My own position first, since I am about to name companies and an organization I have asked things of. I run an independent nutrition practice, which makes several of these platforms competitors of mine in a small way. I have written critically about most of them before. I would rather you know that going in and weigh the documents rather than me.
There is a trade coalition in Washington whose published priority number one is the Medical Nutrition Therapy Act, the bill my profession has been asking Congress to pass since 2020. It has existed since 9 April 2025. Membership is printed at $3,500 a month on a twelve-month commitment.
The Medical Nutrition Therapy Act does not appear anywhere in that coalition’s federal lobbying disclosures. Not the bill number, not the bill name, not the word nutrition.
The organization whose disclosures do name it, by number, in filing after filing, is the Academy of Nutrition and Dietetics.
I had this backwards for most of a week, and the way I had it backwards is the reason I am writing it down.
What I thought I was writing
I sat down to argue that the venture-backed telehealth companies should be lobbying to expand medical nutrition therapy. They bill for it. Every limit on the benefit is a ceiling on their business. Between them the founding members of that coalition include publicly traded companies with tens of billions in annual revenue, a national grocery chain, a hospital system owned by Apollo, and platforms that have taken something on the order of half a billion dollars in venture funding. My profession has a political action committee and a lot of tired people.
If they cared about the patients they say they care about, I was going to write, they would spend some of that money on the fight the rest of us cannot afford.
Then I read the coalition’s material, and it turned out they already claim to. Priority one, in their own recruitment document: “Support for the Medical Nutrition Therapy (MNT) Act: Advocate for the expansion of Medicare coverage for nutrition therapy through telehealth platforms, for conditions like diabetes and hypertension.” Which is a strange sentence, since diabetes has been covered since 2002. But the intent is plain enough.
So I went to check what that advocacy looks like on the record. That is where the piece I was writing died, and a better one started.
What the disclosures say
Federal lobbying is disclosed. Any organization spending above a modest threshold to influence legislation files quarterly under the Lobbying Disclosure Act, names its registrants, reports what it spent, and lists the specific issues and bills it worked. The database is public, free, and searchable. It took me about ten minutes.
ATA Action, the advocacy arm of the American Telemedicine Association and the entity that runs this coalition, spent roughly $170,000 on federal lobbying in the first half of 2026 across four registrants. Its reported issues are telehealth flexibilities, Medicare telehealth, remote prescribing of controlled substances, and digital therapeutics. Medical nutrition therapy does not appear. H.R. 6199 does not appear. S. 3934 does not appear. The word “foodcare” surfaces exactly once in the whole record, in one consultancy’s registration form, and that consultancy filed a termination in the third quarter of 2026.
The Academy of Nutrition and Dietetics spent $421,218 in the same six months. That is $106,603 and $154,615 in its own two quarterly filings, which name the Medical Nutrition Therapy Act and cite H.R. 6199 and S. 3934 by number, plus $80,000 a quarter to BGR Government Affairs, an outside firm whose registered issue reads “health care coverage for Medical Nutritional Therapy and Intensive behavior health,” and whose disclosed lobbying targets include not only the House and Senate but CMS and HHS directly.
So the Academy outspends the coalition on federal lobbying by roughly two and a half to one, pays a K Street firm specifically on this benefit, and is the only party in this entire story whose disclosures name the bill.
I want to be careful about what that does and does not prove. Lobbying disclosures capture registered federal lobbying. A coalition can convene members, brief staff, and shape language below the reporting threshold without any of it appearing. Third-quarter filings are not in yet. What the record establishes is narrower than “they are doing nothing” and more useful: the coalition’s stated priority number one does not appear in the coalition’s disclosed lobbying, and the profession it would most affect is the one paying a registered firm to work it.
I would genuinely like to be corrected on this. If ATA Action can point to the advocacy behind priority one, I will print it.
The correction I owe
The piece I almost published said my profession was not in the room. That was wrong, and it was wrong in a way I should have caught, because the primary record was one query away and I was reading a press release instead. That is the exact failure my own rules exist to prevent.
The Academy is not standing outside asking politely. It is paying a lobbying firm to work this bill at CMS, at HHS, and on the Hill, and it has been doing a version of that for years.
Which makes the next fact much stranger than the one I thought I had found.
Six years, four Congresses, no hearing
CongressHouse billIntroducedCosponsorsCommittee action 116thH.R. 697122 May 202010Referral only 117thH.R. 310811 May 202131Referral only 118thH.R. 640714 Nov 202329Referral only 119thH.R. 619920 Nov 202527 and countingReferral only
The Senate side is the same shape. Susan Collins of Maine has introduced this bill in all four Congresses, most recently S. 3934 on 26 February 2026, with Gary Peters of Michigan as lead cosponsor every time. That bill has had one day of recorded action in its life: introduced, read twice, referred to Finance.
