TITLE 9               HUMAN RIGHTS

CHAPTER 2        AGE

PART 18               NUTRITION SERVICES

 

9.2.18.1                 ISSUING AGENCY:    New Mexico Aging and Long-Term Services Department (NMALTSD)

[9.2.18.1 NMAC - Rp, 9.2.18.1 NMAC, 6/30/2015]

 

9.2.18.2                 SCOPE:  These rules apply to members of the public and organizations that participate in the delivery of services to New Mexico’s aging and disability populations.

[9.2.18.2 NMAC - Rp, 9.2.18.2 NMAC, 6/30/2015]

 

9.2.18.3                 STATUTORY AUTHORITY:  Aging and Long-Term Services Department Act, Sections 9-23-1 to 9-23-12 NMSA 1978; Older Americans Act of 1965, 42 U.S.C. Sections 3001 to 3058, and implementing regulations.

[9.2.18.3 NMAC - Rp, 9.2.18.3 NMAC, 6/30/2015]

 

9.2.18.4                 DURATION:  Permanent.

[9.2.18.4 NMAC - Rp, 9.2.18.4 NMAC, 6/30/2015]

 

9 2.18.5                 EFFECTIVE DATE:  June 30, 2015, unless a later date is cited at the end of a section.

[9.2.18.5 NMAC - Rp, 9.2.18.5 NMAC, 6/30/2015]

 

9.2.18.6                 OBJECTIVE:  The objective of this rule is to establish standards and procedures for the federal and state-funded programs administered by the aging and long term services department.

[9.2.18.6 NMAC - Rp, 9.2.18.6 NMAC, 6/30/2015]

 

9.2.18.7                 DEFINITIONS:  The following words and terms, when used in this part, shall have the following meanings:

                A.            “Congregate meals” are meals provided to eligible individuals in a group setting and which must meet recommended dietary allowance requirements and comply with dietary reference intake standards.

                B.            “Dessert” includes, but is not limited to, pudding, custard, plain or fruited gelatin, baked goods, ice cream, ice milk, yogurt, sherbet, other frozen desserts and ethnic desserts.  If gelatin or other desserts contain at least half (½) cup serving of fruit, they also meet the fruit requirement.

                C.            “Dietary Reference Intake Standards” are a set of guidelines for the daily intake of vitamins, minerals, protein, fats, fiber and other nutrients and food components that include recommended daily allowances, adequate daily intake values, and tolerable upper level values of daily intake.

                D.            “Guest” is an individual under the age of sixty (60) who is not eligible for meals funded by the Older Americans Act.

                E.            “Fats” include, but are not limited to, fortified margarine, gravy, mayonnaise, or salad dressing necessary to increase palatability and acceptability of a meal.  Low fat or fat-free varieties are recommended.

                F.            “Homebound” means an individual who has difficulty leaving home without assistance because of a disabling physical, emotional or cognitive impairment.

                G.            “Home delivered meals” are meals delivered to the homes of eligible homebound individuals which must meet recommended dietary allowance requirements, and comply with dietary reference intake standards.

                H.            “Meat” includes, but is not limited to, poultry, fish, game, red or white meat; it shall not include cured or processed meat high in fat or sodium more than two (2) times per month.

                I.             “Meat alternates” includes, but is not limited to, eggs, cheese, soy and legumes (cooked dried beans and peas, lentils).  One (1/2)-half cup cooked legumes is equivalent to one ounce of meat.  Legumes may be counted as either a meat or a vegetable.

                J.             “Milk” includes, but is not limited to, skim milk, two percent (2%) milk, whole milk, low fat chocolate milk and buttermilk fortified with vitamins A and D.

                K.            “Nutrition professional” includes home economists, nutritionists and registered dietitians.

                L.            “Nutrition service provider” is a contractor selected by an area agency on aging to provide congregate or home-delivered meals in a specified geographical location(s).

 

                M.           “Recommended dietary allowance” or “RDA” is the average dietary intake level that is sufficient to meet the nutrient requirements of ninety-eight percent (98%) of healthy individuals in the U.S.  The RDA as referenced in this section is for older adults.

                N.            “Staff” may include employees, volunteers, and others engaged in work related to the operation of nutrition programs.

                O.            “Standard breakfast meal pattern” (when served in combination with a lunch) includes two (2) servings of bread or cereal, one (1) half cup serving of fruit or fruit juice, and eight (8) ounces low fat milk; and may include one (1) teaspoon of fats.  When served without a lunch, the breakfast shall include one (1) ounce of cooked edible portion of meat or meat alternates.

