CMS Urges DGA-Aligned Hospital Menus and Procurement Under Conditions of Participation

April 13, 2026

From Guidance to the Galley: CMS Urges DGA‑Aligned Menus and Procurement Under Hospital CoPs

Shawn Maree Bishop, Nathan Brown, Kelly Cleary, Oluwaremilekun Mehner, Amaru Sanchez Akin Gump Strauss Hauer & Feld LLP + Follow Contact LinkedIn Facebook X Send Embed

On March 30, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a Quality & Safety Special Alert Memo (QSSAM) to hospitals and Critical Access Hospital (CAH) providers titled “Hospital Nutrition Service Obligations in Light of Updated Federal Nutrition Guidelines.” In the memorandum, CMS links existing hospital Conditions of Participation (CoPs)—the baseline health and safety requirements that hospitals must meet to participate in the Medicare and Medicaid programs and receive federal reimbursement—to the recently released Dietary Guidelines for Americans, 2025–2030 (DGAs), and encourages hospitals to use the DGAs to inform hospital nutrition services, menu development and related protocols.

CMS highlights the DGAs’ focus on dietary patterns that limit ultra‑processed foods (UPFs), sugar‑sweetened beverages, refined carbohydrates and added sugars, while prioritizing whole and minimally processed foods. The memorandum arrives amid the broader federal “food as health” messaging associated with the administration’s Make America Healthy Again (MAHA) agenda.

In the memorandum, CMS reiterates that hospitals must comply with the dietary services CoPs at 42 C.F.R. § 482.28, including requirements that menus meet patient needs and that individual patient nutritional needs are addressed in accordance with recognized dietary practices, supported by appropriate dietary services oversight and a current therapeutic diet manual. Against this compliance backdrop, CMS urges hospitals to proactively review and, as appropriate, revise food and nutrition service policies, standard menus, therapeutic diet orders and food procurement practices to better align with the DGAs.

Key Observations

1. CMS is Attempting to Operationalize the DGAs Through Existing Hospital CoP Regulations

The QSSAM reflects a notable step by CMS to translate the DGAs into the hospital regulatory framework without new rulemaking. By anchoring its guidance in the CoP for Food and Dietetic Services at 42 C.F.R. § 482.28, CMS signals that alignment with the DGAs may be relevant to assessing whether hospitals are complying with the CoP, and in particular, the requirement to provide diets consistent with “recognized dietary practices.”

Current CMS regulations governing Food and Dietetic Services in hospitals do not prescribe any dietary standards. There is a requirement that “individual patient nutritional needs must be met in accordance with recognized dietary practices.” CMS has never before interpreted this requirement as mandating adherence to any set of dietary guidelines. Instead, CMS guidance has interpreted the regulation as requiring individualized assessments of nutritional needs, and has pointed to the Institute of Medicine Food and Nutrition Board’s Dietary Reference Intakes (DRIs)—which focus on recommended daily nutrient intakes—as the “nationally recognized source for recommended dietary intakes. 1

Although the memorandum offers recommendations on what hospitals “should” do (versus what they “must” do), it signals that CMS intends to advance broader federal “food as health” priorities by interpreting existing regulatory standards to incorporate the DGAs. As a result, the DGAs could serve as a benchmark in surveyor expectations and compliance actions.

This approach mirrors how other federal meal programs have historically incorporated the DGAs without wholesale codification of each new edition. For example, the United States Department of Agriculture (USDA)-administered National School Lunch and School Breakfast Programs are statutorily required to be “consistent with the most recent Dietary Guidelines for Americans,” yet USDA has long interpreted that directive as allowing flexibility in how, and when, specific DGA recommendations are reflected in program requirements. In regulatory preambles, USDA has explained that “consistent with” the DGAs is a deferential standard focused on alignment with the Guidelines’ overarching objectives, rather than automatic adoption of discrete quantitative targets.

2. CMS Highlights Specific DGA Elements That Align with Current Federal Nutrition Priorities

CMS identifies several DGA elements that hospitals should evaluate when reviewing inpatient menus and nutrition protocol. These include:

• Limiting ultra‑processed foods.
• Eliminating sugar‑sweetened beverages except in limited clinically appropriate scenarios.
• Replacing refined grains with 100% whole grains.
• Prioritizing minimally processed proteins, including plant‑based options.
• Emphasizing vegetables, fruits, legumes, nuts, seeds, seafood and healthy fats.
• Ensuring baked, broiled, roasted, stir‑fried or grilled vegetables and proteins—and eliminating deep‑fried cooking methods.
• Eliminating processed meats and foods high in added sugars/sodium/artificial additives.
• Ensuring meals contain less than 10 grams of added sugar, unless clinically appropriate. Notably, these themes closely track priorities that USDA recently emphasized to state and regional child nutrition program administrators following release of the 2025–2030 DGAs, where operators were encouraged to familiarize themselves with the new Guidelines and evaluate how whole foods, reduced processing and updated dietary patterns could be reflected across federally supported meal programs.

3. CMS Expressly Brings Food Procurement Practices into the Compliance Conversation

Importantly, the QSSAM frames DGA alignment as extending beyond individualized patient nutrition plans to encompass hospital‑wide food and nutrition service policies and operations, expressly referencing the role of food procurement practices in achieving consistency with federal dietary guidance.

By calling out procurement, CMS signals that upstream decisions—what foods are purchased, how vendors are selected and how food service contracts are structured—are relevant to compliance with dietary services CoPs. Practically, this moves DGA alignment out of a purely clinical lane and into a cross‑functional compliance exercise, where procurement teams, outside food‑management contractors and vendor agreements become part of the compliance conversation alongside clinical nutrition staff.

Key Takeaway

Although CMS characterizes the QSSAM as a reminder of existing obligations, the memo suggests a material change in hospitals’ compliance obligations. CMS is effectively telling hospitals that compliance with the Food and Dietetic Services CoP will require adherence to the newly issued DGAs, and that to evaluate and update not only menus and protocols but also food procurement practices.

The practical takeaway is that nutrition is being framed as a patient care quality and compliance issue—one that may influence purchasing specifications, vendor expectations and how hospitals document alignment with “recognized dietary practices” under 42 C.F.R. § 482.28.

In that respect, CMS’s guidance places hospital nutrition services on a broader federal trajectory that mirrors other federally supported nutrition programs—including USDA’s child nutrition programs—where USDA is required by statute 2 to set nutrition standards that reflect the goals of the most recent DGAs. In those programs, the DGAs increasingly inform program expectations, contracting considerations and oversight—even in advance of formal regulatory updates. By contrast, CMS regulations do not currently incorporate the DGAs in the same way. Viewed through that lens, hospitals, suppliers and food service partners should approach the QSSAM not as a one‑off advisory, but as an early indicator of how DGAs are likely to factor into future survey, compliance and enforcement actions.

1 CMS, State Operations Manual, Appendix A – Survey Protocol, Regulations and Interpretative Guidelines for Hospitals (Rev. 238, Issued Mar. 20, 2026), https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf.

2 See e.g., 42 U.S.C. § 1758(f)(1)(A) (requiring school meal standards to be consistent with the most recent Dietary Guidelines for Americans).

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.
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