MAKING THE CASE FOR 

NUTRITION THERAPY: 

MNT WORKS FOR SENIORS

TOOLKIT
WELCOME & 

INTRODUCTIONS

2
@NRCNA_engAging

A COLLABORATIVE EFFORT

• MNT Works for Seniors Toolkit is a result of an 18-month

partnership between:

3

The Academy of Nutrition 

and Dietetics is the world's 

largest organization of food 

and nutrition professionals.

www.eatright.org

The NRCNA seeks to build 

capacity of the aging services 

network to provide nutrition 

services for both current and 

future older adult populations.

www.nutritionandaging.org
PRESENTATIONS

4
2/18/2020

Marsha Schofield, MS, RD, LD, FAND

Senior Director, Governance and Nutrition Services Coverage

Academy of Nutrition and Dietetics

mschofield@eatright.org
This Photo by Unknown Author is licensed under CC BY-NC-ND
Stars in Alignment

7
Rising Health Care Costs

8

Constant 

2018 dollars 

(top line)
20.4

24.9

28.4 31.1

34.3

37.6 39.7

42.6

47.7

55.6

64.3

73.5

81.5

86.5

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical 

Insurance Trust Funds.

Medicare Enrollment, 1970-2035

In millions: Historical Projected
Total Medicare Advantage Enrollment, 1990-2019 (in millions)

% of Medicare Beneficiaries in 1999 was 18% or 6.9. in 2003/2004 the % of Medicare 

beneficiaries dropped to 13% or 5.3 but then steadily increased. By 2019, % of Medicare 

beneficiaries was 34% or 22. 

Note: Includes cost plans as well as Medicare Advantage plans. About 64 million people are 

enrolled in Medicare in 2019. Source: Kaiser Family Foundation analysis of CMS Medicare 

Advantage Enrollment Files 2008-2019 and MPR, 1999-2007; enrollment numbers from March 

of the respective year, with the exception of 2006, which is from April. 
Figure 2: Medicare Advantage Penetration, by State, 2019. National Average, 2019 – 34%. 

2 states have less than 10% (Alaska and Wyoming)

12 states plus DC have between 11-20% (Montana, North and South Dakota, Nebraska, Kansas, 

Oklahoma, Mississippi, Vermont, New Hampshire, Virginia, Maryland)

8 states have 21-40% (Georgia, Massachusetts, West Virginia, Ohio, Iowa, Indiana, New Jersey 

and Arkansas)

22 states have 31-40%

6 states plus PR have greater than 41% ( Oregon, Michigan, Illinois, Florida and Pennsylvania 

and Hawaii). 
Legislation Creates Opportunities

12
The New Value Proposition

13
Discussion Question

How does your program currently fulfill this value proposition?

14
From Volume to Value

Category 1: Fee for Service- No link to Quality and Value

Category 2- Free for Service – Link to Quality and Value

Category 3- APMS Built on Fee-for-service Architecture

Category 4- Population-Based Payment
Kaiser Family Foundation – Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity 

https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/

Social Determinants of Health

Research shows that Medical Care is Responsible for a mere 10 percent of preventable mortality. Diet/exercise is 

40%, Social/environmental is 20% and Genetics: 30%. 
Building Bridges

17

Health Care 

Systems

Community-Based 

Programs
Discussion Question

How are you currently building bridges with the health care 

system in your community?

18
Medicare Part B Medical 

Nutrition Therapy Benefit

Are You Leaving Money on the Table?
Polling Question

Do you currently offer and bill for MNT services?

1. Yes

2. We offer MNT services, but we don’t bill for them

3. No

4. We’re thinking about doing so

20

Maximizing Revenue Streams
23
24

@NRCNA_engAging

MNT WORKS FOR SENIORS 

PROJECT REPORT 

Commissioned by the 

National Resource Center on Nutrition and Aging

in Collaboration with the 

Academy of Nutrition and Dietetics

Contractor: Paula Ritter-Gooder PhD RDN CSG LMNT FAND

• Commissioned by the 

• National Resource Center on Nutrition and Aging

• in Collaboration with the 

• Academy of Nutrition and Dietetics
@NRCNA_engAging

RATIONALE OF THE PROJECT

• Support community-based nutrition professionals and 

programs to advocate for coverage of medical nutrition 

therapy (MNT) by local health plans

• Survey community-based senior nutrition programs and 

Registered Dietitian Nutritionists (RDNs) working in those 

programs to determine education, training and resource 

needs

• Explore examples of innovative programs from the field

• Develop a toolkit as a compendium of information, 

resources and tools 

27
@NRCNA_engAging

MNT IS NOT NUTRITION EDUCATION

Medical Nutrition Therapy

• In-depth individualized care

• Uses the Nutrition Care Process 

to assess, diagnose, intervene, 

monitor and evaluate outcomes 

for treatment and 

management of disease or 

medical condition

• Provided by RDN, required to 

be licensed to practice in most 

states

Nutrition Education 

• Intervention or training 

intended to provide, build or 

reinforce basic nutrition-related 

knowledge/skills

• Non-individualized offered 

through group settings or other 

media

• Planned or provided by RDN or 

other health professional 
@NRCNA_engAging

POLLING QUESTION

• What is driving your interest in this webinar/topic?

