ARIZONA HOUSE OF REPRESENTATIVES

Fifty-fifth Legislature

First Regular Session

House: HHS DP 8-0-0-1 | 3rd Read 39-20-1-0

Senate: DPA 7-1-0-0 | 3rd Read 19-11-0-0

HB 2820: dietitian nutritionists; licensure

Sponsor:  Representative Hernandez A, LD 3

Senate Engrossed

Overview

Establishes licensure requirements for dietician nutritionists and outlines requirements for the Director (Director) of the Arizona Department of Health Services (DHS).

History

According to the Arizona Academy of Nutrition and Dietetics (AZAND), a registered dietician nutritionist (RDN) is a food and nutrition expert who has met the minimum academic and professional requirements to qualify for the credential. In order to become an RDN, an individual must: 1) complete a bachelor's degree and course work approved by the Accreditation Council for Education in Nutrition and Dietetics (Council); 2) complete a Council-accredited supervised practice program; 3) pass a national exam from the Commission on Dietetic Registration (CDR); and 4) complete continuing professional educational requirements to maintain registration (AZAND).

The CDR is the credentialing agency and organization unit of the Academy of Nutrition and Dietetics and serves the public by establishing and enforcing standards for certification and recertification of registered dieticians (RDs) and RDNs and by issuing credentials to individuals who meet those standards (CDR).

The Health Services Licensing Fund (Fund) is established consisting of monies collected by DHS from licensing fees for child day care centers, child care groups and hearing aid dispensers, audiologists and speech-language pathologists. (A.R.S. 36-414)

Provisions

Hospital Orders

1.   ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal NoteStipulates that a licensed hospital that has policies and procedures that meet specified requirements may allow a licensed dietician nutritionist to order, if initially authorized or granted standing ordering privileges by medical staff, the following:

a)   Diets;

b)   A change in diet orders;

c)   Enteral feeding;

d)   Durable medical equipment related to nutrition;

e)   Nutritional supplementation;

f) Parental nutrition;

g)   Medical nutrition therapy; and

h)   Laboratory tests to check and track nutrition status. (Sec. 3)

2.   Requires a hospital's written policies and procedures to allow licensed dietician nutritionists to issue specified orders or perform medical nutrition therapy. (Sec. 3)

 

Nonhospital Health Care Institution (Institution) Orders

3.   Allows a licensed dietician nutritionist who practices in an institution and is an employee of the institution or an independent contractor to order:

a)   Diets;

b)   A change in diet orders;

c)   Enteral feeding;

d)   Durable medical equipment related to nutrition;

e)   Nutritional supplementation;

f) Parental nutrition;

g)   Medical nutrition therapy; and

h)   Laboratory tests to check and track nutrition status. (Sec. 4)

4.   Requires an institution's written policies and procedures to:

a)   Allow licensed dietician nutritionists to issue specified orders or perform medical nutrition therapy; and

b)   Address the institution's response to adverse events, if any, that arise as a result of orders issued by a licensed dietician nutritionist. (Sec. 4)

Powers and Duties of the Director

5.   Requires the Director to:

a)   Appoint an advisory committee (committee) to collaborate with and assist the Director and to perform statutorily prescribed duties;

b)   License persons who apply for and possess all required qualifications for the practice of dietetics and nutrition;

c)   Authorize all necessary disbursements;

d)   Ensure the public's health and safety by adopting and enforcing qualification standards and a scope of practice for licensees and applicants for licensure; and

e)   Adopt a scope of practice for licensed dietician nutritionists consistent with that adopted by the AZAND. (Sec. 5)

6.   Allows the Director to:

a)   Issue and renew a license;

b)   Deny, suspend, revoke or refuse to renew a license or restrict or limit the practice of a licensee;

c)   Make and publish rules that are consistent with Arizona law; and

d)   Require a licensee to produce records of patients involved in complaints on file with DHS. (Sec. 5)

Committee Requirements

7.   States that the committee consists of the Director, one licensed physician, three licensed dietician nutritionists and one public member. (Sec. 5)

8.   Requires committee members who are licensed dietician nutritionists to have at least five years of experience in their field of practice in Arizona immediately preceding appointment. (Sec. 5)

9.   Requires the committee to provide specified recommendations to the Director. (Sec. 5)

Issuance and Renewal of License

10.  Requires the Director to issue a license to each applicant for a dietician nutritionist license who meets outlined requirements. (Sec. 5)

11.  Specifies that a license is valid for two years and a licensee must renew the license every two years on payment of the renewal fee. (Sec. 5)

12.  States that there is a 30-day grace period after a license expires when the licensee may renew the license on payment of a late fee in addition to the renewal fee. (Sec. 5)

13.  Requires, when renewing a license, a licensee to provide proof of having completed at least 24 hours of continuing professional education units within the prior 24 months. (Sec. 5)

14.  Instructs the Director to provide, by rule, standards for required continuing professional education units. (Sec. 5)

15.  Stipulates that educational courses that are accepted by the CDR are deemed to comply with DHS standards. (Sec. 5)

16.  Requires a person who does not renew a license to reapply for a new license and provide proof of having completed required continuing professional education units within the previous 24 months before the date of reapplication. (Sec. 5)

