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We inadvertently did not update the exception paragraph during CY 2009 PFS rulemaking to reflect the correct policy under which the ( individual furnishing services incident to the services of physicians, physician assistants (PAs), clinical nurse specialists (CNSs), or nurse practitioner (NPs) does not have to meet the state licensure requirement at § 484.115 (although they are required to meet the other standards and conditions that apply to SLPs)

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Particular caution makes sense with: substantial kidney impairment severe liver dysfunction multiorgan failure critical illness very high long-term doses active cancer treatment when supplementation is not integrated into the treatment plan The goal is not to fear glutamine