1. (a) A facility shall provide nutrition services to a patient and the patient's caregivers to maximize the patient's nutritional status.

2. (b) The dietitian shall be responsible for:

   1. (1) conducting a nutrition assessment of a patient;
   2. (2) participating in an interdisciplinary team review of a patient's progress;
   3. (3) recommending therapeutic diets in consideration of cultural preferences and changes in treatment based on the patient's nutritional needs in consultation with the patient's physician;
   4. (4) counseling a patient, a patient's family, and a patient's significant other, as applicable, on prescribed diets and monitoring adherence and response to diet therapy;
   5. (5) referring a patient for assistance with nutrition resources such as financial assistance, community resources, or in-home assistance;
   6. (6) participating in the facility's quality assessment and performance improvement (QAPI) activities; and
   7. (7) providing ongoing monitoring of subjective and objective data to determine the need for timely intervention and follow-up, including weight changes, blood chemistries, adequacy of dialysis, and medication changes that affect nutrition status and potentially cause adverse nutrient interactions.
3. (c) The dietitian shall contact the patient to document and complete the patient's comprehensive nutrition assessment with an educational component no later than 30 calendar days or 13 treatments after the patient's admission to the facility, whichever occurs later.
4. (d) The dietitian shall conduct a nutrition reassessment no less than annually or upon a change in the patient's status, extended or frequent hospitalizations, a change in the patient's modality, or at the patient's request.

5. (e) Each facility shall employ or contract with a dietitian to provide clinical nutrition services for each patient.

   1. (1) The maximum caseload for a full-time equivalent dietitian is 125 patients. The caseload is cumulative across all modalities and facilities where the dietitian is employed. A facility shall employ or contract a second dietitian for a patient caseload over 125 patients.
   2. (2) The governing body shall ensure the facility assigns personnel to assist dietitians with ancillary tasks when the patient load, including all modalities, exceeds 100 patients per facility.
6. (f) The facility shall ensure nutrition services are available at the facility during scheduled patient treatment times. A patient may need an appointment to access nutritional services.

7. (g) A facility shall have written physician standing orders specific to that facility authorizing delegation of responsibilities for the facility dietitian, as determined by the medical director and the facility.

   1. (1) The medical director shall review and approve the standing orders at least annually.
   2. (2) The standing orders shall be consistent with the statutes and rules of the Texas Medical Board, Texas Board of Nursing, and Texas Department of Licensing and Regulation.
8. (h) When the facility uses a medication algorithm or protocol for managing renal bone disease, the nutritional care for each patient shall be individualized.

Source Note:The provisions of this §507.49 adopted to be effective December 23, 2025, 50 TexReg 8289.