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Legislation Document
SPONSOR:
Rep. Hilovsky & Sen. Pettyjohn
Rep. Michael Smith; Sens. Buckson, Hocker
HOUSE OF REPRESENTATIVES
153rd GENERAL ASSEMBLY
HOUSE BILL NO. 449
AN ACT TO AMEND TITLE 24 OF THE DELAWARE CODE RELATING TO THE DIETITIAN/NUTRITIONIST LICENSURE ACT.
WHEREAS, this State has a compelling interest in protecting the health, safety, and welfare of its inhabitants by ensuring that individuals who provide nutrition care services, including medical nutrition therapy, meet rigorous standards of education, supervised practice experience, and professional competency; and
WHEREAS, Chapter 38 of Title 24 of the Delaware Code, the Dietitian/Nutritionist Licensure Act, currently establishes a single licensure category of licensed dietitian/nutritionist, which no longer reflects the distinct educational pathways, competencies, and scopes of practice of dietitians and nutritionists; and
WHEREAS, advances in nutrition science, the emergence of new credentialing standards, and the evolving landscape of healthcare delivery necessitate the creation of 2 separate licensure categories — licensed dietitian and licensed nutritionist — each with its own defined scope of practice, educational requirements, and professional standards; and
WHEREAS, the practice of dietetics involves the integration and application of principles derived from food, nutrition, biochemistry, metabolism, physiology, pharmacology, food systems management, and behavioral sciences, and licensed dietitians provide medical nutrition therapy for complex diseases and medical conditions, including in inpatient settings, enteral and parenteral nutrition, and other high-acuity care environments; and
WHEREAS, the practice of nutrition involves the provision of nutrition care services and medical nutrition therapy for non-complex diseases and medical conditions in low-acuity outpatient settings, and a distinct licensure pathway for licensed nutritionists will increase access to qualified nutrition care professionals across this State while maintaining appropriate safeguards to protect the public; and
WHEREAS, updated educational and examination standards, including a minimum master’s degree and completion of accredited supervised practice programs for licensed dietitians, and similar standards for licensed nutritionists, are necessary to ensure that practitioners possess the knowledge, skills, and competencies required to safely and effectively deliver medical nutrition therapy; and
WHEREAS, it is in the public interest to establish clear definitions of medical nutrition therapy, complex and non-complex diseases and medical conditions, the nutrition care process, therapeutic diets, and other key terms to provide clear guidance to practitioners, the Board, consumers, and other healthcare providers; and
WHEREAS, the Board of Dietetics/Nutrition’s composition should be updated to potentially include representation of both licensed dietitians and licensed nutritionists, as well as a Delaware-licensed physician, to ensure that the Board reflects the broader scope of regulated practice and the healthcare community it serves; and
WHEREAS, the General Assembly finds it necessary and appropriate to establish provisions governing qualified supervisors to ensure that students and trainees in supervised practice experiences receive adequate professional oversight to protect patient safety and ensure the quality of supervised practice training; and
WHEREAS, provisional licensure is a necessary tool to allow qualified applicants who have completed their education and supervised practice requirements to begin practice while completing examination requirements, under appropriate supervision, thereby increasing access to nutrition care services in this State; and
WHEREAS, the right of consumers to receive accurate information about nutrition from a variety of sources should be preserved, and this Act expressly protects the right to disseminate general non-medical nutrition information, engage in health coaching and wellness education, and provide non-medical weight control services, if those disseminating information do not hold themselves out using titles protected under this chapter or provide services constituting medical nutrition therapy; and
WHEREAS, the General Assembly finds that making conforming amendments throughout Chapter 38 of Title 24, including updating references to professional titles, organizational names, regulatory bodies, and scopes of practice, is necessary to ensure the consistency, clarity, and integrity of the law of this State; and
WHEREAS, the General Assembly finds that this Act serves the public interest and that the benefits of this Act to the health, safety, and welfare of the inhabitants of this State outweigh any regulatory burden imposed on practitioners.
NOW, THEREFORE:
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE (Three-fifths of all members elected to each house thereof concurring therein):
Section 1. Amend § 3801, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3801. Statement of purpose.
(a)
The intent of this chapter is
to do all of the following:
(1)
to establish
Establish
minimum standards of education,
experience
experience,
and examination for
professional dietitians/nutritionists
dietitians and nutritionists
so that the public can readily identify those who meet these minimum standards.
(2)
It is also the intent of this chapter to provide
Provide
a licensure process
for professional dietitians/nutritionists, a scope of practice for dietetic and nutrition therapy,
and scope of practice for dietitians and nutritionists
and to establish
“Licensed Dietitian/Nutritionist” as the state-recognized legal title for professional dietitians/nutritionists.
licensed dietitian as the state-recognized legal title for dietitians and licensed nutritionist as the state-recognized legal title for nutritionists.
(3)
It is also the intent of this chapter to assure
Assure
consumers the right to choose from whom they receive information and advice.
(b)
Recognition of
these goals
the intent of this chapter
will protect the health of the public by broadening access to appropriate
dietetic and nutrition therapy.
dietetics and nutrition services.
Section 2. Amend § 3802, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3802. Definitions.
The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them in this chapter, except where the context clearly indicates a different meaning:
For purposes of this chapter:
(1) “Board”
shall mean
means
the State Board of Dietetics/Nutrition.
(2) “Dietetic and nutrition therapy” shall mean the scope of services utilized in the delivery of preventive nutrition services and nutrition therapy. It involves an assessment of the individual’s specific nutritional needs and the development and implementation of an intervention plan. The intervention plan can include nutrition education, counseling, administration and monitoring of specialized nutrition support and referrals for additional services. This application and practice of “dietetic and nutrition therapy” shall include the following Scope of Practice:
Scope of Practice:
(a) Nutrition assessment to include the establishment of nutritional care plans, including the development of nutritional related priorities, goals and objectives.
(b) Provision of nutrition counseling or education as components of preventive, and restorative health care.
(c) Evaluation and maintenance of appropriate standards of quality in food and nutrition.
(d) Evaluation and education of nutrient-drug interactions.
(e) Interpreting and recommending interventions to meet nutrient needs relative to individual health status, including but not limited to medically prescribed diets, tube feedings and specialized intravenous solutions.
(f) Development, administration, evaluation and consultation regarding nutritional care standards.
(g) Conduct independent research or collaborate in research areas including, but not limited to food and pharmaceutical companies, universities and hospitals by directing or conducting experiments to answer critical nutrition and food science questions and develop nutrition recommendations for the public.
(h) Direct supervision of registered dietetic technicians.
(2) “Commission on Dietetic Registration” means the certifying body of the Academy of Nutrition and Dietetics, or its successor organization, that is accredited by the National Commission for Certifying Agencies.
