F-1000 Title III-C, Nutrition Services

F-1010 Overview

Revision 21-0; Effective January 15, 2021

Older Americans Act (OAA) Title III-C, Nutrition Services includes requirements for congregate meals, home delivered meals, nutrition screening, nutrition education, and nutrition counseling.

OAA Title III-C funds are for nutrition services that help older people in Texas live independently. The purposes of the OAA nutrition program are to reduce hunger, food insecurity and malnutrition, promote socialization of older people, and promote health and well-being of older people by giving access to nutrition and other disease prevention and health promotion services.

Area Agencies on Aging (AAAs) must ensure all subrecipients, meal providers, and nutrition services meet the requirements of the OAA, and that they serve only eligible people.

In this section, a meal provider may be a AAA, a subrecipient of the AAA or a contractor of the AAA that provides congregate or Home Delivered Meals (HDMs).  AAAs and subrecipients must keep written policies and procedures to comply with all federal and state requirements and the policies contained in this handbook.

F-1100 Congregate Meals

F-1110 Overview

Revision 21-0; Effective January 15, 2021

Eligible people receive meals and an opportunity for socialization in a congregate setting. This section gives information about eligibility, frequency, serving more than one meal a day, political activity and religious activity.

 

F-1120 Eligibility

Revision 22-1; Effective March 1, 2022

To be eligible for a Title III congregate meal, a person must be:

  • 60 or over; or
  • the spouse of a person 60 and over who participates in the program.

The following may also receive a meal, if the provider offers meals on the same basis as meals served to people 60 and over:

  • a person who volunteers during the meal hours; or
  • a person with a disability who lives in housing facilities:
    • occupied primarily by people 60 and over; and
    • where they serve congregate meals.

The AAA must develop procedures to allow meal providers the option to offer congregate meals to a person who provides volunteer services during the meal hours. Offering a meal to a volunteer must be on the same basis as meals provided to an eligible person who is 60 or older.

Before service initiation and at least every 12 months, complete a DETERMINE Your Nutritional Health checklist for each person who receives congregate meals.

Note: There are no citizenship or residency requirements for OAA services. Do not deny nutrition services based on citizenship or residency criteria.

Documentation for Congregate Meals

Documentation of meals must include the name of the meal provider, date the meal was provided, and the name of the person receiving the meal.

Reporting

Report data for recipients and meals using HHSC’s information management system. Reporting of meals requires unduplicated persons and unit counts.

A unit of service = one meal.

Related Policy

Nutritional Risk Assessment, D-1060

 

F-1130 Frequency of Service

Revision 21-0; Effective January 15, 2021

A meal provider must serve five meals a week at a minimum unless HHSC approves a request to serve less. Providers must serve five meals a week to eligible people for a total of 250 meals a year. Meal providers must serve meals in a congregate setting and must conform to all standards and requirements for nutrition services in this handbook.

A congregate meal may be a hot or other suitable meal per day, and any added meals the provider chooses to serve at the congregate site.

Meal providers who serve rural areas may request HHSC permission to serve less than five congregate meals each week per person. For more guidance, please refer to section F-1580, Serving Fewer than Five Meals a Week.

A rural area is any area not considered urban. Urban areas are (1) a central place and its adjacent densely settled territories with a combined minimum population of 50,000; and (2) an incorporated place or a census designated place with 20,000 or more inhabitants.

Related Policy

Serving Fewer than Five Meals a Week, F-1580

 

F-1140 Second Meals served by a Congregate Meal Provider

Revision 21-0; Effective January 15, 2021

The following meals are eligible meals counted and reported in the HHSC information management system as Nutrition Services Incentive Program (NSIP) eligible if they meet all the conditions for NSIP eligibility:

  • Second Congregate Meal Provided at a Single Setting for Consumption at Another Time – A chilled, frozen, or shelf-stable meal sent home with an eligible person for a holiday, inclement weather or for an older person who is identified as “nutritionally high risk". Report and count the meal as a home delivered meal.
  • More than One Congregate Meal per Day – Congregate meal providers may serve more than one meal per day. Individual meals include the provision of breakfast, lunch or dinner consumed at separate settings during the same day.

The following meals are not eligible meals and not counted or reported in the HHSC information management system. They do not meet NSIP eligibility.  Not funded by HHSC, program income or matching funds, other funds must support these meals:  

  • Second Congregate Meal Served and Consumed at a Single Setting – A second meal served and consumed in a congregate setting is an “add-on” and constitutes the provision of a second Recommended Dietary Allowances (RDA) meal. This applies to any second meal served and consumed at a single setting.

 

F-1150 Political Activity

Revision 21-0; Effective January 15, 2021

Congregate meal sites must not be used for political campaigning except in those instances where a representative from each political party running in the campaign is given an equal opportunity to take part or distribute political materials.

 

F-1160 Religious Activities and Prayer

Revision 21-0; Effective January 15, 2021

A congregate site or its staff must not sponsor, lead or organize religious activity and prayer.  Do not prohibit a person from praying silently or audibly at a congregate meal site if the person so chooses.

F-1200 Home Delivered Meals

F-1210 Overview

Revision 21-0; Effective January 15, 2021

Eligible people receive meals delivered to their homes. This section gives information about eligibility, frequency, and flexible meal models for home delivered meals (HDM).

 

F-1220 Eligibility

Revision 22-1; Effective March 1, 2022

To be eligible for a Title III HDM, a person must be:

  • 60 or over;
  • frail;
  • homebound by reason of illness or incapacitating disability, or otherwise isolated; and
  • have a Consumer Needs Evaluation (CNE) form score of at least 20.

Homebound means a person cannot leave their home without the help of another person. People receiving HDMs must be physically, mentally, or medically unable to attend a congregate nutrition program as shown on the CNE form. This includes people at nutritional risk who:

  • have physical, emotional, or behavioral conditions that would make their service at a congregate nutrition site inappropriate; or
  • are socially or otherwise isolated and unable to attend a congregate nutrition site.

Meals may also be provided to the following, if the provision of the meal supports keeping the person at home and is in the best interest of the eligible older person:

  • the spouse of an eligible older person, regardless of the spouse’s age or condition; or
  • a person with a disability, regardless of age, who lives at home with an eligible older person.
    • Establish procedures to allow meal providers the option to offer HDMs to a person with a disability on the same basis as meals provided to an eligible person who is 60 or older.