• Client need

• Already providing MNT services

• New opportunity/Business development

• Want to know more about topic

• Other

• If you have other reasons for joining the webinar today, 

please enter them in the chat box.
@NRCNA_engAging

DEVELOPMENT OF MNT WORKS FOR SENIORS TOOLKIT

• Quantitative survey of community-based senior nutrition 

programs:

• Determine education, training and resource needs 

• Survey Monkey, Aging and Academy of Nutrition and 

Dietetic networks

• Qualitative inquiry of innovative programs in the field

• Explore models of MNT provided by RDNs in community 

settings

• Informants identified through previous contacts and 

survey participants

• Telephone, semi-structured interviews, written case 

study report verified by informants 

30
@NRCNA_engAging

MNT FOR COMMUNITY BASED OLDER ADULTS SURVEY:

• Results of quantitative survey 

• n= 65 respondents

• 94% were employed at local, state, or regional level to 

provide congregate, home delivered meals or other 

services within senior nutrition programs 

• Over half were RDNs 

• 83% do not provide MNT billed to Medicare Part B

• 86% do not provide MNT billed to Medicare Advantage 

Plans

Challenges and Opportunities
~ Tho National Resource Center on Nutrition & Aging @NRCNA_engAging

Q1 What is your level of agreement to the fol lowing statement: Medicare 

reimbursable MNT is appropriate to offer within senior nutrition progra1ms 

in the community setting. 

Answered: 65 Skipped: 0 

Disagree 

I 

Slight y agree I 

Neither agree 

or disagree 

Slightly agree 

Agree 

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 
@NRCNA_engAging

OPEN-ENDED QUESTION RESPONSES PART 1

Q5 If not currently providing reimbursable MNT in senior nutrition 

programs, please explain why (resources, knowledge, etc)

• “We are interested but need more education about the process”

• “We are currently in the process of researching how to do this. 

Our AAA's are not set up properly to handle the billing at this 

time, and the RD's find the steps to become Medicare 

reimbursable confusing so many do not have the qualifications to 

do so”

• “I did not know we could provide reimbursable MNT”

• “We do not have the level of nutritionists needed to manage all of 

the congregate programs and provide MNT services. In addition, 

the billable piece would require programmatic infrastructure that 

is not in place. We would be very interested in learning more 

about the billable side of things to see if there is opportunity to 

build that into our practice.”
@NRCNA_engAging

OPEN-ENDED QUESTION RESPONSES PART 2

Q6 If currently providing reimbursable MNT in senior 

nutrition programs, please describe any challenges.

• “It took us a bit of time to get all the necessary approvals 

and paperwork. It also takes time to work through the 

referral process”

34
@NRCNA_engAging

QUALITATIVE DATA RESULTS 

Discussions With Informants Who Offer Medicare Reimbursed MNT In Community 

Settings 

• 3 telephone interviews, each approximately 75 minutes in 

length 

• Innovative and emerging programs of 1 1⁄2-6 years 

• Challenge themes- achieving economy of scale, marketing, 

getting “back end” structure in place (physician referral process, 

benefit eligibility, billing procedure) working on denied claims 

• Opportunity themes- positive client outcomes, positive 

engagement with health care partners, new revenue stream 
@NRCNA_engAging

TOOLKIT OVERVIEW

• Access toolkit here: 

https://www.eatrightpro.org/payme

nt#getting-started---payment-basics
@NRCNA_engAging

EXPLORE TOOLKIT CONTENTS

Section I: Making the case for Senior Nutrition Programs- Leveraging Emerging Opportunities for Future 

Readiness and Sustainability Through Health Care Integration, page 5

Section II: Medical Nutrition Therapy in the Changing Landscape of Medicare and Medicare Advantage, Page 7

Section III: Promising Models for Providing Medicare MNT in Community Settings, page 16
@NRCNA_engAging

LEVERAGE KEY ONE PAGERS

MNT Works for Seniors

• The Value of Registered 

Dietitian Nutritionists 

• RDNs Provide Better 

Health Outcomes

• MNT Providing Return on 

Investment 

Share with colleagues, 

employers, funders and 

partners.
@NRCNA_engAging

REVIEW CASE STUDIES

• Understand what works

• Identify opportunities to

leverage learnings to

strengthen your

organization’s MNT

service offerings

• Identify important talking

points
@NRCNA_engAging

GET STARTED!