(3) “Dietetics/nutrition” shall mean the integration and application of principles derived from the sciences of food, nutrition, biochemistry, physiology and behavior as an integral part of health-care delivery to achieve and maintain a person’s health throughout the life cycle. Its application to health care is both preventive and in response to an illness, injury or condition. The application of dietetics/nutrition to health care shall be called “dietetic and nutrition therapy.” The terms “dietetics” and “nutrition” are used interchangeably in this chapter.
(3)a. “Complex”, in reference to a disease state, medical condition, or clinical presentation, means a disease state, medical condition, or clinical presentation that requires the provision of medical nutrition therapy by a licensed dietitian due to one or more of the following:
1. Instability of the patient's health status.
2. The presence of multiple interacting high-acuity comorbidities.
3. A high risk of complications or rapid clinical deterioration.
4. The need for intensive monitoring.
5. The need for advanced nutrition interventions, including therapeutic diets administered via enteral or parenteral routes.
b. “Complex”, in reference to a disease state, medical condition, or clinical presentation, includes severe malnutrition, organ failure, conditions requiring enteral or parenteral nutrition, renal disease requiring dialysis, severe metabolic disturbances, post-bariatric surgery care, and critical illness.
(4) “Dietitian” and/or “nutritionist” shall mean a person who engages in the provision of nutrition services. The terms “nutritionist” and “dietitian” are used interchangeably in this chapter.
(4) “General non-medical nutrition information” means information on any of the following:
a. Principles of human nutrition and food preparation.
b. Principles of self-care and a healthy relationship with food.
c. Essential nutrients needed by the human body.
d. General and non-individualized recommended amounts of essential nutrients in the human body.
e. Actions of nutrients in the human body.
f. Non-individualized effects of deficiencies or excesses of nutrients in the human body.
g. General education surrounding foods, herbs, and dietary supplements that are good sources of essential nutrients in the human body.
(5) “L.D.N.” shall be the abbreviation for the title “licensed dietitian/nutritionist”.
(5) “Licensed dietitian” means an individual duly licensed under this chapter to engage in the practice of dietetics and the practice of nutrition, including the provision of medical nutrition therapy for complex and non-complex disease states and medical conditions.
(6) “License” shall mean any document which indicates that a person is currently licensed by the Board of Dietetics/Nutrition.
(6) “Licensed nutritionist” means an individual duly licensed under this chapter to engage in the practice of nutrition, including the provision of medical nutrition therapy for non-complex disease states and medical conditions.
(7) “Licensed dietitian/nutritionist” shall mean a person holding a current license under this chapter.
(7) “Medical nutrition therapy” means the provision of any of the following nutrition care services for the purpose of management or treatment of a disease state or medical condition:
a. Nutrition assessment.
b. Nutrition diagnosis.
c. Nutrition intervention.
d. Nutrition monitoring and evaluation.
(8) “Medical weight control” means medical nutrition therapy provided for the purpose of reducing, maintaining, or gaining weight.
(9)a. “Non-complex”
, i
n reference to a disease state, medical condition, or clinical presentation, means a disease state, medical condition, or clinical presentation that is stable and does not involve rapid clinical deterioration or high-acuity care needs, and can be safely addressed through medical nutrition therapy delivered in low-acuity outpatient settings by a practitioner practicing within the practitioner’s demonstrated level of competence.
b. “Non-complex” does not include a disease state, medical condition, or clinical presentation that requires intensive monitoring, involves multiple interacting high-acuity comorbidities, or necessitates advanced interventions such as therapeutic diets delivered by enteral or parenteral nutrition.
(10)a. “Non-medical weight control” means nutrition care services for the purpose of reducing, maintaining, or gaining weight that do not constitute the treatment or management of a disease state or medical condition.
b. “Non-medical weight control” includes weight control services for healthy population groups to achieve or maintain a healthy weight.
(11)a. “Nutrition assessment” means the ongoing, dynamic, and systematic process of ordering, obtaining, verifying, and interpreting biochemical, anthropometric, physical, nutrigenomic, and dietary data to make decisions about the nature and cause of nutrition-related problems relative to patient and community needs.
b. “Nutrition assessment” includes not only initial data collection, but also reassessment and analysis of patient or community needs and provides the foundation for nutrition diagnosis and nutritional recommendations and orders and may require ordering laboratory tests to check and track nutritional status.
c. “Nutrition assessment” does not include the collection of nutrition-related data, by itself.
(12) “Nutrition care process” means the systematic problem-solving method that licensed dietitians use to critically think and make decisions when providing medical nutrition therapy or to address nutrition-related problems and provide safe and effective care and consists of 4 distinct, but interrelated, steps, including nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation.
(13) “Nutrition care services” means any part or all of the following services provided within a systematic process:
a. Assessing and evaluating the nutritional needs of individuals and groups and determining resources and constraints in a practice setting, including ordering of nutrition-related laboratory tests to check and track nutrition status.
b. Identifying nutrition problems and establishing priorities, goals, and objectives that meet nutritional needs and are consistent with available resources and constraints.
c. Creating individualized dietary plans and issuing and implementing orders to meet nutritional needs of healthy individuals and individuals with disease states or medical conditions, including ordering therapeutic diets, and monitoring the effectiveness thereof.
d. Determining and providing appropriate nutrition intervention in health and disease, including nutrition counseling on food and prescription drug interactions.
e. Developing, implementing, and managing nutrition care systems.
f. Evaluating, making changes in, and maintaining appropriate standards of quality in food and nutrition services.
(14) “Nutrition counseling” means a supportive process, characterized by a collaborative counselor-patient relationship with individuals or groups, to establish food and nutrition priorities, goals, and individualized action plans and general physical activity guidance, that acknowledge and foster responsibility for self-care, to promote health and wellness or to treat or manage an existing disease state or medical condition.
(15)a. “Nutrition diagnosis” means identifying and labeling nutrition problems managed and treated by a licensed dietitian or licensed nutritionist.
b. “Nutrition diagnosis” does not include a medical diagnosis of the health status of an individual.
(16)a. “Nutrition intervention” means planned actions, including nutrition counseling, intended to positively change a nutrition-related behavior, risk factor, environmental condition, or aspect of health status of an individual, and the individual’s family or caregivers, target groups, or community at large.
b. “Nutrition intervention” includes approving, ordering, and monitoring therapeutic diets and counseling on food and prescription drug interactions.
(17) “Nutrition monitoring and evaluation” means identifying patient outcomes relevant to the nutrition diagnosis, intervention plans, and goals and comparing those outcomes with previous status, intervention goals, or a reference standard to determine the progress made in achieving desired outcomes of nutrition care and whether planned interventions should be continued or revised.
(18) “Patient” means an individual recipient of nutrition care services.