Across eight bills and four Congresses, in both chambers, the complete record of committee activity is referral. No legislative hearing on the bill, no markup, and no vote in any committee of jurisdiction, which means House Energy and Commerce, House Ways and Means, and Senate Finance. The statute is the proof: 42 U.S.C. 1395x still reads “in the case of a beneficiary with diabetes or a renal disease,” and still requires a referral by a physician. Those are the exact clauses the bill would strike. Nothing has ever struck them.
Two honest qualifications. A subcommittee referral is docketing, not consideration, and the one the 118th bill received from Ways and Means arrived on 17 December 2024, seventeen days before that Congress expired. And medical nutrition therapy has been mentioned aloud in hearing rooms, once by a witness at an Appropriations hearing in March 2022 and once by a sponsor describing a companion bill during her question time in September 2024. Neither was a hearing on this bill.
The obvious explanation is that twenty-seven cosponsors is simply not enough support. That explanation is available and it is wrong, and I can prove it with the bill next door.
The Nutrition CARE Act would cover medical nutrition therapy for eating disorders. In the 117th Congress its House version carried ninety-two cosponsors. It received no hearing, no markup, and no vote. It has now run three Congresses and six bills to exactly the same place.
Ninety-two was not enough either. So the constraint is not support, and cosponsorship, which costs a member of Congress nothing, is not the currency that was ever going to buy this.
The score
Here is what I think is actually in the way, and I did not find it in any advocacy material. I found it in a journal.
Rowland and colleagues, writing in JAMA Network Open in April 2025, took the electronic health records of 143,157 Medicare beneficiaries and asked a simple question: who would qualify for medical nutrition therapy if this bill passed? Today, 30.3 percent of those beneficiaries qualify. Under the Act, 85.1 percent would.
That is a single health system’s records rather than a national sample, and it is an estimate rather than a projection of spending. But it is the best published number anyone has, and the authors say the quiet part themselves: expanding coverage to eleven additional conditions “may be perceived by some policy makers as financially unsustainable.”
Now look at what is missing. On the congressional record for both H.R. 6199 and S. 3934, in the field where a bill’s cost estimate goes, the entry reads zero. There is no Congressional Budget Office score. There has never been one, in four Congresses.
A bill that would roughly triple the eligible population of an open-ended Part B benefit, with no score and no offset, is not a bill a Ways and Means or Finance chair schedules. Not because anybody dislikes dietitians. Because the first question in that room is what it costs, and for six years our answer has been that the evidence is good.
The evidence is good. I have spent a year writing about how good it is. It is also not an answer to the question being asked, and I think we have spent six years answering a question nobody in jurisdiction was asking.
That reframes what has been happening. The money was never the obstacle: the Academy already spends more on federal lobbying than the coalition does, and about ten times the price of a seat in it. The support was never the obstacle: ninety-two cosponsors bought nothing. What has never been produced, by anyone, is a number a committee can defend.
What is happening while we wait
Two things, both current, both against us.
The rate fell. In the 2025 physician fee schedule, a follow-up unit of medical nutrition therapy carried a facility total of 0.82 relative value units. In 2026 it carries 0.66, after the indirect practice expense changes. At the 2026 non-qualifying conversion factor of $33.4009, after the statutory eighty-five percent non-physician reduction and the two percent sequestration, a follow-up fifteen-minute unit pays $18.36 nationally in the hospital outpatient setting. Last year the same unit paid $22.09. The rate for the service at the center of all this advocacy dropped about seventeen percent in one year, while the coalition seat stayed at $3,500 a month.
And a live proposal would erase part of it. In the CY2027 proposed rule, CMS describes a new code for shared medical appointments and acknowledges that today a dietitian participating in one “may also bill for their portion of the SMA separately,” naming 97804. It then proposes that this stop: the service “is considered part of the SMA and should not be billed separately.” That is at 91 FR 43904. It is open for comment until 14 September 2026, and it would take a category of our group work out of claims data entirely.
Nothing here changes what I wrote about these companies in July. A business whose product is the spread between what a benefit pays and what the clinician costs has every reason to widen the benefit and no reason at all to raise the rate. Wanting expansion and wanting a decent unit price are different wants, and only one of them is on anybody’s published priority list.
What to actually do
I said two weeks ago that the article was the only thing I would ask anybody for this year, and I meant it. This list is not really aimed at you. It is aimed at the calendar, and at the organizations whose job this is.
1. File a comment on the rule. Before 14 September, 11:59 PM Eastern.
Docket CMS-2026-2377 at regulations.gov. A name, an email, a text box. Address the shared medical appointment provision at 91 FR 43904 and describe one concrete operational consequence from your own practice. Type it into the box rather than attaching a file, because attachments are often not searchable in the docket, and a comment nobody can find is a comment that did not happen. This is the only item on this list with a hard federal deadline inside the next month, and it is the one where an individual dietitian’s voice weighs the most it will ever weigh.
