March 19, 2019

HEALTHCARE POLICY AND PRACTICE 

OPPORTUNITIES FOR SENIOR NUTRITION 

PROGRAMS

PART 2: LAUNCHING AN IN-HOME MEDICAL NUTRITION 

THERAPY PROGRAM
TODAY’S PRESENTER

• Jennifer Raymond

• Chief Strategy Officer and Director of the Healthy

Living Center of Excellence, Elder Services of the

Merrimack Valley
AGENDA

• Brief Overview of Elder Services of the Merrimack Valley, Inc.

• The value of community-based nutrition services to the client, organizations 

and health care systems and payors

• The process and outcomes senior nutrition programs need to focus on 

when contracting with managed care payors for in-home medical nutrition 

therapy services

• Key steps necessary to develop a sustainable medical nutrition therapy 

program;

• Strategies for the successful implementation of key client-centered business 

processes, from referral to billing, for the provision of in-home medical 

nutrition therapy services; and

• Identify scalable and replicable elements of an innovative package of 

nutrition services.
WHO WE ARE

• Largest AAA in Massachusetts

• Serve over 25,000 older adults annually

• 250+ employees and 375+ volunteers

• 40+ programs

• Home of Statewide contracting network for

evidence-based programs (Healthy Living Center of

Excellence)

• Consultant and partner in n4a Aging and Disability

Business Institute

• Evidence-Based Leadership Council Member
POLL

Do you provide Medical 

Nutrition Therapy?

• No

• Yes, in clinical settings

• Yes, in community based 

settings

• Yes, in the home

LAUNCHING IN-HOME MEDICAL NUTRITION THERAPY

Step 1: Why In-home MNT? Develop the Value 

Proposition

- Consumer

- Organization

- Providers

Step 2: Define your Services

Step 3: Establish a Billing Process

Step 4: Staff up!

Step 5: Generate Referrals and Volume

Step 6: Quality Assurance
LAUNCHING IN-HOME MEDICAL NUTRITION THERAPY

Step 1: Why In-home MNT? Develop the Value 

Proposition

- Consumer

- Organization

- Providers
VALUE OF MEDICAL NUTRITION THERAPY 

• Prevalence: In 2015, 30.3 million Americans, or 9.4% of the 

population, had diabetes.

• Approximately 1.25 million American children and adults have 

type 1 diabetes.

• Undiagnosed: Of the 30.3 million adults with diabetes, 23.1 

million were diagnosed, and 7.2 million were undiagnosed.

• Prevalence in Seniors: The percentage of Americans age 65 

and older remains high, at 25.2%, or 12.0 million seniors 

(diagnosed and undiagnosed).

• New Cases: 1.5 million Americans are diagnosed with 

diabetes every year.
MNT AS A SOLUTION, NOT A SERVICE

•Existing Community Relationships

•Connection to resources

•In the Home

• Marketing and Outreach

• Feedback loops

•Training & Technical Assistance 

• Quality & Efficiency through Centralized Infrastructure

• Continuous Quality Improvement (PDSA)
LAUNCHING IN-HOME MEDICAL NUTRITION THERAPY

Step 2: Define your Services
MEDICAL NUTRITION THERAPY 

MNT is a nutrition service provided only by RDs to prevent, 

delay or manage diseases and conditions.

It is a personalized assessment, diagnosis and treatment 

plan.

Multiple visits, over an extended period to measure success 

of the plan.

MNT can be done in the home.
MEDICAL NUTRITION THERAPY 

Screening 

and Referral

Assessment 

and 

Diagnosis

Intervention

Monitoring

and

Evaluation

Feedback
MNT IN THE HOME: INTERVENTION

 Must be billed by a Registered Dietitian (RD).

 Does NOT include Medicare Advantage.

 Type II Diabetes OR Chronic Kidney Disease.

 Must have provider referral.

 Three hours in year one.

 Two hours in subsequent years.