(19)a. “Practice of dietetics” means the integration and application of scientific principles derived from the study of food, nutrition, biochemistry, metabolism, nutrigenomics, physiology, pharmacology, food systems, management, and behavioral and social sciences to achieve and maintain optimal nutrition status of individuals and groups across the lifespan.
b. “Practice of dietetics” includes all of the following:
1. The provision of nutrition care services, including medical nutrition therapy, delivered in person or via telehealth, to prevent, manage, or treat complex disease states or medical conditions and promote wellness in inpatient and outpatient settings.
2. Developing and ordering therapeutic diets, via oral, enteral, and parenteral routes.
3. Providing other advanced medical nutrition therapy and related support activities consistent with current competencies required of academic and supervised practice programs accredited by the Accreditation Council for Education in Nutrition and Dietetics and in accord with the Scope and Standards of Practice for the Registered Dietitian.
(20)a. “Practice of nutrition” means the integration and application of scientific principles derived from the study of nutrition science, cellular and systemic metabolism, biochemistry, physiology, and behavioral sciences to support and maintain health throughout the lifespan.
b. “Practice of nutrition” includes all of the following:
1. The provision of nutrition care services, including medical nutrition therapy, delivered in person or via telehealth, for the prevention, management, or treatment of non-complex disease states and medical conditions in low-acuity outpatient settings, and for the promotion of wellness.
2. Consistent with level of competence, ordering of oral therapeutic diets, ordering of medical laboratory tests related to nutrition interventions, and recommending vitamin, mineral, and other dietary supplements.
c. “Practice of nutrition” does not include the provision of medical nutrition therapy for complex conditions nor the delivery of medical nutrition therapy in inpatient or high-acuity outpatient settings.
(21) “Provisionally licensed dietitian” or “provisionally licensed nutritionist” means an individual provisionally licensed under this chapter.
(22) “Qualified supervisor” means an individual providing supervision who assumes full professional responsibility for the work of the supervisee by verifying, directing, and approving the provided nutrition care services, including medical nutrition therapy, and other work being supervised and meets the requirements of § 3813 of this title.
(23) “Registered dietitian” means an individual who is credentialed by the Commission on Dietetic Registration as a registered dietitian or a registered dietitian nutritionist and is authorized to use such title and the corresponding abbreviations “RD” or “RDN”.
(8)
(24)
“Substantially related” means the nature of the criminal conduct, for which the
person
individual
was convicted, has a direct bearing on the fitness or ability to perform 1 or more of the duties or responsibilities necessarily related to the
provision of dietetics/nutrition therapy services.
practice of dietetics or the practice of nutrition.
(25) “Telehealth” means the use of electronic information and telecommunications technologies to provide services under this chapter between a practitioner in one location and an individual in another location to support clinical health care, public health, patient health-related education, and health administration.
(26) “Therapeutic diet” means a diet intervention ordered by a physician or other authorized provider, including a licensed dietitian or, for oral diets only, a licensed nutritionist, which provides food, fluids, or nutrients by oral, enteral, or parenteral routes and is used in the treatment of a disease or clinical condition to modify, eliminate, decrease, or increase specific macro- or micronutrients, or to provide mechanically altered food when medically indicated.
Section 3. Amend § 3803, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3803. Board of Dietetics/Nutrition; appointment; composition; qualifications; term of office; suspension or removal; compensation.
(a)
Appointment. —
(1)
The Board of Dietetics/Nutrition
shall consist of 5 members
is comprised as provided under subsection (b) of this section.
(2)
who are residents of this State
A member of the Board must be a resident of this State.
(3)
and shall be appointed by the Governor.
The Governor shall appoint each member of the Board.
(4)
Members shall be appointed so that the terms of 3 members shall expire 2 years after the initial appointment and that the terms of the remaining 2 members shall expire 3 years after the initial appointment. Thereafter, appointments shall be made
A member of the Board’s appointment is
for a term of 3 years.
(5)
A
Subject to paragraph (a)(7) of this section, a
member of the Board
shall be
eligible for reappointment, but a member shall
may
not be appointed to serve more than 2 consecutive terms.
(6)
Each
A member’s
term of office
shall expire
expires
on
a
the
date specified in the
appointment except that each
appointment, however, a
member
shall serve
serves
until a successor is duly appointed.
(7)
A member
who was
initially appointed to fill a vacancy may successively serve for only 1 additional full term.
(b)
Composition and provisions. —
(1) The Board is comprised of the following:
a.
Three members shall be Delaware Licensed Dietitian/Nutritionists.
Two members who are licensed dietitians.
b. One member who is licensed dietitian or a licensed nutritionist.
c. One member who is a physician licensed under Chapter 17 of this title.
d.
The remaining 2 members shall be
One member who is
from the general public,
who are not Licensed Dietitians/Nutritionists and are not in any way,
not a licensed dietitian or licensed nutritionist, and not
connected to the provision of
dietetics or
nutrition services
either
monetarily, through business activity, through educational
activity
activity,
or by their immediate family relations.
(2)
No
A
member of the Board, while serving on the Board,
shall
may not
be a president,
chair
chair,
or other elected official of any state professional association for dietitians or nutritionists.
(3)
The provisions set forth for “employees” in Chapter 58 of Title 29
shall
apply to all members of the Board, and to all
individuals
appointed by or otherwise employed by the Board.
(c)
Suspension or removal. —
A member of the Board shall be suspended or removed by the Governor for misfeasance, nonfeasance or malfeasance.
(1) The Governor may suspend or remove a member of the Board for gross inefficiency, misfeasance, nonfeasance, malfeasance, or neglect of duty in office.
a. A Board member is deemed in neglect of duty in office if the member is absent from 3 consecutive Board meetings without good cause or fails to attend at least 50% of all regular Board meetings in a calendar year.
b. A Board member who is deemed in neglect of duty is deemed to have resigned.
(2)
A
Board
member subject to disciplinary proceedings
shall be
is
disqualified from
the
participating in
Board business until the charge is adjudicated, or the matter is otherwise concluded.
(3)
A Board member may appeal any suspension or removal to the Superior Court.
(d)
Compensation. —
Each member of the Board
shall
must
be reimbursed for all expenses involved in each meeting, including travel, and
in addition shall
must
receive compensation
per
for each
meeting attended in an amount determined by the Division
of Professional Regulation
in accordance with
Del. Const. art. III, § 9.
Section 9 of Article III of the Delaware Constitution.
Section 4. Amend § 3804, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3804. Officers; meetings; quorum.
(a) The Board shall
elect
annually
elect
from
its
the Board’s
membership a chair,
vice-chair
vice-chair,
and secretary.
(b) The Board shall hold a regularly scheduled business meeting at least once each quarter and at such other times as the chair deems necessary or at the request of a majority of Board members.
(c) A majority of
members shall constitute
Board members constitutes
a quorum; and
no
action
shall
may not
be taken
by the Board
without the affirmative vote of at least 3 members.
Any member who fails to attend 3 consecutive meetings, or who fails to attend at least
1
/
2
of all regular business meetings during any calendar year, shall automatically, upon such occurrence, be deemed to have resigned from office and a replacement shall be appointed.