2. Ask for a hearing, not another cosponsor.
This is the request almost nobody makes and the one the record says is missing. Ninety-two cosponsors did not produce a hearing for the Nutrition CARE Act, and twenty-seven will not produce one here. If you contact a congressional office, the sentence that matters is that you are asking the committee to hold a hearing on H.R. 6199 this session. If your representative sits on Energy and Commerce or Ways and Means, or your senator on Finance, your call is worth more than most, and their staff will tell you if you ask.
3. Ask our own organization the specific question.
Not whether it supports the bill. It does, it says so, and it pays a firm to say so. The question is what that firm has produced and what the plan is for the score. It is entirely fair to ask a membership organization what $320,000 a year in outside lobbying has delivered on this bill, and who is working the cost estimate problem, because that is the one obstacle no amount of cosponsorship or coalition membership solves. If the answer is that a score is in progress, that is genuinely good news and I will say so. If nobody is working on it, that is the most important thing this profession could learn this year.
4. Ask the coalition to reconcile its priority list with its filings.
ATA Action prints the Medical Nutrition Therapy Act as priority one and sells membership at $3,500 a month on a twelve-month commitment. Its lobbying disclosures do not mention the bill. Those two things can both be true if the work is happening below the reporting threshold, and if so it should be easy to describe. The question is fair, the answer is checkable, and any dietitian working inside a member company can ask it internally without any of this being adversarial.
A related and cheaper test arrives on its own: the comment period closes 14 September, and the docket is public afterward. If the coalition files and addresses the 97804 bundling provision, that is real. I will read the docket either way and report what is in it. Please do not send me anything internal or non-public; there is nothing in this that requires anyone to take a risk at work.
5. Use the seat we already hold.
Dietetics holds one of the thirteen seats on the RUC’s Health Care Professionals Advisory Committee, alongside twelve other non-MD/DO professions, every one of them paid on a schedule it does not set. Physical and occupational therapy take eighty-five percent when an assistant furnishes more than a tenth of a service, on a minute count, with exceptions. We take eighty-five percent on every claim, always, regardless of who does what. Four or five of those professions filing independently on the same rule, each in its own voice about its own patients, is a finding. One profession filing alone is an interest group. That coalition costs nothing to build, because we are already in the room with all of them three times a year.
The calendar
14 September 2026, 11:59 PM Eastern. Comments close on the CY2027 proposed rule. Twenty-eight
days from this posting.
Around 1 November 2026. CMS publishes the final rule and must respond to substantive
comments. This is when we learn whether anyone read ours, and whether 97804 survives inside a shared medical appointment.
1 January 2027. The rule takes effect.
December 2026, at adjournment. The practical end of the 119th Congress, with the
constitutional end at noon on 3 January 2027. H.R. 6199 and S. 3934 die there, along with all twenty-seven cosponsorships, and the seventh year of asking begins with a reintroduction and a count that restarts at zero.
That date has already come three times.
Jason Fee, MS, RDN, LDN is a clinical dietitian and the founder of Vitae Arete. This piece was prepared independently and represents his own views. He filed his own comment on the CY2027 proposed rule on 6 August 2026, tracking number msh-p9oo-yypp.
Sources. Coalition: ATA Action, “Join the ATA Action Virtual Foodcare Coalition” membership document and Virtual Foodcare policy pages, and the ATA Action press release announcing the coalition, 9 April 2025; the eight founding members are those named in that release, which says founding members “include.” Lobbying: Senate Lobbying Disclosure Act filings for ATA Action and for the Academy of Nutrition and Dietetics, first and second quarters of 2026, at lda.gov. Legislation: H.R. 6971 (116th), H.R. 3108 (117th), H.R. 6407 (118th), H.R. 6199 and S. 3934 (119th), and the Nutrition CARE Act bills of the 117th through 119th Congresses, Congress.gov and govinfo bill status records. Eligibility estimate: Rowland S, Hummel S, Sikand G, Brandt EJ, “Expansion of Medicare Coverage for Medical Nutrition Therapy,” JAMA Network Open, 2025;8(4):e257716, doi:10.1001/jamanetworkopen.2025.7716. Rates: CMS 2026 National Physician Fee Schedule Relative Value File, July release, and the 2025 file for the prior-year comparison; facility totals, national unadjusted, non-qualifying conversion factor $33.4009, after the eighty-five percent reduction at 42 U.S.C. 1395l and two percent sequestration; MNT is paid at 100 percent with deductible and coinsurance waived under 42 CFR 410.152. Rule: CY2027 Medicare Physician Fee Schedule proposed rule, Federal Register, 16 July 2026, 91 FR 43842 through 44557, shared medical appointment provision at 91 FR 43903 through 43904; docket CMS-2026-2377, comments close 14 September 2026. All records accessed 17 August 2026.
This article is general nutrition education, not individualized medical or nutrition advice, and it does not create a dietitian–client relationship. Medications and their side effects should be managed with your prescribing clinician. See the full disclaimer.