Delivery Characteristics 650-25-45-01-10

(Revised 01/1/13 ML #3359)

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1. Contract entities must meet all applicable state and local laws and regulations regarding the safe and sanitary handling of food, equipment, supplies, and materials used in the storage, preparation, and delivery of meals and services to older persons. (Refer to the “North Dakota Requirements for Food and Beverage Establishments”, North Dakota Administrative Code (NDAC) Chapter 33-33-04.)

2. Congregate meals may be provided as hot or cold; home-delivered meals may be provided as hot, shelf stable, frozen, modified atmosphere packaging (MAP), or nutritional supplements.

1. Hot Food

1. Hot food must be served at 135 degrees Fahrenheit or higher.
2. Document daily monitoring of hot food temperatures for each meal site.
3. The hot food portion of a home-delivered meal must be packaged at 135 degrees Fahrenheit or higher and delivered within a two-hour time frame unless packaged and stored in a manner that will maintain the food temperature throughout the route (i.e. a plug-in-heating unit).

2. Cold Food

1. Cold food must be served at 41 degrees Fahrenheit or less.
2. Document daily monitoring of cold food temperatures for each meal site.
3. Working thermometers must be in place in all refrigerators/walk-in coolers. Refrigeration temperatures must be maintained between 35-41 degrees Fahrenheit.
4. Document weekly monitoring of temperatures of refrigerators/walk-in coolers.
5. The cold food portion of a home-delivered meal must be packaged at 41 degrees Fahrenheit or less and delivered within a two-hour time frame unless packaged and stored in a manner that will maintain the food temperature throughout the route (i.e. a plug-in cooling unit).

3. Shelf Stable

Label must include entrée selection, and the date of expiration.

4. Frozen

1. If commercially frozen meals are not used, frozen meals must be produced using rapid/blast freeze equipment and technology.
2. Label must include entrée selection, instructions for storage and reheating, and the date of expiration. The date of the expiration should be no longer than three months after the meal was rapid/blast frozen.
3. Working thermometers must be in place in all freezers. Frozen food must be maintained at zero degrees Fahrenheit or below.
4. Documentation of weekly monitoring of temperatures of freezers.
5. The provider must assure the client has the ability to store and prepare the frozen meal.
6. All frozen meals must be recorded only as a sub-service of home-delivered meals.

5. Nutritional Supplement

The provision of any nutritional supplement must be based on a written diet order signed by a physician. The supplement must be part of a supervised nutrition intervention for clients that are only able to consume liquid food. Nutritional supplements are generally prescribed for a short-term basis; therefore, for clients that consume only liquids, the supplement is required to be supervised (preferably by a Registered Dietitian) which includes reviewing intake, toleration, and the need for continued usage of the supplement. Review of intake, toleration, and the need for continued usage must be completed every four to six weeks. The goal is to have clients eating a mixture of solids and liquids in a meal to maintain muscle mass and overall body functioning.

 

Nutritional supplements served in addition to a meal are not considered separate meals, no matter how many cans of supplement are provided. A nutritional supplement given in an amount that equals 1/3 DRI will not be considered a meal unless it is the only food provided and consumed as the meal. A supplement adds on to a meal, it does not serve as a meal. No matter how much a meal provides, adding supplements to that meal will only increase the nutritional value of that single meal.

 

Supplements are also available in a frozen state. The contract entity must check with the manufacturer/supplier for the recommended shelf life of thawed supplements if the discard date is not indicated on the package.

 

For billing purposes, a nutritional supplement is considered as one meal only if the client is unable to consume liquid food as indicated by a physician order and supervised by a Registered Dietitian.

 

6. Modified Atmosphere Packaging (MAP) Meal

Modified Atmosphere Packaging (MAP) is a technology that has been developed to ensure that packaged food products stay fresh and attractive for as long as possible. MAP extends the shelf life and preserves the quality of food without additives or preservatives. Shelf life of fresh food is significantly extended, while spoilage and waste are reduced.

If a MAP meal is used for the home-delivered meal service, the nutrition services contract entity must assure that the client has the ability to store and prepare the MAP meal.