(d) Minutes of all meetings
shall be recorded,
must be prepared,
and copies of the minutes
shall
must
be maintained by the Division of Professional Regulation. At any hearing in which evidence is presented, a record from which a verbatim transcript can be prepared
shall
must
be made. The expense of preparing any transcript
shall
must
be incurred by the person requesting
it.
the transcript.
Section 5. Amend § 3805, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3805. Powers and duties.
The Board
of Dietetics/Nutrition shall have the authority to:
may do any of the following:
(1) Formulate rules and regulations with appropriate notice to those
affected; all
affected. All
rules and regulations
shall be promulgated
must be adopted
in accordance with the procedures specified in the Administrative Procedures Act, Chapter 101 of Title 29. Each rule or regulation
shall
must
implement or clarify a specific section of this chapter.
(2) Grant or deny a license to an applicant in accordance with the qualifications
criteria
for licensure
set forth in this chapter.
(3) Evaluate the credentials of
all persons
an individual
applying for a
license as a Licensed Dietitian/Nutritionist
license, or a provisional license, as a licensed dietitian or licensed nutritionist
in this State,
in order
to determine whether
such persons meet
the individual meets
the qualifications for
licensing
licensure
set forth in this chapter.
(4) Designate the application
form
forms
to be used by
all applicants and to process all applications.
applicants.
(5) Designate the
examination
examinations
to be taken by
persons applying for licensure where such examination is required by this chapter.
applicants.
(6) Refer all complaints from practitioners and from the public to the Division of Professional Regulation for investigation
pursuant to
under
§ 8735 of Title 29 and assign a member of the Board to assist the Division in an advisory capacity with the investigation.
(7) Hold hearings and take such actions as are permitted under the provisions of the Administrative Procedures Act, Chapter 101 of Title 29, and this chapter.
(8)
Where it has been
If the Board has
determined after a disciplinary
hearing,
hearing
that disciplinary action should be imposed,
to
designate
and impose
the
appropriate disciplinary
action
action and,
after time for appeal has
lapsed.
lapsed, impose the appropriate disciplinary action.
(9)
After a hearing conducted in accordance with this chapter and the Administrative Procedures Act, Chapter 101 of Title 29, do all of the following:
a.
Issue cease and desist
orders, injunctive orders and/or
orders and injunctive orders.
b.
seek
Seek
the imposition of other civil penalties defined in this
chapter, and/or
chapter.
c.
fine
Fine
persons for violating cease and desist
orders and/or
orders.
d.
sue
Sue
persons for recovery of fines imposed under this
chapter, after a hearing conducted in accordance with this chapter and the Administrative Procedures Act [Chapter 101 of Title 29].
chapter.
(10) Prepare and maintain a registry of
Licensed Dietitians/Nutritionists.
licensed dietitians and licensed nutritionists.
(11)
Promulgate
Adopt
regulations specifically identifying
those
crimes
which
that
are substantially related to the
provision of dietetic and nutrition therapy.
practice of dietetics and the practice of nutrition.
Section 6. Amend § 3806, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3806. Qualifications of
applicants.
applicants for licensure as dietitian or nutritionist.
(a) An applicant
who is applying
for licensure
as a dietitian
under this chapter shall have the following
education, supervised practice experience, and examination
qualifications:
(1) For applicants who graduated before January 1, 2024, a minimum of a baccalaureate degree from a United States
(U.S.)
regionally accredited college or
university. —
university.
Applicants who have obtained their education outside the
U.S.
United States
and its territories must have their academic degree or degrees validated as equivalent to
the
a
baccalaureate or master’s degree conferred by a regionally accredited college or university in the
U.S.
United States.
(2) For applicants who graduated on or after January 1, 2024, a minimum of a master’s degree from a United States
(U.S.)
regionally accredited college or
university. —
university.
Applicants who have obtained their education outside the
U.S.
United States
and its territories must have their academic degree or degrees validated as equivalent to
the
a
master’s
or doctoral
degree conferred by a regionally accredited college or university in the
U.S.
United States.
(3)
A major course of study in human nutrition, nutrition education, food and nutrition, dietetics, or food systems management.
Completed a program of study accredited by the Accreditation Council for Education in Nutrition and Dietetics, or its successor organization.
(4)
Submitted proof to the Board of the
Documentation verifying
completion of a supervised practice
in dietetics/nutrition
program accredited by the Accreditation Council for Education in Nutrition and Dietetics, or its successor organization,
which consists of a documented supervised practice experience
component in dietetics practice,
in the practice of dietetics and the practice of nutrition
of not less than
900
1,000
hours under the supervision of a
registered dietitian, a state’s licensed healthcare practitioner or an individual with a doctoral degree conferred by a U.S. regionally accredited college or university with a major course study in human nutrition, nutrition education, food and nutrition, dietetics, or food systems management. Supervised practice experience must be completed in the U.S. or its territories. Supervisors who obtained their doctoral degree outside the U.S. and its territories must have their degree validated as equivalent to the doctoral degree conferred by a U.S. regionally accredited college or university.
qualified supervisor.
(5)
Appear at a time and place designated by the Board and submit to examination as to the person’s qualification for registration as a L.D.N.
Passed the registration examination for dietitians administered by the Commission on Dietetic Registration. If passage of the examination occurred more than 5 years before application, demonstration of completion of 75 hours of continuing education meeting the continuing education criteria of the Board for each 5-year period post-examination.
(b)
Persons who provide
An individual who provides
evidence of current registration as a registered dietitian awarded by the Commission on Dietetic
Registration, credentialing agency of the American Dietetic Association shall be
Registration is
considered to have met the qualifications for licensure under this chapter in lieu of
meeting the requirements of
subsection (a) of this section.
(c) An applicant for licensure as a nutritionist under this chapter shall have the following education, supervised practice experience, and examination qualifications:
(1) A minimum of a master's or doctoral degree from a United States regionally accredited college or university with a major in human nutrition, foods and nutrition, community nutrition, public health nutrition, nutrition education, nutrition, nutrition science, clinical nutrition, applied clinical nutrition, nutrition counseling, nutrition and functional medicine, nutritional biochemistry, nutrition and integrative health, or a comparable titled major, or a doctoral degree in a field of clinical healthcare from a United States regionally accredited college or university, or validated foreign equivalent. Regardless of the course of study, the applicant must submit documentation to the Board verifying completion of coursework leading to competence in medical nutrition therapy to treat non-complex conditions, which includes all of the following:
a. Fifteen semester hours of courses on clinical or life sciences, including at least 3 semester hours on human anatomy and physiology or the equivalent.
b. Fifteen semester hours of courses on nutrition and metabolism, including at least 6 semester hours on biochemistry.
