services is the provision of nutrition therapy, which includes the assessment of nutritional status, evaluation of nutritional needs, intervention that ranges from counseling on diet prescriptions to the provision of enteral and parenteral nutrition, and follow-up care as appropriate.

In considering the provision of nutrition services across the continuum of care, the committee focused on distinct patient care settings that included acute (inpatient) care, ambulatory (outpatient) services, home care, and long-term care. Evidence for specific diseases and conditions that commonly impact Medicare beneficiaries and for which nutrition intervention has generally been recommended was examined in depth. In addition, numerous research recommendations were made and can be found at the end of each chapter. The committee’s deliberations led to the following recommendations.

MEDICARE COVERAGE OF NUTRITION THERAPY

Recommendation 1. Based on the high prevalence of individuals with conditions for which nutrition therapy was found to be of benefit, nutrition therapy, upon referral by a physician, should be a reimbursable benefit for Medicare beneficiaries.

Although few randomized clinical trials have directly examined the impact of nutrition therapy, there is consistent evidence from limited data to indicate that nutrition therapy is effective as part of a comprehensive approach to the management and treatment of the following conditions: dyslipidemia, hypertension, heart failure, diabetes, and kidney failure. Conditions evaluated for which data at this time are lacking or insufficient to support a recommendation for nutrition therapy included cancer and osteoporosis. In the case of osteoporosis, although nutrition intervention through calcium and vitamin D supplementation has clearly been found to improve health outcomes, there is a lack of available evidence to suggest that nutrition therapy, as opposed to basic nutrition education from various health care professionals, would be more effective. For cancer treatment, however, with the exception of the role of enteral and parenteral nutrition therapy, a preliminary review of the literature revealed insufficient data at this time regarding the role of nutrition therapy, specifically nutrition counseling, in the treatment of cancer and the management of its symptoms. For this reason, only evidence pertaining to enteral and parenteral nutrition therapy in the management and treatment of cancer was extensively reviewed.

Summaries of the evidence for conditions which were extensively reviewed can be found in Box 15.1. In addition, a summary of the types of evidence available for these conditions can be found in Table 15.1. It was



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