 Additional when medically necessary and with a second referral.
INTERVENTION: BILLING CODES

CPT

codes 

Assessment/Intervention Unit

97802 Initial assessment and intervention

Individual (1:1 and telephonic)

15 minutes/unit 

97803 Reassessment and intervention

Individual (1:1 and telephonic)

15 minute/unit

97804 MNT delivered in a group setting 30 minutes/unit
INTERVENTION BILLING

Year 1: 3 hours of individual MNT:

97802 (Initial Assessment – 60 Min)

4 units @ $30.98 = $123.92

97803 (Reassessment and Intervention)

8 units @ $26.87 = $214.96 

Year 1 Total = $338.88

Subsequent years: 2 hours of individual (subsequent years)

97803 x 8 units @ $26.87 = $214.96
LAUNCHING IN-HOME MEDICAL NUTRITION THERAPY

Step 3: Establish A Billing Process
ENROLLING AS A MEDICARE PROVIDER
LAUNCHING IN-HOME MEDICAL NUTRITION THERAPY

Step 4: Staff up!
STAFFING MODEL

• Registered Dietitian

• Admin. Support

• Billing Partner

This Photo by Unknown Author is licensed under CC BY-NC-ND
LAUNCHING IN-HOME MEDICAL NUTRITION THERAPY

Step 5: Generate referrals and volume
MNT IN THE HOME: SCREENING AND REFERRAL 

Letter to Health Plan

• Who is Eligible?

• Description of service

• Cost of service

• Receiving the service

• Overview of provider

• Contact information
MNT IN THE HOME: SCREENING AND REFERRAL 

Request for Medical Nutrition Therapy (MNT) Referral

Client Name:

Date of Birth:

Client Address:

Agency Submitting Request: Elder Services of the Merrimack Valley

Client Diagnosis:

The above client qualifies for Medicare Reimbursement for Medical Nutrition Therapy 

(MNT) counseling per the listed diagnosis. MNT is defined as, nutritional diagnostic 

therapy and counseling services provided by a registered dietitian or nutrition 

professional for the purpose of managing disease. 
MNT IN THE HOME: SCREENING AND REFERRAL 
LAUNCHING IN HOME MEDICAL NUTRITION THERAPY

Step 6: Quality Assurance
PROBLEM SOLVING AND QUALITY IMPROVEMENT

• Independent Consultants as RDs

• Admin. Support in “chasing” referrals

• Provide MNT services at congregate sites: housing, senior

centers, etc, especially in rural settings

• Information Sessions

• Medicare Advantage Members?
NEXT STEPS: MEDICARE ADVANTAGE 

OPPORTUNITIES

• Healthy Eating for Successful

Living in Older Adults (evidenceinformed)

• Chronic Disease Self Management

Education (group or online)

• Enhance Wellness (1:1 in home)

• PEARLS or Healthy IDEAS

(Behavioral Health 1:1)

• Other Evidence-based Programs

www.eblcprograms.org
NEXT STEPS: MEDICARE ADVANTAGE OPPORTUNITIES: 

RESOURCES

• Home Delivered Meals

• Medically Tailored Meals

• Congregate Meal Sites

• Brown Bag

• Farmers Market

• Farm to Table Initiatives
NUTRITION SERVICES

• Assessment: (including Medical

Nutrition Therapy)

• Education: Healthy Eating for

Successful Living, MNT, Evidencebased Programs

• Resources: Home Delivered

Meals, Congregate Meals, Brown

Bag, Famers Market, Farm-totable
CONTACT INFORMATION

Jennifer Raymond

Chief Strategy Officer, ESMV

jraymond@esmv.org

www.esmv.org

www.healthyliving4me.org

Uche Akobundu, PhD, RD

Director, NRCNA

uche@mealsonwheelsamerica.org

https://nutritionandaging.org/
QUESTIONS AND DISCUSSION
• Title Text

– Body Level Five
ARCHIVED WEBINAR MATERIALS

Missed the first part of this webinar series? 

• Visit the Training and Events section of the NRCNA

website: https://nutritionandaging.org/training/webinarresources/.

• Archived webinars or Toolkits are Available:

o Healthcare Policy and Practice Opportunities (Part 1)

o Nutrition Education in Congregate/Home Delivered

Meal Programs

o Strategies for Your RDN to Add Value & Increase

Engagement in Healthcare Arena

o Positioning Your HCBS Program in the Healthcare

Market
• 2018-2019 plan THANK YOU!