The AAA must develop procedures to allow meal providers the option to offer home delivered meals to a person with a disability who lives with an older person.  Offering a meal to a person with a disability must be on the same basis as meals provided to an eligible person who is 60 or older.

AAAs and their subrecipients complete the following before service initiation and at least every 12 months, for each person receiving HDMs:

  • a DETERMINE Your Nutritional Health checklist; and
  • a CNE functional assessment.

Complete a Determination of Type of Meal before service initiation and at least every 12 months, for each person assessed for meals that are consumed at a time other than the day of delivery.

Note: There are no citizenship or residency requirements for OAA services. Do not deny nutrition services based on citizenship or residency criteria.

Related Policy

Consumer Needs Evaluation, D-1040
Nutritional Risk Assessment, D-1060

 

F-1230 Home Delivered Meals for Caregivers

Revision 21-0; Effective January 15, 2021

A Title III-E eligible caregiver can receive a HDM as a supplemental service according to AAA written policy.

If counted for Nutrition Services Incentive Program (NSIP) cash, a HDM purchased through Title III-E as a supplemental service is a meal to a person 60 and over who is either a care recipient (as well as their spouses of any age) or a caregiver.

Documentation for Home Delivered Meals

Documentation of meals must include the name of the meal provider, date the meal was provided and the name of the person receiving the meal.

Reporting

Report data for people and meals using HHSC’s information management system. Reporting of meals requires unduplicated persons and unit counts.

A unit of service = one meal.

 

F-1240 Frequency of Service

Revision 21-0; Effective January 15, 2021

Providers must make available at least five meals per week to eligible homebound people and are encouraged to provide seven meals per person if feasible.

A HDM may be a hot, chilled, frozen, fresh, or shelf-stable meal and any supplemental foods the provider choses to deliver.

Providers must make available five meals a week for a total of 250 meals a year whether the meals served are hot, chilled, frozen, or other meals, or a combination of meals. If a meal provider is in a rural area, it can request HHSC permission to provide less than five HDMs each week.

The State Program Report (SPR) defines rural as any area not defined as urban. Urban areas are (1) a central place and its adjacent densely settled territories with a combined minimum population of 50,000 and (2) an incorporated place, or a census designated place, with 20,000 or more inhabitants.

 

F-1250 Flexible Meal Model for Home Delivered Meals

Revision 21-0; Effective January 15, 2021

The flexible meal model gives people and meal providers an alternative option to the hot meal delivered daily model. Providers may offer the flexible meal model based on:

  • meal providers not available in the area served;
  • meal providers only available on a limited basis;
  • interest lists;
  • a person’s ability to access nutrition is limited, e.g. cannot be home for a regularly scheduled delivery due to medical issues such as dialysis or outpatient rehabilitation or lives in a rural area;
  • meal providers cannot meet a person’s dietary needs; or
  • other situations that call for a flexible meal model.

AAAs may purchase meals from a variety of contractors under case management if a provider cannot provide meals to meet special dietary needs.

A flexible meal model can range from delivering four hot meals and one chilled or frozen meal to delivering a combination of five or more meals once a week.

Meal providers must deliver meals at least one time each week, regardless of the type and number of meals delivered. All meals must meet the nutritional requirements in this policy handbook. A meal provider, including a AAA, must complete an assessment for a person who receives meals to consume on a day other than the day of delivery.

F-1300 Nutrition Screening, Nutrition Education and Nutrition Counseling

F-1310 Overview

Revision 21-0; Effective January 15, 2021

AAAs and their subrecipients must provide nutrition screening and nutrition education to all people receiving congregate and HDMs.  If appropriate, people may also receive nutrition counseling.

 

F-1320 Nutrition Screening

Revision 22-1; Effective March 1, 2022

Every person receiving congregate, HDMs or nutrition counseling must be screened for the risk of poor nutritional health and malnutrition. Use the DETERMINE Your Nutritional Health checklist (D-1060) to complete the assessment.

Complete the DETERMINE Your Nutritional Health checklist at intake and then annually within 30 days of the anniversary of the person’s initial risk assessment date. The content of the form is required and may not be altered.

Documentation

Documentation of the nutrition screening must include the:

  • name of the meal provider;
  • date the screening was performed; and
  • name of the person receiving the screening.

Reporting

Report the nutrition screening results using HHSC's information management system.

Related Policy

Intake, D-1020
Caregiver Intake, D-1030
Nutritional Risk Assessment, D-1060

 

F-1330 Nutrition Education

Revision 21-0; Effective January 15, 2021

Nutrition education helps to promote nutritional well-being and to delay the onset of adverse health conditions from poor nutritional health or sedentary behavior by providing accurate and culturally sensitive information and instruction on nutrition, physical fitness, or health (as it relates to nutrition).

Design material to provide participants with the understanding, skills, and motivation necessary to make informed food, activity, and behavioral choices that can improve their health and prevent chronic disease.

A qualified dietitian or a person with equivalent education and training in nutrition science must develop and approve the material. After the qualified dietitian or other qualified person provides training and guidance on using the materials, a nurse, social worker, therapist, congregate meal site director, wellness coordinator or other person may provide the nutrition education session.

While educational or informational flyers or handouts are good reinforcements of nutrition education, the distribution of flyers or handouts alone is not nutrition education.

Provide nutrition education to all recipients of nutrition services at least once every 12 months. Participants must receive at least 15 minutes of nutrition education annually.

Provide nutrition education to recipients of congregate meals in group settings or one-on-one.

Provide nutrition education to recipients of HDMs:

  • in person;
  • by phone; or
  • through other electronic means such as webcasts, if such electronic means can give each person an opportunity to ask questions.

Documentation

Document that nutrition education was provided and include the following:

  • name of the meal provider;
  • date of the session;
  • name of the person providing the education;
  • lesson plan or curriculum approved by the qualified dietitian; and
  • name of each person receiving the service.

Reporting

Report the total units of service and the estimated number of eligible people who received nutrition education using the HHSC information management system.

A unit of service = one session per participant. Count a session for every eligible person attending a nutrition education session.

 

F-1340 Nutrition Counseling

Revision 21-1; Effective December 1, 2021

Nutrition counseling:

  • provides one-on-one individualized advice and guidance to people or the caregivers of people who are at nutritional risk because of their health or nutrition history, dietary intake, chronic illness or medication use;
  • provides information on the options and methods for improving nutrition status with a measurable goal;
  • differs from nutrition education as nutrition counseling is specific to the person receiving the help; and
  • must be provided by a registered dietitian.