• Step 1. Understand the Landscape

• Step 2. Obtain a National Provider Number

• Step 3. Obtain an Employee Identification Number

• Step 4. Enroll as a Medicare Provider

• Step 5. Understand Medicare Requirements for Referral and 

Billing
@NRCNA_engAging

EXPLORE OFFERING MNT IN YOUR COMMUNITY SETTING

• Inform and engage leadership using “MNT Works for 

Seniors” toolkit to understand framework. 

• Research market, emerging trends, and prospective 

partners that would be incentivized to partner with you.

• Survey seniors, conduct information sessions.

• Evaluate readiness to change in organization and barriers 

to moving forward.

• Network with other programs or RDNs: 

• Contact the local Area Agency on Aging and State Unit 

on Aging. 

41
@NRCNA_engAging

NEXT STEPS

• Stay touch, stay tuned

• Feedback on Toolkit Evaluation form following the webinar

• Keep the conversation going:

• Join NRCNAengage https://nrcna.mn.co/

• An online networking community
@NRCNA_engAging

CONCLUSION & CALL TO ACTION 

• Providing MNT in community settings is intended to increase 

beneficiaries access to service and respond to changing 

healthcare environment.

• Resources are available to advocate and initiate MNT service 

and assist with challenges.

• For future sustainable programming that enhances the health of 

seniors, senior nutrition programs and RDNs are encouraged to 

be innovative, be collaborative, and establish programs within 

their community.
@NRCNA_engAging

RESOURCES

• Position of the Academy of Nutrition and Dietetics and the Society for Nutrition 

Education and Behavior: Food and Nutrition Programs for Community-Residing 

Older Adults. J Acad Nutr Diet. 2019;119(7):1188-1204. Available at: 

https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-andpractice-papers/position-papers/pp_foodnutritionprogramsolderadults.pdf. 

• Academy of Nutrition Dietetics. Payment. Available at: 

https://www.eatrightpro.org/payment#getting-started---payment-basics. 

• National Coalition of Care Coordination. Building the Business Case: Community 

Organizations Responding to the Changing Healthcare Environments for Older 

Adults. 

https://www.rush.edu/sites/default/files/N3C_Building%20the%20Business%20C

ase_final.pdf

• Leadership Council of Aging Organizations. Issue Brief: The Growing Role of Aging 

Network in Improving Health Care and Reducing Healthcare Costs. Available at: 

https://www.lcao.org/issue-brief-role-aging-network-health-care/
UPCOMING TRAINING & 

NETWORKING 

OPPORTUNITIES

45
@NRCNA_engAging

CELEBRATE THE SENIOR NUTRITION PROGRAM THIS MARCH

During March 2020, the Administration for Community 

Living will kick off, together with the National Resource 

Center on Nutrition and Aging, a series of weekly webinars.

Date: Wednesday March 4

Time: 3:30pm – 5pm ET

Focus: Congregate Nutrition Program

Details: Register at 

www.nutritionandaging.org/training

46
@NRCNA_engAging

ANNUAL 3-PART TRAINING SERIES

STAY TUNED

Join us for a Virtual and In-Person 

Training Series this Summer:

July, August and September 2020

Learn more: 

https://nutritionandaging.org/pastevents/

47
@NRCNA_engAging

Quisti ab inctatiam saperci pientur rest, consequid que 

venihitam, occaborepel im quid que laceptas

dolendestiam et illaborum verionempore volorat

uribus nimintium quo min nessitis volores estionsed

que nihillo repudit vent remperum nonem qui ut od 

quid quo coriae. Et odignis molor acestist, optat am, 

unt omnimossi omnis si voluptin nam fuga. Orrovit et 

exerovit doluptati corrore stiusam qui quaernam unt.

Raecti ut aut pelliqui aut aturem. Aperit dellendae cone 

porporest archill orrupta nem aciunt intore duntotat

adicipi entint lab ist optaquam fugia quia dolupta assin

eaquunt qui dolores inullorem conest, omnis eum

fugia simoluptae. Fuga. Fugia in nulparum facea

doluptas conseque voluptatese cum cuptium quunt.

Rio. Am enderio riasiminctem quat.

Borat eumquae reperovit harumquid mos non 

consequunt quaspid emporerovid qui berum imus es

etur am ipsa nis provid qui aspider iatem. Nemolo

volupta turemoditium es necum rehenihil

CONNECT WITH YOUR PEERS VIA NRCNAengage

48
@NRCNA_engAging

CONNECT WITH YOUR PEERS VIA NRCNAengage

• NRCNAengage is an online venue for nutrition and aging professionals and 

stakeholders across the country to connect, share best practices, resources, 

recipes and ideas for action!

49

Signing up is easy! 

Visit www.nrcna.mn.co

and click ‘Invite’!
THANK YOU!

50

Q & A

Reminders: 

Please complete the webinar 

evaluation!CPEU Forms will be sent via 

email.