                P.            “Standard lunch meal pattern” includes three (3) ounces meat or meat alternates, two (2) half cup servings of vegetable(s), one (1) half cup serving of fruit (a minimum of three (3) times per week), one (1) or more serving(s) of whole grain or enriched bread, eight (8) ounces of low fat milk, one (1)-half cup of dessert (optional if fruit is served), and may include one (1) teaspoon of fats.

                Q.            “Therapeutic diet” is a diet prescribed by a physician or other primary care practitioner, as part of treatment for a disease, clinical condition or metabolic disorder, to eliminate, decrease or increase specific nutrients.  Liquid formula meals are considered therapeutic diets and must meet therapeutic diet requirements.  A “no sugar added” or “no sodium added” meal is not bound by therapeutic diet requirements.

                R.            “Variance” is the difference between the number of meals prepared and the number of meals served, expressed in a percent.

                S.             “Vegetables” include, but are not limited to, red or green chile.  Rice or pasta may not be counted as a vegetable.

                T.            “Whole grain or enriched bread or bread alternate” means biscuits, muffins, rolls, sandwich buns, corn bread, tortillas, wheat breads and ethnic breads.  The use of whole grain products is strongly encouraged.  Alternates include, but are not limited to, rice, barley, bulgur, pasta, dumplings, pancakes, waffles, and high fiber/vitamin fortified cereals with no added sugar.  Starchy vegetables such as potatoes, yams, sweet potatoes, green peas, corn or legumes may not be counted as bread.

[9.2.18.7 NMAC - Rp, 9.2.18.7 NMAC, 6/30/2015]

 

9.2.18.8                 DEPARTMENT RESPONSIBILITIES:  The department shall:

                A.            Review and approve area plans, which contain plans for providing nutrition services.

                B.            Monitor and assess area agencies on aging for compliance with these rules.

                C.            Provide technical assistance in the areas of nutrition, meal preparation, menu planning, and meal delivery.

                D.            Conduct or coordinate training.

                E.            Develop eligibility criteria for home-delivered meals; and.

                F.            Review and grant or deny any waivers to this rule as requested by area agencies on aging.  Such waivers shall not override applicable regulations issued by other state or local agencies that regulate food service and sanitation.

[9.2.18.8 NMAC - Rp, 9.2.18.8 NMAC, 6/30/2015]

 

9.2.18.9                 AREA AGENCY ON AGING RESPONSIBILITIES:  Area agencies on aging shall:

                A.            Assess the need for nutrition services and further develop eligibility criteria in the planning and service area(s) administered.

                B.            Select nutrition service providers through a competitive bid process, which may include a multi-year request for proposals.

                C.            Monitor the performance of nutrition services, including conducting at least one annual assessment of each provider.

                D.            Approve the menu used each month for each provider which must be:

                                (1)           Evaluated with a computer software program; or

                                (2)           Evaluated and signed by a nutrition professional; or

                                (3)           Approved by the department.

                E.            Provide monthly meal counts to the department by the deadline established.

                F.            Ensure that providers develop and maintain policies for cancellation of services due to inclement weather.

                G.            Implement criteria developed by the department and area agency on aging to be used by providers to determine eligibility for home-delivered meals.

                H.            Designate an individual with overall responsibility to plan, develop, coordinate and administer the nutrition program.

                I.             Ensure that service providers develop and maintain inventory control systems to account for food and supplies purchased and used.  Evaluate meal cost and variance at least annually.

                J.             Ensure that service providers develop and coordinate nutrition education activities for participants at congregate meal sites and for those receiving home delivered meals.

                K.            Provide technical assistance and ongoing training to staff and service providers in the areas of nutrition, purchasing, sanitation, safety, inventory, portion control, meal preparation, meal planning, and other relevant topics.

                L.            Ensure that all participants receive nutritional screening upon entry into the program and at least annually thereafter.  Those participants evaluated at high risk may be screened more frequently as circumstances dictate.

                M.           Develop, approve, and ensure compliance of service providers with regard to measuring, maintaining, and documenting adequate temperature controls for home delivered meals.  If the method utilized relies on test meals, such tests shall be conducted no less than monthly and the test meal temperature recorded at the beginning and end of each home delivery route; and.

                N.            Ensure that service providers solicit the advice of nutrition professionals, participants, and others knowledgeable about the needs of older individuals in planning nutrition services.

[9.2.18.9 NMAC - Rp, 9.2.18.9 NMAC, 6/30/2015]

 

9.2.18.10               NUTRITION SERVICE PROVIDER RESPONSIBILITIES:  Nutrition service providers shall:

                A.            Establish and administer nutrition program(s) with the advice of nutrition professionals, participants, and others knowledgeable about the needs of older individuals.

