and food service include the education level of the dietitian, the food service manager and staff.

To begin, CMS has revised and expanded the Dietary Services Title §483.35 to Food and Nutrition Services §483.60. The regulations have added a support staff section which requires facilities to provide sufficient personnel to safely and effectively carry out the functions of the food and nutrition services.

Next, facilities are mandated to have either a full time RD (Registered Dietitian) certified by the commission (or licensed by the state), or employ a certified dietary manager with a consulting dietitian. The facility must ensure that all staff has the competency and skill sets for the population. Many of these positions require a bachelor’s degree in the related field of study.

A food and nutrition staff member is now required to be a member of the interdisciplinary team. Facilities must provide each resident with palatable well-balanced meals three times daily in concordance with their special nutritional needs, with no longer than 14 hours between a sufficient evening meal and the morning meal. 

Providers also must take into consideration any special dietary requests as related to the patients’ ethnic, cultural, religious or other preferences of their specific population. Facilities must provide appetizing and appealing alternative options not only in food, but now also in beverages.

Finally, in accordance with state laws, the new regulations allow for the attending physician to authorize the RD to prescribe diets. Consistent with the previous regulations, facilities must provide the necessary assistive eating devices as well as properly trained eating assistive staff. Facilities have been granted the ability to provide their own homegrown food sources as well as food from local producers according to the new food safety provisions, though food must still be properly prepared and distributed to the population.

As the healthcare industry evolves with our aging population and the expected changes in applicable federal law, we can expect further changes to the regulations and with that, changes to the demands of thedietitian and associated staff.

Janet Feinstein, RD LD, CNSC, is a Traveling Dietitian for Dietitians on Demand, a staffing company that specializes in placing Registered Dietitians nationwide in short-term, long-term and permanent positions. She has more than 36 years of clinical nutrition, wellness and food service experience.