Nutrition counseling is an optional service to support the best health possible for people who receive other nutrition services.

Documentation

Document the following in the eligible person’s case file:

  • name of the dietitian providing the counseling;
  • date of each counseling session;
  • name of person receiving counseling;
  • why the person is receiving nutrition counseling;
  • name of physician referring person for nutrition counseling;
  • measurable goals set up for the person receiving the service; and
  • their progress in meeting the specific goals.

Reporting

Report unduplicated persons and units of service using HHSC’s information management system.

Unit of service is hour(s). Partial hours may be reported in two decimal places, e.g. 0.25 hours.

F-1400 Nutrition Services Incentive Program (NSIP)

F-1410 Overview

Revision 21-0; Effective January 15, 2021

The Nutrition Services Incentive Program (NSIP) provides additional funds for nutrition services programs. The added funds are based on the number of qualified meals served in the previous fiscal year.

Meals reported as NSIP eligible must be:

  • served to a person eligible to receive a meal;
  • served to an eligible person who has not been means-tested (checked for income or assets to decide eligibility) for participation;
  • compliant with the OAA nutrition requirements;
  • served by an eligible agency (i.e. has a grant or contract with a SUA or AAA); and
  • served to a person who has an opportunity to make a voluntary contribution.

Report eligible meals to receive NSIP cash when the meal is reimbursed through:

  • Title III;
  • program income;
  • general revenue; or
  • local cash.

Do not reduce payments for nutrition services (including meals) provided under parts B (supportive) or C (nutrition) of the OAA to reflect an increase in the level of help provided through NSIP funds.

AAAs must ensure meal providers expend NSIP funds solely for the purchase of foods produced in the United States.

Meals under contractual arrangements with food service management companies, caterers, restaurants or institutions, must contain foods produced in the United States at least equal in value to the per meal cash payment received by the meal providers.

Documentation

Document NSIP eligible meals in the HHSC information management system using the correct fund identifier to show meals met all requirements in this section. Do not report meals in the information management system using NSIP as a fund identifier. Do not report ineligible meals using an NSIP eligible fund identifier. Documentation of meals must follow a AAA or subrecipient’s written policy.

Reporting

Report all meals using the HHSC information management system. A provider must use the correct fund identifier in the system for meals claimed for NSIP cash. A provider must ensure all meals are claimed for NSIP cash are eligible.

F-1500 Administration of Nutrition Programs

F-1510 Overview

Revision 21-0; Effective January 15, 2021

Selecting, administering, and evaluating a network of meal providers responsible for the provision of nutrition services to older people is a critical function of AAAs.

Coordinate local community resources to increase capacity for an effective and comprehensive local system for nutrition and supportive services. Local resources include:

  • agencies that administer home and community care programs;
  • tribal organizations;
  • providers (including voluntary organizations or other private sector organizations) of supportive services, nutrition services and multipurpose senior centers;
  • organizations representing or employing older persons; and
  • organizations that have experience in training, placing and providing stipends for volunteers.

 

F-1520 Planning Nutrition Services

Revision 21-0; Effective January 15, 2021

Determine the extent of need for congregate and HDMs and find resources within the PSA to support the provision of nutrition services to meet the identified need. Evaluate the effectiveness of the use of all resources in meeting the needs of people within the PSA.

Nutrition services funds may be awarded to subrecipients that provide congregate and HDMs. HDMs may also be purchased from contractors to serve people on a case-by-case basis through case management.

In setting up a system of providers, ensure:

  • eligible people receive congregate or HDMs;
  • service design is based on regional needs;
  • facilities and meals meet all requirements for safety and nutritional standards;
  • services coordinate with nutrition-related supportive services including nutrition screening and education; and
  • nutrition assessment and counseling are available, if appropriate.

Maintain written policy and procedures for procuring services to be provided with OAA funds. Approval and oversight of the service provider application process is the responsibility of the AAA’s governing body.

All procurement transactions must comply with applicable laws and regulations, including the CFR, and in compliance with established policy.

Subrecipients must request written approval from the AAA before contracting with another entity for meal preparation or delivery of meals.

 

F-1530 Outreach

Revision 21-0; Effective January 15, 2021

Ensure nutrition subrecipients develop and maintain a written outreach plan that gives priority to older people:

  • who live in rural areas;
  • with the greatest economic or social need (particularly low-income older people, low-income minority older people, older people with limited English skill, and older people who live in rural areas);
  • with severe disabilities;
  • with limited English skill;
  • with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such people);
  • at risk for institutional placement, specifically including survivors of the Holocaust; and
  • who are Native Americans, if there is a significant population of older people who are Native Americans in the AAA’s region.

Outreach to Native American populations and their caregivers must include information about the help available to them through the nutrition program.

 

F-1540 Budgeting and Monitoring Performance

Revision 21-0; Effective January 15, 2021

Establish and maintain procedures and processes to monitor progress in achieving benchmarks and performance to effectively manage resources.

Consider the following when setting up a system to monitor progress:

  • federal funds;
  • matching funds;
  • program income;
  • local cash;
  • number of meals served;
  • cost per meal;
  • number of unduplicated persons served; and
  • targeting.

 

F-1550 Cost Controls for Meals

Revision 21-0; Effective January 15, 2021

Planning is essential for meals to stay within budgeted costs, be appealing to the consumer, and comply with the nutrition program guidelines. To control meal cost, consider the following:

  • use of raw foods vs. frozen, canned or other prepared food items;
  • food availability or seasonal foods;
  • purchasing practices that provide the correct quantity and the best quality at the right price;
  • food storage procedures and equipment to minimize loss or waste;
  • labor, skill and number of employees to maximize efficiency; and
  • packaging and food containers to support food safety and temperature control.

A key to cost control in menu planning is the use of cycle menus and standardized recipes.

The cycle menu allows the food manager to become accustomed to the foods and amounts of food needed for specific menus. This lets the food manager analyze quality of raw food against cost variances based on upcoming menu cycles and find the best sources of food. The purchase history sets up patterns and practices for staff to follow.

