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ARIZONA STATE SENATE
Fifty-Fifth Legislature, First Regular Session
AMENDED
dietitian nutritionists; licensure
Purpose
Establishes and outlines licensing requirements for dietitian nutritionists and prescribes related duties for the Director of the Department of Health Services (DHS).
Background
Current statute defines a registered
dietitian (RD) as a person who meets the qualifications of the
credentialing agency for the American Academy of Nutrition and Dietetics (A.R.S.
§ 36-416). 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 (ACEND); 2) complete an ACEND-accredited
supervised practice program; 3) pass a national exam from the U.S. Commission
on Dietetic Registration (U.S. CDR); and 4) complete continuing professional
educational requirements to maintain registration (AZAND).
The U.S. CDR is the credentialing agency and organization unit of the American Academy of Nutrition and Dietetics and serves the public by establishing and enforcing standards for certification and recertification of RDs and RDNs and by issuing credentials to individuals who meet those standards (U.S. CDR).
In Arizona, a licensed hospital may allow a RD or other qualified nutrition professional to order diets, enteral feeding, nutritional supplementation or parenteral nutrition if authorized by medical staff and if: 1) the hospital's written policies and procedures allow RDs or other qualified nutrition professionals to issue such orders; and 2) the hospital has written policies and procedures that address the hospital's response to adverse events, if any, that arise as a result of issued orders by a RD or other qualified nutrition professional (A.R.S. § 36-416).
The Health Services Licensing Fund (Fund) is administered by DHS and consists of monies collected by DHS from licensing fees for child day care centers, childcare groups and hearing aid dispensers, audiologists and speech-language pathologists (A.R.S. § 36-414).
H.B. 2820 requires the Director of DHS (Director) to deposit 10 percent of monies collected from dietitian nutritionist licensure fees into the state General Fund and requires that the remaining 90 percent be deposited into the Fund.
Provisions
Application and Licensure Requirements
1. Outlines education and training requirements for initial applicants for a dietitian nutrition 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 or a university in a foreign country validated as equivalent by the Director;
b) successfully completing a planned clinical program in the practice of dietetics and nutrition that meets specified competency requirements and includes at least 1,000 hours under the supervision of a U.S. CDR-registered or licensed dietitian nutritionist; and
c) passing the examination for RDs administered by the U.S. CDR or another examination accredited by the National Commission of Certifying Agencies (NCCA) if approved by the Director for measuring competence in issuing orders and in performing medical nutrition therapy.
2. Requires that an initial applicant for a dietitian nutritionist license be of good moral character, 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.
3. Allows the advisory 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.
4. Outlines circumstances in which the Director or DHS may deny, revoke or suspend a license.
Powers and Duties of the Director
5. Requires the Director to:
a) license persons who apply for and possess all required qualifications for the practice of dietetics and nutrition;
b) authorize all necessary disbursements;
c) 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
d) adopt a scope of practice for licensed dietitian nutritionists consistent with that adopted by AZAND.
6. Allows the Director to:
a) appoint an advisory committee to collaborate with and assist the Director and to perform prescribed duties;
b) issue and renew a license;
c) deny, suspend, revoke or refuse to renew a license or file a letter of concern, issue a decree of censure, prescribe probation, impose a civil penalty or restrict or limit the practice of a licensee;
d) make and publish related rules; and
e) require a licensee to produce records of patients involved in complaints on file with DHS.
Advisory Committee
7. Establishes an advisory committee which consists of the Director, one licensed physician, three licensed dietitian nutritionists and one public member.
8. Requires advisory committee members to have at least five years of experience in their fields of practice in Arizona immediately preceding appointment.
9. Allows the advisory committee to provide recommendations to the Director on:
a) license issuance and renewal;
b) disciplinary procedures;
c) rules that are consistent with Arizona law and that are necessary to carry out; and
d) licensee production of records of patients who are involved in complaints on file with DHS.
10. Requires the Director to act on advisory committee recommendations within a reasonable period of time.
License Issuance and Renewal
11. Requires the Director to issue a license to each applicant who meets outlined requirements and specifies that a license is valid for two years.
12. Directs licensees to renew their license every two years upon payment of the renewal fee.
13. Institutes a 30-day grace period after a license expires in which the licensee may renew the license on payment of a late fee in addition to the renewal fee.
14. Requires, when renewing a license, a licensee to attest to having completed required continuing professional education during the licensing period and make documentation of completion available on DHS's request.
15. Instructs the Director to provide, by rule, standards for required continuing professional education units.
16. Specifies that educational courses that are accepted by the U.S. CDR are deemed compliant with DHS standards.
17. Requires a person who does not renew a license to apply 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.
License Issuance and Renewal for Military Members
18. Exempts a license issued to any member of the National Guard or the U.S. Armed Forces Reserves from expiration while the member is serving on federal active duty and extends the expiration to 180 days after the member returns from federal active duty if the member notifies the Director of their active duty status.
