agement of diabetes, Congress approved Medicare coverage for diabetes self-management training as part of the Balanced Budget Act.

In addition to the recent coverage for diabetes education, the Balanced Budget Act of 1997 also required that the Department of Health and Human Services contract with the National Academy of Sciences, Institute of Medicine to examine the benefits and costs associated with extending Medicare coverage for certain preventive and other services. The services specifically targeted for examination included screening for skin cancer; medically necessary dental services; elimination of time restrictions on coverage for immunosuppressive drugs after transplants; routine patient care for beneficiaries enrolled in approved clinical trials; and nutrition therapy, including the services of a registered dietitian. This report addresses the benefits and costs associated with extending Medicare coverage specifically for nutrition therapy.

In early 1999, the Institute of Medicine appointed an expert committee charged with the task of analyzing available information, hearing from other experts, and developing recommendations regarding technical and policy aspects of the provision of comprehensive nutrition services, delineated as follows:

• coverage of nutrition services provided by registered dietitians and other health care practitioners for inpatient medically necessary parenteral and enteral nutrition therapy;

• coverage of nutrition services provided by registered dietitians and other health care practitioners for patients in home health and skilled nursing facility settings; and

• coverage of nutrition services provided by registered dietitians and other trained health care practitioners in individual counseling and group settings, including both primary and secondary preventive services.

In addition, the committee was charged with evaluating, to the extent data were available, the cost and benefit of such services to Medicare beneficiaries as well as the research issues needed to provide additional understanding of the relationship between provision of quality nutrition services and quality-of-life outcomes.

The expert committee was composed of 14 individuals and represented the areas of geriatric medicine, clinical nutrition and metabolism, epidemiology, clinical dietetics, nursing, evidence-based medicine, outpatient counseling, nutrition services management, nutrition support,