A cycle menu sets a different menu every day that repeats itself after a set number of weeks. A cycle menu for the nutrition program is usually four to six weeks in length with four cycles per year (spring, summer, fall and winter).

Consider the following when developing a cycle menu:

  • available storage for food;
  • purchasing and delivery schedule of food suppliers;
  • production limitations based on labor, equipment, or number of meals;
  • seasonal foods availability; and
  • regional or traditional foods of the people served.

The advantages of using cycle menus include:

  • reduction in menu planning time;
  • streamlined buying procedures;
  • standardized food production;
  • simplified staff training; and
  • ability to better evaluate food service quality, efficiency and costs.

A standardized recipe is one that is tested for consistency, quality, correct serving size and yield. Use of the same procedures, serving utensil, and ingredients to produce the same serving size produces the same product each time. The history of labor, production time and amount of food needed to produce a menu item using a standardized recipe supports efficient planning for future increases or reductions in the number of meals.  The advantages of using standardized recipes include:

  • customer satisfaction due to a high-quality product;
  • consistent nutrient content because the recipes use the same ingredients and amounts;
  • food cost control due to reduced food waste in storage and preparation;
  • efficient purchasing by knowing exact amounts of food to buy;
  • labor control through efficient use of staff skills; and
  • portion control based on information about the serving size, serving utensil and yield.

 

F-1560 Calculating and Posting the Full Cost of a Meal

Revision 21-0; Effective January 15, 2021

Calculation of the full cost of a meal is an essential food service management practice. The meal cost is the basis to find a suggested donation per meal and to inform ineligible participants of the full cost of the meal.

Calculate the costs of each meal according to the following categories:

  • Personnel
    • food service operations should include all expenditures for salaries and wages, for personnel involved in food preparation, cooking, delivery, serving and cleaning of meal sites, equipment and kitchens, including the valuation of volunteer hours; and
    • project management should include all expenditures for salaries and wages for personnel involved in project management.
  • Professional Development should include all costs for conference fees, dues and materials.
  • Meals or Raw Food should include all costs of buying foodstuff or purchased, pre-prepared meals to be used in the program.
  • Equipment should include all expenditures for items with a useful life of more than one year and an acquisition cost of less than $5,000.
  • Occupancy should include all expenditures for rent, gas, electricity, water, sewer, waste disposal, etc.
  • Transportation or travel should include all costs for mileage, fuel, vehicle insurance or repairs, etc.
  • Administrative or general should include expenditures for all other items that do not belong in any of the above categories (e.g. supplies, printing, communications, etc.).

Do not include capital expenditures in the calculation of a unit rate. Capital expenditures are expenses to buy capital assets (land, buildings, equipment and intellectual property) used in the meal program that have a useful life of more than one year, are capitalized according to with generally accepted accounting principles, and cost $5,000 or more. Capital expenditures can also include expenses which increase the value or useful life of capital assets and exclude routine repairs or maintenance.

Congregate meal sites must post the full cost of a meal.  Establish written policy and procedures to ensure:

  • all congregate nutrition sites post the full cost of a meal;
  • ineligible people pay the full cost of a Title III meal;
  • providers develop suggested voluntary contributions per meal;
  • providers separate payments for meals served to ineligible people from voluntary contributions made by people eligible for a meal; and
  • funds for nutrition services are not spent on meals provided to ineligible people.

 

F-1570 Reimbursement for Meals

Revision 21-0; Effective January 15, 2021

Establish and maintain written policies and procedures to ensure reimbursement is made to providers only for meals served to eligible recipients in compliance with the requirements for those meals.

Do not reimbursement providers for meals not delivered or meals delivered but damaged in transit and not edible because of the damage, with the following exception:

  • Reimburse an HDM provider for a maximum of two attempted, but unsuccessful meal deliveries per eligible person per month.

 

F-1580 Serving Fewer than Five Meals a Week

Revision 21-0; Effective January 15, 2021

The provision of congregate or HDMs is based on providing at least five meals a week and allowing 10 days a year for observing holidays.

All meal providers must make at least five meals a week available and congregate meal sites must be open to make meals available at least 250 days a year.

If a provider covers a rural area and it is not possible to meet that minimum requirement, request HHSC approval for the provider to serve fewer than five meals a week.  A meal provider can serve less than five meals a week in different parts of their total service area. HHSC approval to serve fewer than five meals a week for those individual sites is not needed if the congregate provider has multiple sites that, in total, make available 250 meals each year.

For provider requests to serve fewer than five meals per week, review the request and:

  • verify the information to ensure it is not possible for the provider to make five meals available each week;
  • submit the request to HHSC for approval;
  • ensure the provider does not implement a reduction in serving days or provide fewer than five meals a week until HHSC approves the request; and
  • notify the provider of HHSC’s approval or disapproval of the request.

Note: AAAs and meal providers must comply with their disaster plan when an emergency or inclement weather prohibits the provision of regularly scheduled meals.

Related Policy

Emergency Conditions, Inclement Weather, Disasters and Holidays, C-1211
Congregate Meal Site Closure, C-1212

 

F-1590 Suspension and Termination of Meals

Revision 21-0; Effective January 15, 2021

Establish and maintain written policy for the suspension and termination of meals.

A meal provider may suspend or stop meal service for the following reasons.

The eligible person:

  • dies;
  • is admitted to a long-term care facility;
  • requests the service be stopped;
  • threatens the health or safety of a person at the congregate site;
  • threatens, or another person living in the home threatens, the health or safety of a person delivering meals;
  • racially discriminates against a person at the congregate site;
  • racially discriminates against, or another person living in the home racially discriminates against, a person delivering meals;
  • sexually harasses a person at the congregate site; or
  • sexually harasses, or another person living in the home sexually harasses, a person delivering meals.

A meal provider may also suspend HDMs if the eligible person is not home to accept delivery of a meal for:

  • two consecutive service days in a calendar month; or
  • three non-consecutive service days in a calendar month.

Meal providers who serve meals under AAA case management must notify the AAA case manager and request permission before suspending the delivery of meals to an eligible person. The meal provider must specify the reason for the request to suspend or stop meal service. The AAA case manager must notify the participant in writing that meals are being suspended and for all documentation of the suspension or termination of service.

Documentation

Document the following in the eligible person’s record when the provision of meals is suspended or stopped:

  • reason for the suspension or termination;
  • date and method the case manager notified the meal provider of the action leading to suspension or termination of service;
  • how the action leading to suspension or termination was confirmed;
  • if the delivery of meals to the eligible person should be reinstated or stopped; and
  • date of reinstatement or termination.