                B.            Provide eight (8) hours per year of food service training to nutrition staff.

                C.            Provide congregate, home-delivered meals, or both, on a regularly scheduled basis.

                D.            Assess the need for home delivered meals based on established criteria.

                E.            Have a disaster plan in place to address the availability of meals in emergencies.

                F.            Maintain required food services licensure or certification.

                G.            Prepare, publicize, and adhere to a monthly menu that meets the dietary needs and ethnic and cultural preferences of participants.

                H.            Conduct and document testing and temperature control procedures to ensure that meals are served or delivered at appropriate temperatures.

                I.             Conduct outreach at least annually to ensure that the maximum number of eligible persons have the opportunity to participate in the program.

                J.             Provide nutrition education for participants at each congregate meal site at least every three (3) months for fifteen (15) minutes or more and provide nutrition education for home-delivered meal recipients through materials sent to the home, home visits, or telephone contact at least twice annually.

                K.            Report cases of suspected abuse, neglect, and exploitation to adult protective services; report to designated authorities any conditions or circumstances which place participants in imminent danger.

                L.            Obtain prior written approval of the area agency on aging that funds the program prior to cancelling services,  closing a site or reducing days of operation, except in the case of inclement weather per area agency on aging policy.

                M.           Maintain, at a minimum, the following:

                                (1)           Documentation identifying participants, guests, and staff;

                                (2)           Monthly menus verified for nutritional requirements as specified in this rule;

                                (3)           Documentation of nutrition education provided to participants;

                                (4)           Documentation of food service training provided to nutrition program staff; and

                                (5)           Daily temperature logs for freezers, refrigerators, and food.

                N.            Persons under the age of eligibility may consume a meal when it will not deprive an eligible individual of a meal.  These persons must pay the full cost of the meal.

[9.2.17.10 NMAC - Rp, 9.2.18.10 NMAC, 6/30/2015]

 

9.2.18.11               MENU REQUIREMENTS:  All meals served must:

                A.            Meet recommended dietary allowance requirements, or dietary reference intake standards.

                B.            Provide for no more than thirty percent (30%) of total calories from fat.

                C.            Follow the U.S. dietary guidelines; and.

                D.            Comply with the standard breakfast meal and standard lunch meal patterns as defined in 9.2.18.7 NMAC.

[9.2.18.11 NMAC - Rp, 9.2.18.11 NMAC, 6/30/2015]

 

9.2.18.12               FOOD PREPARATION AND SERVICE REQUIREMENTS:  Providers must:

                A.            Comply with all state and local health laws and ordinances governing procurement, preparation, handling and serving of food.

                B.            Keep a copy of current state and local food service regulations; and review these annually with staff.

                C.            Submit to inspections by state and local authorities and promptly correct any deficiencies.

                D.            Serve food within thirty (30) minutes after preparation or refrigerate food until ready for use or maintain food at an appropriate temperature as described in 9.2.18.16 NMAC.

                E.            Bring the internal temperature of food served hot to a temperature of at least one hundred sixty- five (165) degrees Fahrenheit (F) during cooking or reheating.

                F.            Maintain hot foods at one hundred forty (140) degrees F or higher and maintain cold foods at forty (40) degrees F or lower, until served.

                G.            Not use steam tables or hot food tables to reheat prepared foods.

                H.            Provide meals that are reflective of participant choice, religion, ethnicity, and culture, and are attractive, palatable and appealing, and contain a variety of color and texture.

                I.             Minimize leftover food by developing accurate production forecasting.  A maximum ten percent (10%) variance between the number of leftover meals and the number of meals served is the target.  Leftover food may be served to participants within forty-eight (48) hours of preparation if proper food handling and storage techniques have been implemented.

                J.             Exercise discretion as to whether to permit leftover food from a meal to be taken from the site by a participant; and.

                K.            Obtain all commercial foods from vendors that comply with all laws relating to food and food labeling. Commercially packaged food must arrive in containers with labels, and, must have been stored at all times at appropriate temperatures.  Fresh or frozen meat, poultry or fish must be processed to comply with all safety requirements.  Fresh produce must be in good condition, free from spoilage, filth or other contamination, and safe for human consumption.  Use of home prepared or home canned food is prohibited.

[9.2.18.12 NMAC - Rp, 9.2.18.13 NMAC, 6/30/2015]

 

9.2.18.13               THERAPEUTIC DIETS:  Therapeutic diets may be provided when:

                A.            A sufficient number of persons require therapeutic diets and the program determines it has the ability to prepare them.

                B.            The food and skills necessary to prepare therapeutic diets are available to the program, including the supervision of a registered dietitian; or the meals are purchased from a hospital or similar facility at which meal preparation is supervised by a registered dietitian.

