Type: Medicaid or Medicare
Program Goal: The goal of this plan is to improve the health of rural seniors with comprehensive care that specifically respond to the social factors that affect a senior’s overall health and wellbeing.
This is a pilot with Foodsmart to assess nutrition improvements and mental health.
Target Population: 120 participants who are > 60 years old and have a diagnosis of hypertension, diabetes, or heart disease.
State Served: VA
RD Requirements:
Health Plan Credentialing | State Medicaid Enrollment | Foodsmart Credentialing Requirements |
|
| Medallion Credentialing Application |
Benefits Overview:
Video Required | # of Allowed Visits | # of Allowed Units per Visit | Schedule Cadence | Billing Codes | Foodsmart Program Features |
No | 3 | 4
| Visit 1 (week 1), Visit 2 (week 2-3), Visit 3 (week 4-5)* | Initial: 97802 Follow Up: 97803 |
|
*Visits need to be completed within a 6 week timeframe.
RD Assessments:
Nutriquiz | SNAP Required | Risk Assessment Required |
No | Recommended | No |
Food Benefits:
Foodsmart Bucks | Foodboxes/MTM | Food Selection Instructions |
NONE | NONE | Get access to food through community resources |
Community Resources:
Food Pharmacy
Patients can visit the Food Pharmacy at Blue Ridge Health Center once a week. They will receive 2 reusable grocery bags of items they can select themselves.
Two Nourishing Neighbor Classes
Community group nutrition classes hosted by Blue Ridge Medical center to provide patients with additional health and nutrition information.
Care Plan 3 Total Visits in 6 Weeks
Rural Senior Nutrition Education Support:
All of these patients live in rural areas. As a dietitian you’ll have to get crafty and creative on how patients can use shelf-stable items and navigate limitations with transportation to grocery stores. These are barriers this population likely will face.
Focusing on personalized nutrition with an emphasis on low-cost, heart healthy/ blood sugar friendly based on the patient's medical conditions will be beneficial to this population. These three Foodsmart Programs have materials that will be relevant for this patient population.