Notify an eligible person in writing when their service is suspended or stopped. Documentation of the notification must be kept in the person’s file.

F-1600 Meals

F-1610 Overview

Revision 21-0; Effective January 15, 2021

Providers establish the types and frequency of meals served based on local needs and characteristics including demographics and geography. Meals must meet the requirements of the Older Americans Act and HHSC policy.

 

F-1620 Meal Types

Revision 21-0; Effective January 15, 2021

Providers may deliver or serve hot, chilled, frozen, dried, shelf-stable, emergency meals or a combination of meal types. Requirements for the different types of meals are as follows:

  • Hot Meals: Food items are required to be held at temperatures at or above 135 degrees Fahrenheit until served or packaged for delivery. May include chilled items, fresh fruit, crackers or bread.
  • Chilled Meals: Food items are required to be held at refrigerated temperatures at or below 41 degrees Fahrenheit until served, packaged for delivery or cooked. They are intended to be consumed on a day other than the day the meals are delivered. Chilled meals may include Modified Atmosphere Packaging or Reduced Oxygen Packaging chilled meals.
  • Frozen Meals: Food items must remain in a solid frozen state until delivered. Congregate sites may also use frozen meals at congregate sites in rural areas where participation is low and other food service options are not possible.  Heated and served daily at the congregate meal site, such meals are reported as hot meals.
  • Shelf-stable Meals: Food items do not need refrigeration and are non-perishable. Shelf-stable meals are not required by the U.S. Department of Agriculture (USDA) to have a safe handling statement, cooking directions or a “keep refrigerated” statement.
  • Emergency Meals: Food items are provided on a temporary basis when a regular meal service is not possible. Each meal provider maintains written policy to define when an emergency exists. Emergency meals generally consist of shelf-stable items that do not require refrigeration and can be consumed at room temperature if necessary due to power outages. Defined as “Health Maintenance” other emergency meals may be funded through various sources such as Title III-B and do not need to comply with the meal requirements. Meals are not eligible for Nutrition Services Incentive Program (NSIP) cash when they do not meet the nutrition guidelines

 

F-1630 General Meal Service and Delivery Requirements

Revision 21-0; Effective January 15, 2021

Meal providers must:

  • serve or deliver only meals that are safe and sanitary;
  • establish regularly scheduled time of day to serve or deliver meals to maximize participation;
  • for meals delivered outside the established schedule, deliver meals on the day of the week and at a time agreed upon by the provider and person receiving the meal;
  • deliver HDMs directly to the eligible person or the person’s caregiver at the person’s home;
  • not leave meals unattended at the home of the person receiving HDMs;
  • follow-up on the same day with a person receiving HDMs who was not available to receive a meal when a meal delivery was attempted;
  • ensure a significant change in a person’s physical or mental condition or environment is reported to the provider by people delivering meals;
  • act on the same day the person delivering the meals reports the change
  • prepare and keep meals at the temperatures required by Texas Department of State Health Services (DSHS), Retail Food rules (25 Texas Administrative Code, Subchapter C, Food) until serving or packaging for delivery; and
  • manage all aspects of nutrition programs in compliance with DSHS, Retail Food rules and Food and Drug rules, U.S. Department of Health and Human Services (DHHS), U.S. Food & Drug Administration, Food Code and USDA, Dietary Guidelines.

 

F-1640 Nutrition Requirements

Revision 21-0; Effective January 15, 2021

All hot, frozen, chilled, and shelf-stable meals must meet the nutrition requirements of the OAA.

Include the guidelines in all requests for proposals, bids, contracts, and open solicitations for meals and ensure that all meals served meet the requirements in this section

The nutrition program guidelines align with the most recent Dietary Guidelines for Americans (DGAs) and dietary reference intakes (DRIs) to support more fruit, vegetable, and whole grains consumption, reduce the sodium content of the meals substantially over time, and control fat and calorie levels. The established guidelines specifically address prevalent disease conditions for the aging population.

Providers must serve meals that:

  • comply with the most recent DGA, published by the U.S. Department of Health and Human Services (DHHS) Secretary and the Secretary of Agriculture;
  • provide:
    • a minimum of 33-1⁄3 percent of the DRI established by the Food and Nutrition Board of the Institute of Medicine of the National Academies of Sciences, Engineering and Medicine, if the program provides one meal per day;
    • a minimum of 66-2⁄3 percent of the allowances if the program provides two meals per day; and
    • 100 percent of the allowances if the program provides three meals per day; and
  • meet any special dietary needs of people participating in the program, to the maximum extent practicable.

 

F-1650 Dietary Guidelines for Americans (DGA)

Revision 21-0; Effective January 15, 2021

DHHS and the USDA publish the DGA jointly every five years. The DGA provides authoritative advice about how good dietary habits can promote health and reduce risk for major chronic diseases. The guidelines serve as the basis for federal food and nutrition education programs and encourage people to consume more healthy foods with emphasis on certain food groups. The DGA is available at www.dietaryguidelines.gov.

 

F-1660 Dietary Reference Intakes (DRI)

Revision 21-0; Effective January 15, 2021

DRI is a system of nutrition recommendations from the Institute of Medicine (IOM) of the U.S. National Academies of Sciences, Engineering, and Medicine. The DRI system broadened the existing guidelines known as Recommended Dietary Allowances. The current DRI recommendation is composed of four categories:

  • Estimated Average Requirements (EAR);
  • Recommended Dietary Allowances (RDA);
  • Adequate Intake (AI); and
  • Tolerable Upper Intake Levels (UL).

 

F-1670 Nutrient Needs of Older Adults

Revision 21-0; Effective January 15, 2021

In addition to the Target Nutrient Requirements provided in this policy, menus and meals should include rich sources of vitamins B6, B12, E, folate, magnesium and zinc. Include foods fortified with vitamin D in the meals when possible through sources such as milk products or juice fortified with vitamin D. In addition to the meal, nutrition education should reinforce the message that diets for older adults should include nutrient dense foods.