(2) Documentation verifying completion of a supervised practice experience, approved by the Board, that demonstrates competence in the practice of nutrition meeting all the following requirements:
a. Completion of a supervised practice experience under this paragraph (c)(2) within 5 years of completing the requirements under paragraph (c)(1) of this section.
b. Completion of a supervised practice experience under this paragraph (c)(2) involving at least 1,000 hours in the following practice areas, with a minimum of 200 hours in each of the following practice areas: nutrition assessment, nutrition intervention, and nutrition monitoring and evaluation.
c. Completion of a supervised practice experience under this paragraph (c)(2) under the supervision of a qualified supervisor.
d. Determination by the Board that the supervised practice experience under this paragraph (c)(2) prepared the applicant to provide nutrition care services for various populations of diverse cultures, genders, and across the life cycle, and to be able to competently formulate actionable medical nutrition therapies and interventions, education, counseling, and ongoing care for the prevention, modulation, and management of a range of non-complex medical conditions.
(3) Completion of the examination requirements by demonstrating one of the following:
a. Passage of the certified nutrition specialist examination administered by the Board for Certification of Nutrition Specialists, or its successor organization, or an equivalent examination on all aspects of the practice of nutrition that has been reviewed under a program that requires a master's degree or higher, is accredited by the National Commission for Certifying Agencies, and is approved by the Board. If passage of the examination occurred more than 5 years before application, demonstration of completion of 75 hours of continuing education meeting the continuing education criteria of the Board for each 5-year period post examination.
b. That the applicant holds a valid current certification with the Board for Certification of Nutrition Specialists, or its successor organization, that gives the applicant the right to use the title “certified nutrition specialist”.
(c)
(d)
The Board may refuse or reject an applicant if, after
a
hearing, the Board finds that the applicant meets any of the following conditions or actions:
(1) Those specified in §
3811(a)(1)-(5)
3811(a)(1) through (5)
of this title.
(2) Has been convicted of a crime that is substantially related to the provision of
dietetic and nutrition therapy.
the practice of dietetics or the practice of nutrition, as applicable.
However, if after consideration of the factors set forth under § 8735(x)(3) of
Title 29
Title 29,
through a hearing or review of
documentation
documentation,
the Board determines that granting a waiver would not create an unreasonable risk to public safety, the Board, by an affirmative vote of a majority of the quorum, shall waive this paragraph
(c)(2).
(d)(2).
a.-d. [Repealed.]
(3) Has
been the recipient of
received
any administrative penalties from any other jurisdiction
or jurisdictions
regarding the applicant’s practice of
dietetic and nutrition therapy, including but not limited to
dietetics or practice of nutrition, as applicable, including
fines, formal reprimands, license suspensions or revocation (except for license revocations for nonpayment of license renewal fees), probationary limitations,
and/or
or
has entered into any “consent agreements”
which
that
contain conditions placed by
a Board
another jurisdiction
on the applicant’s professional conduct and practice, including any voluntary surrender of a license in lieu of discipline. The Board may determine, after a hearing, whether such administrative penalty is grounds to deny licensure.
(d)
(e)
Where
If
the Board has found to
its
the Board’s
satisfaction that
an application
an individual applying for licensure under this chapter
has been intentionally fraudulent, or that false information has been intentionally supplied,
it
the Board
shall report
its
the Board’s
findings to the Attorney General for further action.
(e)
(f)
Where the
If an
application
of a person
has been refused or rejected and
such applicant feels
the applicant believes
that the Board has acted without justification, has imposed higher or different standards for the applicant than for other applicants, or has in some other manner contributed to or caused the failure of
such
the
application, the applicant may appeal to the Superior Court.
(f)
(g)(1)
[Repealed.]
An individual who is a Delaware licensed dietitian/nutritionist on [the effective date of this Act] is licensed as a licensed dietitian without meeting any additional requirements if the individual holds the registered dietitian credential issued by the Commission on Dietetic Registration.
(2) An individual who is a Delaware licensed dietitian/nutritionist on [the effective date of this Act] and does not hold the registered dietitian credential issued by the Commission on Dietetic Registration is licensed as a licensed nutritionist without meeting any additional requirements.
(3) A licensee to whom paragraph (g)(1) or (g)(2) of this section applies shall maintain continuing education as provided by this chapter.
Section 7. Amend § 3807, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3807. Reciprocity.
(a)
Reciprocity will be provided for
registered,
certified or licensed dietitians or
registered,
certified or licensed nutritionists from
other states provided that
another state if
the standards for
registration,
certification
and/or
or
licensure in that state are
reasonably equivalent to
substantially the same as
those set forth in § 3806 of this title.
(b)
Reciprocity applicants must follow the rules and regulations for application established under § 3809 of this title.
Section 8. Amend § 3808, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3808. Continuing education.
(a)
In order to
To
maintain eligibility for licensure, renewal applicants must submit proof of continuing education.
(b)
Thirty hours of continuing education are required during the 2-year licensure period.
Continuing education hours must meet the requirements of the American Dietetic Association to be valid.
(c)(1) Continuing education hours for licensed dietitians must meet the requirements of the Commission on Dietetic Registration to be valid.
(2) Continuing education hours for licensed nutritionists must meet the requirements of the Board for Certification of Nutrition Specialists to be valid.
Section 9. Amend § 3809, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3809. Issuance and renewal of licenses; fees.
(a) The amount charged for each fee imposed under this chapter
shall
must
approximate and reasonably reflect all costs necessary to defray the expenses of the Board and the proportional expenses incurred by the Division of Professional Regulation in
its
the Division’s
services on behalf of the Board.
There shall be a
A
separate fee
must be
charged for each service or activity, but
no fee shall
a fee may not
be charged for a purpose not specified in this chapter. The application fee
shall
may
not be combined with any other fee or charge. At the beginning of each calendar year, the Division of Professional Regulation, or any other state agency acting on
its
the Division’s
behalf, shall compute for each separate service or activity the appropriate Board fees for the coming year.
(b) The Board shall issue a license to each applicant who meets the requirements of this chapter for licensure as a
dietitian/nutritionist
dietitian or nutritionist
and who pays the
established fees.
fees established under subsection (a) of this section.
(c) Each license
shall
must
be renewed biennially, in such manner as is determined by the Division
of Professional Regulation
and
upon
on
payment of the appropriate fee and submission of a renewal form provided by the Division, and proof that the licensee has met the continuing education requirements established by the Board.
(d) The Board, in
its
the Board’s
rules and
regulation,
regulations,
shall determine
all of the following related to a licensee that has failed to renew a license on or before the licensee’s renewal date:
(1)
the
The
period of time
after the renewal date
within which a licensee may
still
renew the licensee’s
license
license, not to exceed 1 year after the renewal date.
(2)
and determine
The amount of
late fees associated with the
license renewal, notwithstanding the fact that such licensee has failed to renew on or before the renewal date, provided, however that such period shall not exceed 1 year.
renewal of a license after the renewal date.