3. The Older Americans Act authorizes the provision of congregate meals and home-delivered meals. There is no provision for carry-out or take-out meals. Meals must be provided five or more days per week in the defined service area. Congregate meals must be served a minimum of three days per week at each congregate meal site. A minimum of five home-delivered meals must be made available per client per week in the client’s home. Meals must be served during appropriate meal times.
4. A contract entity may choose not to serve congregate meals on holidays. The contract entity must identify the specific holidays a site(s) will be closed in their Program Policies and Procedures Manual. Site closures must also be included in the menus, the contract entity’s newsletter (if applicable), and posted in a visible location at the meal site.

For home-delivered meals, an alternative option (i.e. shelf stable, frozen, or modified atmosphere packaging (MAP) meal) must be made available to avoid an interruption of service to the home-delivered meals client.

5. Congregate meal service must address the following:

1. All eligible congregate meals clients who participate or plan to participate shall be requested to provide baseline data as outlined in the SAMS Congregate Meals Program Registration form.  The contract entity must attempt to obtain all data requested in the assessment. Contact information, demographic data, and the Nutrition Screening Checklist are required for federal reporting purposes. Contacts may be documented in the Narrative section of the SAMS Congregate Meal Program Registration form, as appropriate. The Nutrition Screening Checklist must be reviewed and updated in the SAMS data system within a consecutive 12-month period for congregate meals clients.

If the consumer resides within the service area as identified in the contract entity’s Contract with the Department, a Consumer Record must be created and completed in SAMS. This assures compliance with federal reporting requirements under NAPIS and the State Program Report. Non-compliance may result in non-payment for services.

A SAMS Consumer Group posting should be used only for those eligible consumers that are one time guests.

2. Clients who request service may be required to sign up in advance of the date the service is desired as identified in the contract entity’s Program Policies and Procedures Manual.
3. Copies of the menu, and voluntary contribution information must be publicly displayed at all congregate meal sites.  
4. Adaptive equipment to meet special needs must be available.
5. Food not requiring refrigeration may be taken home by participants.
6. For safety reasons, a provider may choose to deliver a meal to a congregate client during inclement weather and/or disaster situations. The contract entity should include this in their Program Policies and Procedures Manual under ‘procedures to assure service delivery in weather-related emergencies’ and 'written emergency disaster preparedness plan' [Reference: Section 650-25-45-30-01(1)(i) and (j) of this service chapter].

If a contract entity chooses to deliver a meal to a congregate client during inclement weather/disaster situations, the meal should be recorded in the SAMS service delivery as a congregate meal.

6. Home-delivered meals criteria include:

1. Client must be homebound because of physical incapacity, mental or social conditions, or isolation. A person is considered homebound when one or more of the following exist:
2. Limited physical mobility;
3. Emotional or psychological impairments that prohibit participation at a congregate site;
4. Remote geographic location where no congregate meal site exists; or
5. Remote geographic location that prohibits accessing the meal site due to transportation issues.

2. A home-delivered meal may be provided to the spouse of an eligible client, regardless of the spouse’s age or condition, when receipt of the meal is in the best interest of the eligible home-delivered meals client.

 

The only exceptions to the home-delivered meal criteria are provisions for meals in weather-related emergencies and other disasters:

• If a provider delivers a meal to a congregate client during inclement weather [Reference: OAA Policies and Procedures Section 650-25-45-01-10(4)(f)]; or
• If provisions for the delivery of a frozen, modified atmosphere packaging (MAP), or shelf stable meal for a congregate client as an emergency meal are included in the contract entity’s Program Policies and Procedures Manual assuring service delivery in weather-related emergencies and in their disaster preparedness plan.

3. Eligibility for home-delivered meals must be determined using the SAMS Home-Delivered Meal Program Registration form. Initial determination of eligibility may be accomplished by telephone. Within two weeks after beginning meal service, a home visit and the SAMS Home-Delivered Meal Program Registration form must be completed to verify eligibility. The Nutrition Services contract entity may accept program registration information from another Older Americans Act entity. Information must be recorded in the SAMS data system. Documentation must include verification of eligibility for individuals under the age of 60.