Related Policy

Target Nutrient Requirements Computer Analysis of Nutrients, Appendix III

 

F-1680 Standardized Recipes

Revision 21-0; Effective January 15, 2021

Meal providers must use standardized recipes in the planning and preparation of menu items. This ensures menu items include nutrients documented by the Target Nutrient Requirements Computer Analysis of Nutrients or the Texas Model for Menu Planning. Food production using standardized recipes adjusted to yield the number of servings needed gives consistency in quality and documented nutrient content of food prepared.

Related Policy

Target Nutrient Requirements Computer Analysis of Nutrients, Appendix III
Texas Model for Menu Planning, Appendix IV

F-1700 Menus

F-1710 Overview

Revision 21-0; Effective January 15, 2021

AAAs and subrecipients must plan and offer approved menus that meet dietary requirements of the Older Americans Act and HHSC.

 

F-1720 Menus and Menu Approval

Revision 22-1; Effective March 1, 2022

Meal providers must get written approval from a dietitian for each meal on the menu and allowable substitutions before serving the meal. Written approval must show that the meal meets:

  • one-third of the Recommended Dietary Allowances (RDA) referenced in the Dietary Reference Intakes (DRIs), for a person 60 years or older; and 
  • the current Dietary Guidelines for Americans (DGA).

The dietitian must:

  • be licensed by the state of Texas in accordance with Texas Occupations Code, Chapter 701;
  • be registered with the Commission on Dietetic Registration (CDR), Academy of Nutrition and Dietetics; or
  • have a baccalaureate degree with major studies in food and nutrition, dietetics or food service management.

Texas Department of Licensing and Regulation licenses and regulates dietitians in Texas. A license is required to use the titles "licensed dietitian" and "provisionally licensed dietitian." A license is not required to use the titles "dietitian" or "nutritionist."

Meal providers must get service recipient input when planning menus through menu committees, food preference surveys, focus group, or other methods. Culturally or ethnically appropriate, high quality, and tasty meals can be an effective outreach to the target population.

 

F-1730 Menu Documentation

Revision 21-0; Effective January 15, 2021

Keep documentation of menu review and approval on file and include:

  • approved menus and service dates for menus;
  • signature of dietitian with Texas license or CDR registration number;
  • date of menu approval by the dietitian;
  • Computer Nutrient Analysis or compliance with the Texas Model for Menu Planning, as applicable; and
  • approved allowable substitutions.

Related Policy

Texas Model for Menu Planning, Appendix IV

 

F-1740 Menu Substitutions

Revision 21-0; Effective January 15, 2021

Any substitutions on an approved menu must be comparable in nutrient content to the original menu. Document and record all menu substitutions with the menu as served. A dietitian must approve the substitution prior to meal service. A provider can also select from a dietitian-approved list of food substitutes for each food group.

 

F-1750 Menu Choice

Revision 21-0; Effective January 15, 2021

To increase satisfaction of participants in the nutrition program, the meal provider may offer the choice of entrée, choice of food items within the meal or choice of two or more distinct and complete menus. All menu choices must comply with the meal requirements provided in this policy. If more than one menu item is offered, the food item with the lowest nutrient value is counted toward meeting the meal requirement.

 

F-1760 Menu Evaluation

Revision 21-1; Effective December 1, 2021

An evaluation of the menu and meal service can include:

  • compliance with program requirements using the Menu Monitoring for Compliance Tool;
  • analysis of the actual cost per meal against budget costs;
  • customer satisfaction surveys; and
  • survey of plate waste (congregate setting).

Related Policy 

Menu Monitoring for DRI and DGA Compliance, Appendix V
 

 

F-1770 Menus and Special Dietary Needs

Revision 21-0; Effective January 15, 2021

Whenever possible, meal providers must meet any special dietary needs of participants including adjusting meals for cultural considerations and preferences and medical needs.

  • Culturally or ethnic meals and menus are adjusted for the cultural, religious, or ethnic preference of the population served, when possible and appropriate.
  • The meal provider decides the extent to which it can provide therapeutic medical diets.
  • Modified meals alter the regular menu but must meet the menu planning guidelines as provided in this policy.
  • The types and amounts of all food items must conform to the regular menu pattern. Modifications may include consistency or texture, reduced sodium, fat, cholesterol, carbohydrate or calories.
  • The eligible person, along with their physician, decides whether the regular or modified menu would meet and not jeopardize their health needs.
  • Therapeutic meals change the meal pattern significantly by either limiting or eliminating one or more menu items, or by limiting the types of foods allowed, often resulting in a meal that does not meet the meal requirements of this policy. Provide therapeutic meals only under the direction and supervision of a dietitian with a written diet order from a participant’s physician.  Keep the written diet order in the participant’s file.
  • Medical Nutritional Supplements are foods for special dietary uses that appropriately address a person’s individual nutrition needs. Nutritional supplements (e.g., canned formulas, powdered mixes, food bars or puddings) may be available to service participants based on a documented, assessed need and funding sources available. Medical Nutritional Supplements are products defined as health maintenance and are funded through Title III-B.

 

F-1780 Menus and Methods of Compliance

Revision 21-1; Effective December 1, 2021

Show and document compliance with the DGA and DRI requirements for Texas using one of the following methods:

  • Target Nutrient Requirements Computer Analysis of Nutrients; or
  • Texas Model for Menu Planning.

Plan menus and check meals for meeting nutritional requirements using either of these two methods. Use of a computerized nutrient analysis rather than the Texas Model for Menu Planning helps to ensure nutritional adequacy of meals and increases menu planning flexibility.

Plan menus to provide variety in flavor, consistency, texture and temperature. Plan meals to provide a variety of food and preparation methods, including color combinations, texture, size, shape, taste, and appearance.

Adjust menus to yield the number of servings needed. Provide consistency in quality of the food prepared, and maintain documented nutrient content of the food prepared.

Related Policy

Target Nutrient Requirements Computer Analysis of Nutrients, Appendix III
Texas Model for Menu Planning, Appendix IV 

F-1781 Computer Analysis of Nutrients

Revision 21-0; Effective January 15, 2021

Computer Analysis of Nutrients evaluates a menu through analyzing the nutrient content of all foods offered. This ensures that meals meet the specific standards as specified in the Target Nutrient Requirements Computer Analysis of Nutrients chart.