(e) A licensee,
upon
on
written request, may be placed in an inactive status for no more than 5 years.
Such person,
A licensee placed in an inactive status
who desires to reactivate
that person’s
license,
the licensee’s license
shall complete a Board-approved application form, submit a renewal fee, and
provide
proof of fulfillment of continuing education requirements in accordance with the
Board’s
rules and
regulation of the Board.
regulations.
Section 10. Amend § 3810, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3810. Licensure required.
(a)
No person shall represent oneself or
Except as otherwise provided under this chapter, an individual may not
engage in the practice of
dietetics and nutrition therapy as a Licensed Dietitian/Nutritionist in this State or use the title “Licensed Dietitian,” “Licensed Nutritionist,” “Nutritionist,” “Dietitian,” use the letters “L.D.N.”, or any combination of above terms and/or abbreviations unless such a person
medical nutrition therapy in this State, unless the individual
is licensed under this chapter.
(b) Except as otherwise provided under this chapter, an individual may not designate or hold the individual’s self out as a licensed dietitian or use or assume the titles “licensed dietitian”, “dietitian”, “dietitian nutritionist”, “dietician”, or any other title indicating that the individual is a licensed dietitian or append to or use in conjunction with that individual’s name the letters “LD”, unless the individual is a licensed dietitian under this chapter.
(c) Except as otherwise provided under this chapter, an individual may not use or assume the title “licensed nutritionist” or append to or use in conjunction with that individual’s name the letters “LN”, unless the individual is a licensed nutritionist under this chapter.
(d) Except as otherwise provided under this chapter, an individual may not designate or hold the individual’s self out as a nutritionist or use or assume the title “nutritionist”, unless the individual is licensed under this chapter.
(e) Identifying oneself using an earned, federally trademarked nutrition credential is not prohibited, but such permitted use does not give the right to practice medical nutrition therapy or identify using the general titles listed under subsections (b), (c), or (d) of this section, unless the individual is also licensed under this chapter.
(f)
This chapter does not prohibit or restrict:
(1)
Any person
An individual
licensed in this State under
any
other
act
law of this State
from engaging in the practice for which
that person is licensed.
the individual is licensed, however, the individual may not represent the individual’s self using titles protected under this section.
(2)
The practice of dietetic and nutrition therapy by a person who is employed by the United States or state government or any of its bureaus, divisions, or agencies while in the discharge of the employee’s official duties.
A dietitian or nutritionist who is serving in the armed forces of the United States or the United States Public Health Service or is employed by the United States Veterans Administration from engaging in the practice of dietetics or the practice of nutrition or using government issued titles, if the practice or title use is related to the dietitian’s or nutritionist’s federal service or employment.
(3)
The supervised practice of dietetic and nutrition therapy of person pursuing a course of study leading to a degree in dietetics, nutrition or an equivalent major, as authorized by the Board, from a regionally accredited school or program, if the activities and services constitute a part of a supervised course of study and if the person is designated by a title that clearly indicates the person’s status as a student. This period is not to exceed 2 years unless written approval is provided by the Board. The individual will be supervised by an individual licensed under this chapter.
A student or trainee, if any of the following apply:
a. The student or trainee practices under this paragraph (f)(3) as a part of a course of study or as part of a planned, continuous, and supervised practice experience to satisfy educational or supervised practice experience requirements under § 3806 of this title.
b. The student or trainee practices under this paragraph (f)(3) only while supervised by a qualified supervisor and as provided for in § 3813 of this title.
c. While practicing under this paragraph (f)(3), the student or trainee uses a title that clearly indicates the student’s or trainee’s status as a student, intern, trainee, or supervisee.
(4)
An herbalist, retailer or other person who does not hold himself or herself out to be a dietitian or nutritionist by using 1 or more of the titles restricted by this chapter, who makes recommendations regarding lifestyle, or who markets, distributes, sells, or who recommends, advises, or furnishes nonfraudulent information about, herbs, vitamins, minerals, amino acids, carbohydrates, sugars, enzymes, food concentrates, foods, other food supplements, or dietary supplements. For purposes of this paragraph, “fraud” shall be defined as an intentional misrepresentation for financial gain. Legitimate disagreement about the role of the above-listed nutrients and foods as they apply to human nutrition shall not, in and of itself, constitute fraud.
A person who disseminates non-individualized, written, general non-medical nutrition information in connection with the marketing and distribution of dietary supplements, food, herbs, or food materials, including explanations of federally regulated label claims, any known drug-nutrient interactions, their role in various diets, or suggestions as how to best use and combine them, if the information does not constitute medical nutrition therapy and the person does not represent the person’s self using titles protected under this section.
(5) The practice of the tenets of any religion,
sect or denomination whatsoever, provided that
sect, or denomination, if
a member of
such
the
religion,
sect
sect,
or denomination
shall
does
not designate
himself or herself
the member’s self
by any other term or title which implies that
such
the
member is engaged in the practice of
dietetic and nutrition therapy.
medical nutrition therapy.
(6) A person presenting a general program of instruction for weight control need not be a Licensed Dietitian/Nutritionist provided the general program is approved in writing by:
a. A dietitian registered by the Commission of Dietetic Registration of the American Dietetic Association; or
b. A licensed physician.
(6) A person that does not represent the person’s self using titles protected under this section while providing medical weight control for obesity as part of any of the following:
a. An instructional program that has been approved in writing by at least one of the following:
1. A licensed nutritionist or licensed dietitian.
2. A health care practitioner licensed or certified in this State whose authorized scope of practice includes medical nutrition therapy.
b. A plan of care that is overseen by a health care practitioner licensed in this State whose scope of practice otherwise authorizes the health care practitioner to provide and delegate medical nutrition therapy, if the medical weight control services are not discretionary and do not require the exercise of professional judgment.
(7)
The practice of dietetic and nutrition therapy by a person who is eligible to take the registration examination for dietitians as administered by the Commission of Dietetic Registration, the credentialing agency of the American Dietetic Association. This individual is excluded under this chapter for a period of 1 year upon completion of qualifying experience as set forth by the American Dietetic Association.
[Repealed.]
(8) An individual who is employed by, or a person that contracts with, any of the following for the purposes of providing nutrition care services for the Women, Infants, and Children program from providing nutrition care services utilizing the title of “nutritionist” within the discharge of the individual’s or person’s official duties:
a. This State.
b. A county of this State.
c. A municipality of this State.
d. Any other political subdivision of this State.
(9) An individual who does not represent the individual’s self using titles protected under this section while assisting with the provision of medical nutrition therapy if the individual performs only support activities that are not discretionary and that do not require the exercise of professional judgment for their performance, and the individual is directly supervised by a licensed dietitian, licensed nutritionist, or a health care practitioner licensed in this State acting within the scope of the health care practitioner's license.
