Navigating Reimbursement Strategies in the Food as Medicine Space
Food as Medicine (FaM), also referred to as ‘Food Is Medicine’ or ‘Food Is Health,’ is playing a significant role in the ever-evolving healthcare landscape. Innovative business models in the FaM space include telehealth-enabled dietitian networks, mobile-ordered meal kits, AI-powered meal plan creators, and integrated nutrition pilot programs.
The FaM ecosystem includes stakeholders ranging from dietitians and behavioral support providers focused on chronic conditions, to retail grocery stores and global food distributors, to tech-first consumer-focused FaM wellness platforms. These stakeholders often collaborate to further their shared goals of improving the health of individuals and the population as a whole while reducing the overall cost of healthcare.
One of the key factors in FaM’s growth is reimbursement policy across various payors and providers. This post introduces reimbursement frameworks and strategies that support the FaM space, including medical nutrition therapy (MNT), medically tailored meals (MTM), the Supplemental Nutrition Assistance Program (SNAP), and employer-sponsored benefits programs. Proposed federal and state legislation may soon open additional revenue opportunities for FaM companies in this rapidly growing sector of healthcare.
How Food as Medicine Programs are Reimbursed
Insurance reimbursement, a primary method of payment for healthcare providers, is evolving in the FaM space. Below is an overview of how various programs are reimbursed.
Medical Nutrition Therapy (MNT)
What is MNT?
MNT is a nutrition-based treatment provided by registered dietitians (RDs) or other “nutritional professionals” as defined by each state. MNT includes focused nutrition therapy services under an individual care plan, nutrition assessments, and continued follow-ups to promote behavioral change. MNT services can be provided via telehealth.
How is MNT Reimbursed?
MNT is reimbursed by Medicare, Medicaid, and some commercial insurance plans under certain conditions. Coverage is often limited to individuals with certain chronic conditions which can vary by plan. Reimbursement codes include:
97802: medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes;
97803: medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes;
97804: medical nutrition therapy; group (2 or more individual(s)), each 30 minutes;
G0270: a 15-minute individual session for MNT reassessment and subsequent interventions following a second referral in the same year for a change in diagnosis, medical condition, or treatment regimen;
G0271: a 30-minute group session for MNT reassessment and subsequent interventions following a second referral in the same year for a change in diagnosis, medical condition, or treatment regimen; and
S9470: nutritional counseling, dietitian visit. This code is not time-based.
Medicare currently covers MNT services, including RD-provided nutritional assessments and counseling, but only for people with certain chronic conditions (currently limited to diabetes and kidney disease). The number of visits is limited to three hours in the first year and two hours in subsequent years.
Medicare Advantage (MA) plans cover MNT to the same extent as traditional Medicare, though some MA plans may offer expanded MNT benefits.
About half of state Medicaid programs provide some coverage of MNT or similar services. Requirements and reimbursement amounts vary by state. There is often additional coverage through contracts with Medicaid Managed Care plans in most states.
Most commercial insurance payers now cover some RD-provided MNT services and dietary counseling, particularly when a beneficiary has one or more chronic conditions. Coverage and reimbursement by commercial payers varies.
Some employers offer MNT or MNT-like services as part of their wellness programs.
Medically Tailored Meals (MTM)
What is MTM?
MTMs are RD-designed meals based on evidence-based guidelines for specific chronic diseases and conditions. They come in various forms, including “heat and eat” meals, prescription groceries, and mobile meal delivery services.
How are MTMs Reimbursed?
MTM is generally not covered by Medicare, except in facilities like hospitals or skilled nursing facilities.
MA plans may offer home-delivered meals for some chronic illness patients on a limited basis, but benefits vary by plans.
Some Medicaid Managed Care plans cover MTM through waivers or In Lieu of Services (ILOS) programs. Typical reimbursement codes are:
• S5179: Home-delivered meals
• S9977: Meals per diem
MTM is generally NOT covered by most commercial payers.
Supplemental Nutrition Assistance Program (SNAP)
What is SNAP?
SNAP provides nutrition assistance to eligible low-income individuals and families. Beneficiaries can use SNAP funds to purchase groceries and food products that align with FaM’s positive health goals.
How is SNAP Reimbursed?
The federal government funds SNAP, with states sharing administrative costs. Food service providers and retailers can become SNAP retailers to receive payment for recommended healthy food.
Employer-Sponsored Benefits
What are Employer-Sponsored Benefits?
Employers may offer employee wellness programs that could include subscriptions to meal delivery kits, meal plan providers, and wellness and nutrition apps.
How are Employer-Sponsored Benefits Reimbursed?
An employer may cover the cost of FaM/wellness benefits, or self-insured plans may do so.
Legislation to Expand Food as Medicine Services
There are currently several bills pending in Congress that could expand coverage for FaM services, including:
Medical Nutrition Therapy Act: Expands Medicare coverage of MNT to individuals with conditions like obesity, eating disorders, cancer, and HIV/AIDS, in addition to existing coverage for diabetic or kidney disease patients.
Medically Tailored Home-Delivered Meals Demonstration Pilot Act: Establishes a Medically Tailored Home-Delivered Meals Demonstration Program to evaluate a payment and service delivery model aimed at improving health outcomes and reducing readmissions.
States are also enacting FaM legislation, with New York becoming the first state to enact a law to cover MNT for all Medicaid patients as a preventive service. RDs are now considered Medicaid eligible providers, and Medicaid Managed Care companies in New York will be required to include MNT as a covered service.
The Future of Reimbursement in Food as Medicine
Food as Medicine is a rapidly growing sector of the healthcare innovation landscape. This growth is fueled in part by reimbursement for some FaM services that may be available through Medicare, Medicaid, and commercial health plans. New legislation at the state and federal levels may provide additional opportunities for reimbursement, further fueling growth. FaM now has a real role to play in improving healthcare outcomes and reducing overall costs of care.
Navigating the legal, regulatory, and commercial landscape around Food as Medicine requires a deep understanding of federal/state laws and issues around insurance coverage, experience negotiating with managed care and commercial payers, and a demonstrated commitment to the space. Nixon Gwilt Law is here to help. Please contact us to learn more.