The Target Nutrient Requirements Computer Analysis of Nutrients chart shows key nutrients to track for maintenance and improvement of long-term health among older people served by the nutrition program. The chart gives the Compliance Range per meal based on one-third of the DRI. Meals are planned to reach these values, but the provider should also consider other nutrients essential for good health. Track the nutrients in the Target Nutrient Requirements Computer Analysis of Nutrients chart for compliance purposes. Calories and protein values must be attained on a daily average. Vitamin A, vitamin C, calcium, sodium, potassium, and fiber must be averaged over the number of serving days per week by each nutrition site.

If serving meals less than five days per week, average the vitamin A, vitamin C, calcium, sodium, potassium and fiber over the number of serving days per week by each nutrition site. For example, if a meal provider or a nutrition site serves meals three days during a week, average the required target nutrients over the three days of meal service. For two-day meal service, average the required target nutrients over the two days of service.

The Compliance Range column in the chart supports approval and monitoring of the nutritional adequacy of menus. The range is one meal for one day. When two meals a day are served, the Target Values and Compliance Ranges are doubled for a combined total; when three meals are served the Target Values and Compliance Ranges are tripled for a combined total. The computer nutrient analysis software program used to document nutritional adequacy should include the U.S. Department of Agriculture (USDA) National Nutrient Database for Standard Reference, standardized recipes, and correct nutrition data from food suppliers and manufacturers.

Related Policy

Target Nutrient Requirements Computer Analysis of Nutrients, Appendix III

 

F-1782 Texas Model for Menu Planning

Revision 21-0; Effective January 15, 2021

The Texas Model for Menu Planning chart must be used to identify the types and amounts of foods recommended to meet specific nutritional requirements when Computer Analysis of Nutrients software is not used.

All planned meals using the Texas Model for Menu Planning must also incorporate the instructions provided within the chart.

Do not classify foods twice when using the Texas Model for Menu Planning. For example, a food item included in one or more food group type is used only once in the meal to meet a requirement under the Texas Model for Menu Planning.

Limit foods high in sodium and include foods high in potassium, vitamin C, and fiber daily.

Provide foods high in vitamin A three times per week if the meal provider or nutrition site serves five or more days per week. Provide foods high in vitamin A two times per week for meal providers or nutrition sites serving fewer than five days per week.

Related Policy

Texas Model for Menu Planning, Appendix IV

F-1800 Food Service Requirements

F-1810 Overview

Revision 21-0; Effective January 15, 2021

In all phases of a food service operation, meal providers adhere to federal, state and local fire, health, sanitation and safety regulations related to facilities, storage, preparation, handling, cooking, serving, delivery or any other provision for food service. Subrecipients and AAAs providing nutrition services directly must have written policy and procedures to ensure safe meals consumption.

AAAs ensure meal providers comply with 25 Texas Administrative Code, Chapter 228, Retail Food, for all meals served through OAA programs, and applicable local or federal (U.S. Department of Agriculture (USDA) or Food and Drug Administration (FDA)) regulations.

 

F-1820 Facilities and Food Service

Revision 21-0; Effective January 15, 2021

Meals can be prepared in a kitchen that serve one meal site, a central kitchen which serves multiple meal sites, through a written contractual agreement with a contractor (e.g., nearby schools, restaurants or hospitals) or a food service management company (an organization under contract by the meal provider to manage any aspect of the food service).

A meal provider obtains written approval from the AAA before contracting with any entity for meal preparation or service delivery to ensure proper monitoring or quality assurance activities occur.

Results from facility and food inspections required by state law must be maintained by AAAs for all meal providers, including meal provider contractors.

A Certified Food Protection Manager, who ensures the application of hygienic techniques and practices in food preparation and service, must be present during the food service operation. Programs that do not prepare their own food must have a Certified Food Protection Manager responsible for the storage, display, and serving of food for meal sites. A Certified Food Protection Manager is an individual who has successfully completed a Texas Department of State Health Services (DSHS) approved food safety and sanitation course and has a current certificate of completion.

 

F-1830 Food Preparation and Safety Standards

Revision 21-0; Effective January 15, 2021

All kitchens producing meals for a nutrition program must maintain a written, formal sanitation and food preparation program that meets or exceeds the minimum requirements of applicable local, state (25 Texas Administrative Code, Chapter 228, Retail Food), and federal (USDA or FDA) regulations.

  • Cleaning and Sanitizing: Effective methods for cleaning and sanitizing dishes, equipment, food contact surfaces, work areas, serving and dining areas must be written and posted or readily available to staff and volunteers.
  • Poisonous or Toxic Materials: The use and storage of toxic materials, such as cleaners and sanitizers, must be written and posted or readily available to staff and volunteers.
  • Quality and Quantity of Meals: Use standardized written quantity recipes, adjusted to yield the number of servings needed, to achieve the consistent and desirable quality and quantity of all meals.
  • Food Palatability: All foods are prepared and served in a manner to preserve the best flavor and appearance, while retaining nutrients and food value.
  • Portion Control: Nutrition programs must use standardized portion control procedures, equipment and utensils to ensure that each served meal is uniform, meets the Texas guidelines for nutrition and reduces plate waste.

 

F-1840 Food Purchasing and Use of Donated Food

Revision 21-0; Effective January 15, 2021

Food used in the nutrition program must be obtained from sources that comply with requirements in 25 Texas Administrative Code, Chapter 228, Retail Food, Subchapter C, Food; USDA; and all other applicable local, state or federal requirements relating to food quality, labeling, sanitation and safety.

All ready-to-eat, or drink, foods must have an expiration date, use-by date, sell-by date, or best-by date. All food and drinks must be received prior to the expiration date, use-by date, sell-by date, or best-by date.

Meal providers buy and use foods that meet the standards of quality, sanitation and safety applying to commercially processed foods.

All foods the provider purchases and uses in a nutrition program must meet standards of quality for sanitation and safety applying to commercially processed foods.

Nutrition programs may use contributed and discounted foods only if they meet the same standards of quality, sanitation, and safety that apply to foods bought from commercial sources. Unacceptable food items include:

  • foods from sources not approved by DSHS;
  • foods previously served to another person;
  • time or temperature-controlled for safety foods not kept at temperature at time of receipt by the meal provider;
  • unlabeled foods;
  • time or temperature-controlled foods exceeding their shelf life (expiration date, use-by date, sell-by date or best-by date);
  • damaged foods such as heavily rim or seam-dented canned foods, or packaged foods without the manufacturer’s complete labeling; and
  • distressed foods such as those subjected to fire, flooding, excessive heat, smoke, radiation, other environmental contamination or prolonged storage.