Issuance and Renewal of License for Military Members

17.  States that a license issued to any member of the National Guard or the U.S. Armed Forces Reserves does not expire while the member is serving on federal active duty and is extended 180 days after the member returns from federal active duty if the member notifies the Director of their active duty status. (Sec. 5)

18.  Stipulates that a license issued to any member serving in the regular component of the U.S. Armed Forces is extended 180 days after the date of expiration if the member notifies the Director of their federal active duty status. (Sec. 5)

19.  Specifies that a license issued to any member of the National Guard, the U.S. Armed Forces or the regular component of the U.S. Armed Forces does not expire and is extended 180 days after the date the military member is able to perform activities necessary under the license, if the member:

a)   Is released from active duty service;

b)   Suffers an injury as a result of the active duty service that temporarily prevents the member from being able to perform activities necessary under the license. (Sec. 5)

20.  Asserts that, if the license is renewed during the applicable extended time period after the member returns from federal active duty, the member is responsible only for normal fees and activities relating to renewal of the license and may not be charged any additional costs. (Sec. 5)

21.  Requires a military member to present to the Director a copy of their official military orders, a redacted military identification card or a written verification from the member's commanding officer before the end of the applicable extended time period in order to qualify for an extension. (Sec. 5)

Notification Requirements

22.  Requires a licensee to notify the Director in writing of the address of the place or places where the person engages in the practice of dietetics and nutrition or provides nutrition care services and of any change of address. (Sec. 5)

23.  Instructs the Director to keep a record of the places of practice of all license holders. (Sec. 5)

24.  Specifies that any notice that the Director is required to give to a license holder may be given by mailing it to the address that was last given by the license holder. (Sec. 5)

Title Designations

25.  Allows a person to use the titles certified nutrition specialist, licensed dietician or licensed dietician nutritionist or their abbreviations in any advertisement, publication or orally or in writing to any member of the public only if that person has the appropriate credentials. (Sec. 5)

26.  Allows a person to use the titles dietician, registered dietician or registered dietician nutritionist or their abbreviations only if the person is credentialed by the CDR. (Sec. 5)

Application and Licensure Requirements

27.  Requires the Director to prescribe and collect fees for licensure in an amount to be determined by the Director. (Sec. 4)

28.  Outlines education and training requirements for applicants for a dietician nutritionist license that include the following:

a)   Earning a bachelor's degree, master's degree or doctoral degree from a regionally accredited college or university with a major course of study relating to health, dietetics or nutrition;

b)   Successfully completing a planned clinical program in the practice of dietetics and nutrition that meets specified competency requirements and includes at least 1000 hours under the supervision of a CDR-registered or licensed dietician nutritionist; and

c)   Passing the examination for registered dieticians administered by CDR. (Sec. 5)

29.  Specifies that an applicant for a dietician nutritionist license be of good moral character and not have had a license, registration or certificate revoked or suspended within the past two years and not be presently ineligible for licensure because of a prior revocation or suspension. (Sec. 5)

30.  Allows the committee to recommend to the Director a waiver of the outlined educational requirements if an applicant submits satisfactory proof that they received an equivalent professional education in another country. (Sec. 5)

31.  Outlines circumstances in which the Director may deny, revoke and suspend a license. (Sec. 4)

Definitions

32.  Modifies the definition of pharmacy and prescription order. (Sec. 1)

33.  Removes the definition of registered dietician and defines medical nutrition therapy and standing order privileges. (Sec. 3)

34.  Defines related terms. (Sec. 5)

Miscellaneous

35.  Requires the Director to deposit 10% of all monies collected from the licensure of dietician nutritionists in the state General Fund and deposit the remaining 90% in the Fund. (Sec. 5)

36.  Allows the Director to enforce any aforementioned provision by injunction or by any other appropriate proceeding. (Sec. 5)

37.  Specifies that a violation of this act is a Class 3 misdemeanor. (Sec. 5)

38.  Outlines civil penalties that can be imposed by the Director. (Sec. 5)

39.  Exempts DHS from administrative rulemaking requirements. (Sec. 6)

40.  Makes technical and conforming changes. (Sec. 1 and 2)

41.  Contains a legislative intent clause. (Sec. 7)

 

 

Senate Amendments

1.   Requires a licensed hospital's and institution's written policies and procedures to define the qualifications necessary for qualified nutrition professionals to issue orders and list any additional restrictions on qualified nutrition professionals' ability to issue orders.

2.   Allows, rather than requires, the Director to appoint an advisory committee to collaborate with and assist the Director and to perform statutorily prescribed duties.

3.   Allows, rather than requires, the advisory committee to provide specified recommendations to the Director.

4.   Requires a licensee to attest to having completed continuing professional education requirements and make documentation of completion available on DHS's request.

5.   Modifies examination requirements for licensees.

6.    

7.    

8.   ---------- DOCUMENT FOOTER ---------

9.                     HB 2820

10.  Initials EB  Page 0 Senate Engrossed

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12.  ---------- DOCUMENT FOOTER ---------