19. 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.
20. 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; and
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.
21. Clarifies 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 prohibits the charge of additional costs.
22. 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 expiration extension.
Notification Requirements
23. 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.
24. Instructs the Director to keep a record of the places of practice of all license holders.
25. 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.
Hospital Orders
26. Authorizes a licensed hospital that meets prescribed requirements to allow a licensed dietitian nutritionist or other qualified nutrition professional to order, if initially authorized or granted standing order privileges by medical staff, the following:
a) diets;
b) a change in diet orders;
c) durable medical equipment related to nutrition;
d) nutritional supplementation;
e) parenteral nutrition;
f) medical nutrition therapy; and
g) laboratory tests to check and track nutrition status.
27. Requires a hospital's written policies and procedures to:
a) allow a licensed dietitian nutritionist or other qualified nutrition professional to issue outlined orders or perform medical nutrition therapy;
b) define the qualifications necessary for qualified nutrition professionals to issue orders and list any additional restrictions on qualified nutrition professionals' ability to issue the orders; and
c) address the hospital's response to adverse events, if any, that arise as a result of orders issued by a licensed dietitian nutritionist or other qualified nutrition professional.
Nonhospital Health Care Institutions
28. Allows a licensed dietitian nutritionist or other qualified nutrition professional who practices in a licensed nonhospital health care institution and who is either an employee or an independent contractor to order the following:
a) diets;
b) a change in diet orders;
c) durable medical equipment related to nutrition;
d) nutritional supplementation;
e) parenteral nutrition;
f) medical nutrition therapy; and
g) laboratory tests to check and track nutrition status.
29. Specifies that a nonhospital health care institution's written policies and procedures must:
a) allow licensed dietitian nutritionists to issue orders or perform medical nutrition therapy;
b) define the qualifications necessary for qualified nutrition professionals to issue orders and list any additional restrictions on qualified nutrition professionals' ability to issue the orders; and
c) address the nonhospital health care institution's response to adverse events, if any, that arise as a result of orders issued by a licensed dietitian nutritionist or other qualified nutrition professional.
Title Designations
30. Authorizes a person to use the title certified nutrition specialist or any alternative spelling or abbreviation of the title in an advertisement or publication or orally or in writing to any member of the public only if the person holds a valid current certification with the Board for Certification of Nutrition Specialists that authorizes the person to use the title certified nutrition specialist or the abbreviated CNS.
31. Allows a person to use the titles dietitian, registered dietitian or registered dietitian nutritionist or the abbreviations RD or RDN only if the person is currently credentialed as a RD or RDN nutritionist by the U.S. CDR.
32. Allows a person to use the titles licensed dietitian or licensed dietitian nutritionist or any alterative spelling or abbreviation of those titles in any advertisement or publication or orally or in writing to any member of the public only if that person is licensed as a dietitian nutritionist.
33. Authorizes the Attorney General to investigate and take appropriate action against individuals who violate title designation requirements.
Miscellaneous
34. Defines relevant terms.
35. Requires the Director to deposit 10 percent of all monies collected from the licensure of RDNs in the state General Fund and deposit the remaining 90 percent in the Fund.
36. Requires the Director to prescribe and collect fees, in an amount to be determined by the Director, from licensed individuals for the following:
a) an initial application for a license;
b) the issuance of a license;
c) the renewal of a license;
d) issuance of a duplicate license; and
e) a late fee.
37. Allows the Director to enforce any aforementioned provision by injunction or by any other appropriate proceeding.
38. Classifies, a class 3 misdemeanor, violations of prescribed dietitian nutritionist licensure requirements.
39. Outlines civil penalties that can be imposed by the Director and enforced by the Attorney General and a county attorney.
40. Exempts DHS from administrative rulemaking requirements for one year after the general effective date of this legislation.
41. Contains a legislative intent clause.
42. Makes technical and conforming changes.
43. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Requires both hospital and nonhospital health care institutions to define the qualifications and restrictions related to the issuance of orders by qualified nutrition professionals.
2. Requires that a renewing licensee attest to having completed prescribed continuing professional education requirements and provide documentation of completion upon DHS request.
3. Modifies prescribed requirements for the Director.
4. Allows initial licensure applicants to fulfill education requirements by passing an examination accredited by the NCCA, if approved by the Director.
5. Defines qualified nutrition professional.
6. Makes technical changes.
House Action Senate Action
HHS 2/15/21 DP 8-0-0-1 HHS 3/24/21 DPA 7-1-0
3rd Read 2/24/21 39-20-1
Prepared by Senate Research
March 26, 2021
CRS/AP/kja