                C.            A written diet order, signed by a physician, is on file; and.

                D.            The need of each individual is reassessed as determined by the physician.

[9.2.18.13 NMAC - Rp, 9.2.18.14 NMAC, 6/30/2015]

 

9.2.18.14               CONGREGATE MEAL SITE REQUIREMENTS:

                A.            Meal sites shall be located as close as possible to the residences of the majority of eligible individuals with the greatest economic and social needs.

                B.            Meal sites must not restrict participation or illegally discriminate in any way.

                C.            Meal sites must comply with all applicable federal, state and local health, fire, safety, building, accessibility, zoning and sanitation laws, ordinances, or codes, and, at a minimum, each meal site must:

                                (1)           Conduct evacuation drills twice per year;

                                (2)           Maintain a basic first aid kit on the premises at all times;

                                (3)           Maintain a fire extinguisher on the premises at all times with a current inspection tag; and

                                (4)           Meet Americans with Disabilities Act access guidelines;

                D.            Meal sites must post, in a conspicuous location, the following information:

                                (1)           The rights of eligible individuals to equal opportunity and access to services;

                                (2)           Policy for serving guests and staff;

                                (3)           The full cost of the meal;

                                (4)           The recommended amount for contributions from participants and how contributions are used;

                                (5)           Menus for a minimum of one week in advance;

                                (6)           Grievance procedures for participants; and

                                (7)           An evacuation plan;

                E.            Meal sites shall conform to state and local no smoking ordinances, but at a minimum:

                                (1)           Smoking shall not be permitted in food preparation and food serving areas;

                                (2)           Smoking in dining rooms shall not be permitted during meal times; and

                                (3)           Signs shall be posted in all non-smoking areas;

[9.2.18.14 NMAC - Rp, 9.2.18.15 NMAC, 6/30/2015]

 

9.2.18.15               HOME-DELIVERED MEAL SERVICE REQUIREMENTS:

                A.            Providers must implement procedures for determining participant eligibility and assessing the need for service. This includes, at a minimum:

                                (1)           An initial home visit to assess need within fifteen (15) working days of beginning service; and

                                (2)           Six (6)-month reassessment of individuals whose eligibility is subject to change.

                B.            Providers must implement procedures for addressing other participant needs identified during assessment or in the process of serving participants.

                C.            Only trained nutrition program meal delivery staff may deliver meals.

                D.            Supplies, carriers and vehicles that maintain appropriate temperatures must be used to transport hot and cold foods; hot foods must be packaged and transported in separate carriers from cold foods.

                E.            Potentially hazardous foods (such as eggs or milk or foods prepared with eggs or milk) must be pre-chilled and kept at forty (40) degrees F or below.

                F.            Hot foods must be kept at one hundred forty (140) degrees F or above, except during periods of preparation.

                G.            Meal carriers must be cleaned and sanitized daily or have a sanitized inner liner.

                H.            Meals must be packed and sealed to provide easy access for participants while minimizing food spillage and damage.

                I.             Dried foods or shelf-stable meals must be packaged and transported in covered containers and instructions for rehydration or heating provided with each meal.

                J.             Frozen or chilled meals may only be used if:

                                (1)           The provider and the participant are able to provide safe conditions for storage, thawing and reheating;

                                (2)           The frozen food is appropriately packaged and kept at thirty two (32) degrees F or below until it is thawed for use;

                                (3)           Instructions for proper storage and heating are provided to each participant by methods determined by an area agency on aging to be effective; and

                                (4)           Providers have developed procedures for delivering other supportive services to participants to prevent isolation.

[9.2.18.15 NMAC - Rp, 9.2.18.16 NMAC, 6/30/2015]

 

9.2.18.16               NUTRITION SERVICES INCENTIVE PROGRAM (NSIP):

                A.            The Older Americans Act, Section 311, rewards federally funded nutrition programs.

                B.            Any meal served by a provider to eligible individuals which meets RDA requirements, regardless of funding source, shall be reported for NSIP assistance. However, only programs funded with Title III federal funds are eligible to receive assistance.

                C.            NSIP funding must only be used to purchase food which is grown or processed in the United States.  Coffee, tea, cocoa, decaffeinated beverages, fruits, and vegetables grown outside of the U.S. are not reimbursable.

[9.2.18.16 NMAC - Rp, 9.2.18.17 NMAC, 6/30/2015]

 

HISTORY OF 9.2.18 NMAC:

Pre-NMAC History:  SAA Rule 95-18, Nutrition Services Standards, filed 4/13/1995.  9.2.18 NMAC, Nutrition Services Standards, effective 5/31/2001- replaced SAA Rule 95-18, filed 4/13/1995.

History of Repealed Material:

9.2.18 NMAC, filed 5/10/2001 - Repealed 6/30/2015.