(10) A person that provides any of the following services if the services do not constitute medical nutrition therapy and the person does not represent the person’s self using titles protected under this section:
a. Individualized nutrition recommendations for the wellness and primary prevention of chronic disease.
b. Health coaching.
c. Holistic and wellness education, guidance, or motivation.
d. Behavior change management.
e. Services for non-medical weight control.
f. Any other nutrition care services.
(11)a. An out-of-state dietitian or nutritionist who provides medical nutrition therapy services by telehealth to a patient located in this State, if the out-of-state practitioner is a dietitian or nutritionist licensed or certified in good standing in any state or territory and any of the following apply:
1. The medical nutrition therapy services are provided in consultation with a medical nutrition therapy practitioner licensed in this State who has a practitioner-patient relationship with the patient.
2. The medical nutrition therapy services are provided for a patient whom the out-of-state practitioner has a current practitioner-patient relationship, and the patient is temporarily present, as defined by the Board by regulation, in this State.
3. The medical nutrition therapy services are provided under a current practitioner-patient relationship, and the care is limited to temporary or short-term follow-up, as defined by the Board by regulation, medical nutrition therapy services to ensure continuity of care.
b. By engaging in telehealth with a patient located in this State, an out-of-state practitioner exempted from licensure under subsection (a) of this section consents to applicable laws, rules, and regulations of this State governing dietitians or nutritionists, as applicable, and to the jurisdiction of this State, including the Board's complaint, investigation, and hearing process and ability to seek injunctions and impose civil penalties and fines.
Section 11. Amend § 3811, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3811. Grounds for
discipline/sanctions/penalties of
discipline, sanctions, or penalties for
unlicensed practice.
(a)
The following conditions and actions of an applicant or L.D.N. may result in disciplinary action as set forth in subsection (b) of this section if,
If,
after a hearing, the Board finds that an applicant or
L.D.N.:
licensee has done any of the following, the Board may take disciplinary action under subsection (b) of this section:
(1) Has employed or knowingly cooperated in fraud or material deception
in order
to be
licensed; or
licensed.
(2) Has engaged in illegal,
incompetent
incompetent,
or negligent conduct in the
provision of dietetic and nutrition therapy; or
practice of dietetics or the practice of nutrition, as applicable.
(3) Has as a
dietitian/nutritionist
dietitian or nutritionist,
or otherwise, in the practice of
the profession,
dietetics or the practice of nutrition, as applicable,
knowingly engaged in an act of consumer fraud or deception, or engaged in the restraint of competition, or participated in price-fixing
activities; or
activities.
(4) Has violated the Code of Ethics as established by the
American Dietetic Association; or
Board.
(5) Has violated a lawful provision of this chapter or any lawful rule or regulation established
hereunder; or
under this chapter.
(6) Has been convicted of a crime that is substantially related to the
provision of dietetic and nutrition therapy.
practice of dietetics or nutrition, as applicable.
(b)
Persons
An individual
regulated under this chapter who
have
has
been determined
by the Board
to be in violation of this chapter
shall be
is
subject to the following disciplinary
actions:
actions by the Board:
(1) Issuance of a letter of reprimand.
(2)
Censorship.
Censure.
(3) Placement on probationary status.
(4) Denial of license.
(5) Suspension of license.
(6) Revocation of license.
(c) As a condition to reinstatement of a suspended license or removal from probationary status, the Board may impose
such
disciplinary or corrective measures as are authorized under this chapter.
(d)
Penalties of unlicensed practice. —
(1)
Where
If
the Board has determined,
upon
on
notice and hearing
pursuant to
under
Chapter 101 of
Title 29
Title 29,
that
a person
an individual
is engaged in the practice of
dietetics and
medical
nutrition therapy
and
as
regulated by this chapter without having lawfully obtained a license or that
a person
an individual
previously licensed under this chapter is engaged in the practice of
dietetic and
medical
nutrition therapy as regulated by this chapter notwithstanding that the
person’s
individual’s
license has been suspended or revoked, the Board may issue a cease and desist order. In addition to the power to issue a cease and desist order, the Board may seek an injunctive order prohibiting such unlawful practice
and/or
or
seek the imposition of other civil penalties
defined by
under
this chapter.
(2)
Upon
On
notice and hearing
pursuant to
under
Chapter 101 of Title 29, the Board may fine any
person
individual
who violates
such
a
cease and desist order
issued under this subsection
not less than $100 or more than $1000.
Each
The Board may deem each
day a violation continues
may be deemed a separate offense in the Board’s discretion.
to be a separate offense.
(3)
Any
A
person
who
that
violates any provisions of this chapter or any rules and regulations
promulgated hereunder shall be
adopted under this chapter is
liable for a civil penalty of not more than $2,500 for the first offense; and not more than $5,000 for the second and each subsequent offense, which penalty may be sued for, and recovered
by
by,
the Board. Nothing in this section
shall
may
be construed to prevent prosecution under, or be inconsistent with, Chapter 5 of Title 11.
(e)
(1)
In the event of
If
a formal or informal complaint
is filed
concerning the activity of a licensee that presents a clear and immediate danger to the public health,
safety
safety,
or welfare, the Board may temporarily suspend the
person’s
licensee’s
license, pending a hearing,
upon
on
the written order of the Secretary of State or the Secretary’s designee, with the concurrence of the Board chair or the Board chair’s designee.
(2)
An order temporarily suspending a license may not be issued unless the
person
licensee
or the
person’s
licensee’s
attorney received at least 24 hours’ written or oral notice before the temporary suspension so that the
person
licensee
or the
person’s
licensee’s
attorney may file a written response to the proposed suspension.
(3)
The decision as to whether to issue the temporary order of suspension will be decided on the written
submissions.
submissions to the Secretary of State or the Secretary’s designee and the Board chair or Board chair’s designee.
(4)
An order of temporary suspension pending a hearing may
not
remain in effect for
no
longer than 60 days from the date of the issuance of the order unless the temporarily suspended
person
licensee
requests a continuance of the hearing date.
(5)
If the temporarily suspended
person
licensee
requests a continuance, the order of temporary suspension remains in effect until the hearing is convened and a decision is rendered by the Board.
(6)
A
person
licensee
whose license has been temporarily suspended
pursuant to
under
this section may request an expedited hearing. The Board shall schedule the hearing on an expedited
basis, provided that
basis if
the Board receives the request within 5 calendar days from the date on which the
person
licensee
received notification of the decision to temporarily suspend the
person’s
licensee’s
license.
Section 12. Amend § 3812, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3812. Administrative procedures.
All procedures under this chapter
shall be
are
governed by the Delaware Administrative Procedures Act, Chapter 101 of Title 29.
Section 13. Amend Chapter 38, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3813. Qualified supervisor
.
(a) To be a qualified supervisor for purposes of this chapter, an individual shall do all the following:
(1) Only supervise a clinical activity or nutrition care service for which the qualified supervisor is qualified and is authorized to perform.