For continued home-delivered meal service, redetermination of eligibility must be completed every six months, or sooner, as needed. Redetermination can be accomplished through a home visit or by telephone. At a minimum, one home visit must occur within a consecutive 12-month period. The redetermination must be documented in the SAMS data system. Documentation must include verification of continued eligibility for individuals under the age of 60.

4. Initially and on an annual basis, the Nutrition Services contract entity must provide copies and review content of the menu, voluntary contribution information, and home-delivered meals policies and procedures with the client. The contract entity is encouraged to provide available medical information approved by health care professionals, such as informational brochures and information on how to get vaccines, including vaccines for influenza, pneumonia, and shingles, in the individuals’ communities.
5. The Nutrition Services contract entity must limit the amount of time meals spend in transit before they are consumed.

7. Nutrition education must be provided to both congregate and home-delivered meals clients by the Nutrition Services contract entity. A licensed registered dietitian or person with comparable expertise shall provide input regarding the content of the nutrition education prior to presentation or distribution of materials.

1. Nutrition education shall be provided at each congregate meal site on a semi-annual basis (minimum). Nutrition related presentations, printed materials, videos, food demonstrations, and cooking classes are acceptable formats for the provision of the service. Documentation indicating the meal site, date, presenter, topic presented, number of clients receiving nutrition education, and the number of service units must be maintained. To record Service Delivery in the SAMS data system, a separate Consumer Group should be created for each meal site. Each client attending a presentation equals one unit of service.
2. Nutrition education for home-delivered clients must be carried out on a semi-annual basis (minimum). Printed materials are an acceptable format for the provision of the service.  A copy of the printed nutrition education material and documentation of the date of distribution, number of clients receiving the service must be maintained. To record Service Delivery in the SAMS data system, a separate Consumer Group should be created for each meal site. Each client receiving the printed material equals one unit of service.
3. Expenses for the provision of nutrition education are included in the unit cost of a congregate and home-delivered meal and are not a separate billable unit.
4. Units of service and the estimated cost must be reported on the Monthly Data & Payment Report.

8. All congregate and home-delivered meals clients must be screened for nutritional risk using the Nutrition Screening Checklist, which is a part of the SAMS Congregate Meals Registration form and the SAMS Home-Delivered Meal Program Registration form.

1. For congregate meals clients, the screenings must be conducted a minimum of one time within a consecutive 12-month period.
2. For continued receipt of home-delivered meals, redetermination of eligibility must occur every six months or sooner as applicable. Redetermination must include completion of the Nutrition Screening checklist and ADL/IADL's. The redetermination may be conducted through a home visit or by telephone. At a minimum, one home visit must occur within a consecutive 12-month period. If additional services are indicated, a referral should be made to the appropriate agency and/or to the regional ADRL.
3. Screening results for all clients must be recorded in the SAMS data system. Clients should be encouraged to 're-check' their nutritional scores as indicated: Score of 0-2 should recheck in 6 months; score of 3-5 should recheck in 3 months; score of 6 or more are at high nutritional risk and should be referred to their physician or licensed registered dietitian to discuss nutritional concerns and ways to improve their nutritional health (see information in 7d).
4. Clients who screen ‘at high nutritional risk’ shall be referred to a doctor or licensed registered dietitian for follow-up and possible nutrition counseling. The Nutrition Services contract entity shall make a referral to the licensed registered dietitian providing services to the Nutrition Services contract entity or to the client’s physician. Documentation of the referral or referral attempt must be recorded in the Narrative section of the applicable SAMS meal registration form.

9. Nutrition counseling for congregate and home-delivered meals clients identified at high nutritional risk through the Nutrition Screening Checklist can only be provided by a licensed registered dietitian. All nutrition counseling must be recorded as Service Delivery for each individual client in the SAMS data system.

1. For recording purposes, a unit of service is one session.
2. Expenses for the referral/provision of nutrition counseling are not a separate billable unit.
3. Units of service and the estimated cost must be reported on the Monthly Data & Payment Report.

10. Any alteration in the pattern of service delivery must be discussed with the Regional Aging Services Program Administrator prior to the change. All service delivery options should be considered and/or explored.

After discussions have been held and an alternative plan has been agreed upon, the contract entity must complete and submit a revised Service Provision Form to Aging Services Division as outlined in Section 650-25-75-05-05 of this service chapter.