 

F-1850 Leftover Food

Revision 21-0; Effective January 15, 2021

Meal providers observe trends of foods typically left over and if due to participant refusal, consider revising the menu to accommodate the preferences of most of the participants.

  • Do not transport leftover food from a congregate meal site or from a HDM route back to the preparation site.
  • Store leftover food properly or discard leftover food at the congregate nutrition meal site.
  • Do not freeze leftover food to be served as meals later.

Staff, volunteers or others cannot take food from kitchens or nutrition sites, except when packaged, taken and counted as a home-delivered meal to an eligible person.

The risk of foodborne illness should be stressed through nutrition education to people who are eligible for congregate meals to discourage taking home leftover foods from the nutrition site.  People may take home only leftovers that are safe at room temperature, such as packaged crackers, cakes, breads and fresh fruit.

 

F-1860 Food Packaging and Transporting Meals

Revision 21-0; Effective January 15, 2021

All meal providers must have processes, supplies and equipment that maintain the safe and sanitary handling of all menu items from the time the cooking process is complete through the end of the delivery period.

Do not leave meals unattended. Deliver meals directly to an eligible person or the person’s caregiver. If the eligible person or the caregiver as documented in the eligible person’s file is not present to accept the meal, the provider cannot leave the meal.

The meal provider must document the meal as undelivered and the reason the meal is undelivered.

Discard hot or chilled meals not served or delivered within the four-hour period after removal from temperature control.

Meals prepared using reduced oxygen packaging method must comply with 25 Texas Administrative Code, Chapter 228, Retail Food, Subchapter C, Food.

Chilled, frozen, or other meals delivered for consumption at a time later than the time of delivery must be clearly labeled, including an expiration date. Instructions for storage and cooking must be in large print. Meals are delivered and scheduled to be consumed prior to the expiration date.

 

F-1861 Meal Packaging

Revision 21-0; Effective January 15, 2021

Meal providers must use proper packaging for transporting meals. A meal provider must:

  • use supplies and carriers to package and transport hot foods separately from chilled foods;
  • use enclosed meal carriers to transport easily damaged trays or containers of hot or cold foods to protect them from contamination, crushing, or spillage;
  • ensure the meal carrying equipment or vehicle is equipped with insulation or supplemental hot or chilled sources as is necessary to maintain temperatures;
  • clean and sanitize food carriers, or use containers with inner liners that can be sanitized;
  • seal individual meal containers to prevent moisture loss or spillage to the outside of the container throughout transport (Styrofoam “clam shells” are not acceptable as they do not seal);
  • completely wrap or package food utensils to protect them from contamination;
  • use a container designed with compartments to separate food items for visual appeal and to minimize spillage between compartments;
  • use a container an eligible person can easily open;
  • ensure meals delivered in bulk maintain temperature throughout the delivery period;
  • help people in taking meals delivered in bulk inside the home, as needed;
  • help people in opening a bulk container and storing meals inside a proper appliance (refrigerator or freezer), as needed;
  • notify the AAA within one day of planned delivery if meals delivered in bulk cannot be left with an eligible person due to damage;
  • replace unconsumable damaged meals in compliance with AAA policy; and
  • not request reimbursement for unconsumable meals damaged in transit.

 

F-1862 Holding Time and Temperatures

Revision 21-0; Effective January 15, 2021

Serve or deliver hot or cold foods within four hours from the point in time when the food is removed from temperature control:

  • hot foods must have an initial internal temperature of 135º F. or above when removed from temperature control; and
  • cold foods must have an initial internal temperature of 41º F. or below when removed from temperature control.

Meal providers must have written processes in place to:

  • record temperatures for all menu items when the food is ready to leave production area temperature control for serving on site or packaging for home delivery;
  • take meal temperatures each day a meal is prepared;
  • document meal temperatures;
  • record the time the staff takes the temperature of each menu item;
  • mark hot and chilled foods to show four hours past the point in time when the food is removed from temperature control;
  • deliver hot and chilled foods to an eligible person within four hours from the point the food is removed from temperature control; and
  • be sure food transport is safe and sanitary when a central kitchen is preparing food and transporting food to other nutrition sites.

 

F-1863 Frozen Food

Revision 21-0; Effective January 15, 2021

Foods frozen for later consumption must meet applicable local, state, and federal standards. Equipment and methods for freezing must also meet these standards. A meal must still be frozen when delivered to an eligible person.

 

F-1864 Reduced Oxygen Packaging Food

Revision 21-0; Effective January 15, 2021

Foods which are prepared by a food establishment that packages time or temperature-controlled food for safety using a reduced oxygen packaging method must comply with 25 Texas Administrative Code, Chapter 228, Retail Food, Subchapter C, Food.

 

F-1870 Suspected Foodborne Illness Outbreak

Revision 21-0; Effective January 15, 2021

AAAs must ensure meal providers promptly notify the Texas Department of State Health Services (DSHS) and the AAAs of a foodborne disease outbreak. A foodborne disease outbreak may have occurred when two or more persons experience a similar illness resulting from the ingestion of a common food.

 

F-1880 Socialization for People Receiving Multiple Meals

Revision 21-0; Effective January 15, 2021

Meal providers maintain written procedures to provide socialization contacts for people who receive fewer than five home delivered meals a week.

  • Socialization contacts must occur at least three times a week for people who receive fewer than three meal deliveries each week, regardless of the type of meal or meals delivered:
    • count one contact when meals are delivered; and
    • make two additional contacts by phone, email, text or another method agreed upon by the meal service recipient and the meal provider.
  • A person receiving meals may choose to opt out of receiving socialization contacts other than the meal delivery day.
  • A person making a socialization contact must report any significant changes in the person’s physical or mental condition or environment to the proper person or entity.

AAAs that authorize meals through a contracted meal provider must maintain written procedures on socialization for people receiving multiple meals in accordance with this handbook.

Acceptable forms of contact with the eligible person include:

  • phone;
  • email;
  • text messages;
  • skype; or
  • any method that lets the eligible person to ask questions or request help if needed.

Documentation

Documentation of socialization contacts must include the name of the meal provider, date of contact, type of contact and name of contacted person.

If a person opts out of socialization contacts other than the meal delivery day, document the person’s choice in their file. Update information annually.