(2) Develop and carry out a program for advancing and optimizing the quality of care provided by the supervisee. A qualified supervisor and a supervisee shall identify and document goals for supervised practice experience, the assignment of clinical tasks as appropriate to the supervisee’s evolving level of competence, the supervisee’s relationship with, and access to, the qualified supervisor, and a process for evaluating the supervisee’s performance.
(3) Oversee the activities of and approve and accept responsibility for the nutrition care services rendered by the supervisee.
(4) At a minimum, be physically on-site and present where the supervisee is providing nutrition care services or be immediately and continuously available to the supervisee by means of two-way real-time audiovisual technology that allows for the direct, contemporaneous interaction by sight and sound between the qualified supervisor and the supervisee. If the qualified supervisor assigns a nutrition care service to a supervisee that is to be provided in a setting where the qualified supervisor is not routinely present, the qualified supervisor shall ensure that the means and methods of supervision are adequate to ensure appropriate patient care, which may include synchronous videoconferencing, or another method of communication and oversight that is appropriate to the care setting and the education and experience of the supervisee.
(5) Review on a regular basis the charts, records, and clinical notes of the supervisee, and maintain responsibility for the supervisee’s clinical record keeping.
(6) Be available to render assistance during the provision of nutrition care services when requested by the patient or have arranged for another qualified practitioner lawfully able to render nutrition care services to be available in the absence of the qualified supervisor.
(7) Limit the assignment of nutrition care services to those services that are within the training and experience of the supervisee and customary to the practice of the qualified supervisor.
(b) A qualified supervisor shall comply with subsection (a) of this section and, if supervising the provision of medical nutrition therapy, shall meet one of the following:
(1) Is licensed or certified as a dietitian, nutritionist, dietitian nutritionist, or health care practitioner whose scope of practice includes medical nutrition therapy in the state or territory where the supervised practice experience occurs
.
(2) Meets such other criteria as the Board may establish by rule or regulation when a state where the supervised practice occurs does not provide for licensure or certification of dietitians, dietitian nutritionists, or nutritionists
.
(3) Meets the exemption requirements of § 3810(f)(2) of this
title.
Section 14. Amend Chapter 38, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3814. Provisional license
.
(a) The Board may issue a provisional license for an individual who has not passed the required licensure examination to engage in both the practice of dietetics and the practice of nutrition for 1 year under the supervision of a licensed dietitian on the filing of an application with appropriate fees and submission of evidence of successful completion of the education and supervised practice requirements for dietitian licensure provided for in § 3806(a) of this title.
(b) The Board may issue a provisional license for an individual to engage in the practice of nutrition for 1 year under the supervision of a licensed dietitian or licensed nutritionist on the filing of an application with appropriate fees and submission of evidence of successful completion of the education and supervised practice requirements for nutritionist licensure provided for in § 3806(c) of this title.
Section 15. Transitional provision. The term of an individual who is a member of the Board of Dietetics/Nutrition (“Board”) before the effective date of this Act continues after the effective date of this Act as follows:
(1) If the individual appointed as a member of the Board is a licensed dietitian/nutritionist, until the expiration of the individual’s term and the individual’s successor is appointed.
(2) If the individual appointed as a member of the Board is from the general public, until the Governor appoints an individual to succeed that individual under the requirements of Section 3 of this Act.
SYNOPSIS
This Act comprehensively amends Chapter 38 of Title 24 of the Delaware Code, the Dietitian/Nutritionist Licensure Act, to modernize the regulation of dietitians and nutritionists in this State. This Act replaces the single “licensed dietitian/nutritionist” license with 2 distinct licensure categories—“licensed dietitian” and “licensed nutritionist”—each with its own defined scope of practice, educational pathway, supervised practice requirements, examination standards, and protected professional titles. Licensed dietitians are authorized to provide medical nutrition therapy for complex and non-complex disease states and medical conditions, including in inpatient and high-acuity settings, while licensed nutritionists are authorized to provide medical nutrition therapy for non-complex conditions in low-acuity outpatient settings.
This Act updates the definitions in Chapter 38 of Title 24 to add defined terms, including “medical nutrition therapy”, “complex”, “non-complex”, “practice of dietetics”, “practice of nutrition”, “nutrition care process”, “therapeutic diet”, “qualified supervisor”, “telehealth”, and “registered dietitian”.
This Act raises the minimum educational requirement for licensed dietitian applicants from a baccalaureate degree to a master’s degree with a program accredited by the Accreditation Council for Education in Nutrition and Dietetics, increases the required supervised practice experience from 900 to 1,000 hours, and modernizes examination requirements by tying them to the Commission on Dietetic Registration. This Act establishes a parallel licensure pathway for licensed nutritionists based on a master’s or doctoral degree in nutrition with a supervised practice experience of at least 1,000 hours and passage of the certified nutrition specialist examination administered by the Board for Certification of Nutrition Specialists.
This Act amends the composition of the State Board of Dietetics/Nutrition to include 2 licensed dietitian members, 1 licensed dietitian or licensed nutritionist member, 1 Delaware-licensed physician, and 1 public member. It updates the licensure renewal section to require that continuing education hours for licensed dietitians meet the standards of the Commission on Dietetic Registration, and that continuing education hours for licensed nutritionists meet the standards of the Board for Certification of Nutrition Specialists.
This Act revises the licensure required section (§ 3810 of Title 24) to establish protected titles for both licensed dietitians and licensed nutritionists, to clarify who may engage in the practice of medical nutrition therapy, and to update the exemptions from licensure requirements. Exemptions are updated or added for students and trainees in supervised practice programs; persons providing general non-medical nutrition information; out-of-state practitioners providing services via telehealth; persons providing wellness, health coaching, and non-medical weight control services; WIC program employees; and others providing non-discretionary support activities under direct supervision.
This Act adds a new § 3813 of Title 24 establishing detailed standards for qualified supervisors of students and trainees in supervised practice experiences, and a new § 3814 of Title 24 authorizing the Board to issue provisional licenses to applicants who have completed education and supervised practice requirements but have not yet passed their licensure examination.
This Act provides that existing Delaware licensed dietitian nutritionists who hold the registered dietitian credential will be grandfathered as licensed dietitians and those who do not hold that credential will be grandfathered as licensed nutritionists, without additional requirements.
This Act also makes conforming amendments throughout Chapter 38 of Title 24 to replace outdated titles, organizational references, and scope of practice language consistent with the dual licensure structure created by this Act.
Finally, this Act makes technical corrections to conform Chapter 38 of Title 24 to the standards of the Delaware Legislative Drafting Manual.
This Act requires a greater than majority vote for passage because § 11 of Article VIII of the Delaware Constitution requires the affirmative vote of three-fifths of the members elected to each house of the General Assembly to impose or levy a tax or license fee.