PRINTER'S NO. 4256
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2721
Session of
2018
INTRODUCED BY MEHAFFIE, BARRAR, WATSON, CHARLTON, DRISCOLL,
KAUFER, PICKETT, CARROLL, RAVENSTAHL, HELM, SCHWEYER, FRITZ,
R. BROWN, PASHINSKI, STURLA, DALEY, MULLERY AND ENGLISH,
OCTOBER 16, 2018
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE,
OCTOBER 16, 2018
AN ACT
Amending the act of May 22, 1951 (P.L.317, No.69), entitled "An
act relating to the practice of professional nursing;
providing for the licensing of nurses and for the revocation
and suspension of such licenses, subject to appeal, and for
their reinstatement; providing for the renewal of such
licenses; regulating nursing in general; prescribing
penalties and repealing certain laws," further providing for
definitions, for State Board of Nursing, for dietitian-
nutritionist license required, for examinations and
certificates, for fees and qualifications for licensure, for
persons entitled to practice, for licenses and durations and
renewal fee and inactive status, for reporting of multiple
licensure, for setting of fees and disposition of fees, fines
and civil penalties, for continuing nursing education, for
punishment for violations, for refusal, suspension or
revocation of licenses and for injunction or other process.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2(5), (7), (9) and (10) of the act of May
22, 1951 (P.L.317, No.69), known as The Professional Nursing
Law, are amended and the section is amended by adding paragraphs
to read:
Section 2. Definitions.--When used in this act, the
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following words and phrases shall have the following meanings
unless the context provides otherwise:
* * *
(5) "Treating" means selection and performance of those
therapeutic measures essential to the effective execution and
management of the nursing or dietetics and nutrition regimen,
and execution of the prescribed medical regimen.
* * *
(7) The ["Practice of dietetics-nutrition"] "Practice of
dietetics and nutrition" means the integration and application
of principles derived from the sciences of food nutrition,
biochemistry, physiology, management and behavior to provide for
all aspects of nutrition therapy for individuals and groups,
including nutrition therapy services and medical nutrition
therapy, compatible with dietitian-nutritionist education and
professional competence.
* * *
(9) ["Licensed dietitian-nutritionist"] "Licensed dietitian
nutritionist" means a [dietitian-nutritionist] dietitian
nutritionist who holds a current license under this act and is
qualified to provide dietetics and nutrition services, including
medical nutrition therapy. The term does not include an
individual who engages in the medical differential diagnosis of
the health status of an individual.
[(10) "Medical nutrition therapy" means the component of
nutrition therapy that concerns determining and recommending
nutrient needs based on nutritional assessment and medical
problems relative to diets prescribed by a licensed physician,
including:
(i) tube feedings;
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(ii) specialized intravenous solutions;
(iii) specialized oral solutions; and
(iv) interactions of prescription drugs with food or
nutrients.]
* * *
(16) "Board for Certification of Nutrition Specialists"
means the board that is accredited by the National Commission
for Certifying Agencies to certify nutrition specialists and
nutrition specialist-scholar credentials.
(17) "Commission on Dietetic Registration" means the
commission accredited by the National Commission for Certifying
Agencies to be the credentialing agency for the Academy of
Nutrition and Dietetics.
(18) "Dietetics" means the integration, application and
communication of practice principles derived from food,
nutrition, social, business and basic sciences to achieve and
maintain the optimal nutrition status of an individual.
(19) "Dietitian" or "dietitian nutritionist" means an
individual licensed under this act who may be referred to as a
nutritionist, a dietitian nutritionist or a dietician.
(20) "Family or household members" means a parent, child,
spouse, former spouse, an individual related by consanguinity or
affinity, a current or former sexual or intimate partner or an
individual who shares biological parenthood.
(21) "General nonmedical nutrition information" means
information on any of the following:
(i) Principles of good nutrition and food preparation.
(ii) Food that should be included in the normal daily diet.
(iii) The essential nutrients needed by the human body.
(iv) The recommended amounts of the essential nutrients.
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(v) The actions of nutrients in the human body.
(vi) The effects of deficiencies or excesses of nutrients.
(vii) Food and supplements that are good sources of
essential nutrients.
(22) "Medical nutrition therapy" means the use of the
nutrition care process and specific nutrition services for the
purpose of disease management and to treat or rehabilitate an
illness, injury or condition. The term includes the use of the
all of the following services:
(i) Interpreting anthropometric, biochemical, clinical and
dietary data in acute and chronic disease states and
recommending or ordering nutrient needs based on the data,
including, but not limited to, tube feedings and parenteral
nutrition.
(ii) Food and nutrient counseling regarding prescription
drug interactions.
(iii) Developing and managing food service operations with
the primary functions of nutrition care and ordering therapeutic
diets.
(23) "Nutrition" means the science of food and nutrients,
including the action, interaction and balance of food and
nutrients in relation to health and disease and the process by
which humans ingest, absorb, transport, utilize and excrete food
substances.
(24) "Nutrition assessment" means all of the following:
(i) The evaluation of an individual for nutritional status
through a systematic process of obtaining, verifying and
interpreting biochemical, anthropometric, physical and dietary
data to make decisions about the nature and cause of nutrition-
related problems.
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(ii) The reassessment and analysis of dietary data to
determine the foundation for nutrition diagnosis and nutritional
recommendations, including enteral and parenteral nutrition.
(25) "Nutrition care" means the services that a patient
receives during the nutrition care process.
(26) "Nutrition care process" means the systematic methods
which a licensed dietitian nutritionist uses to make decisions
when providing medical nutrition therapy or addressing
nutrition-related problems, including nutrition assessment,
nutrition diagnosis, nutrition intervention and nutrition
monitoring and evaluation.
(27) "Nutrition diagnosis" means identifying and labeling
nutritional problems managed and treated by a licensed dietitian
nutritionist.
(28) "Nutrition intervention" means purposefully planned
actions and counseling intended to positively change a
nutrition-related behavior, risk factor, environmental condition
or aspect of the health status for an individual.
(29) "Nutrition monitoring and evaluation" means identifying
patient outcomes relevant to the nutrition diagnosis and
comparing the outcomes with the patient's previous health
status, intervention goals or reference standards to determine
the progress made in achieving desired outcomes of nutrition
care and whether planned interventions should be continued or
revised.
(30) "Nutritionist" means a licensed dietitian nutritionist,
dietitian or dietitian nutritionist.
(31) "Registered dietitian" or "registered dietitian
nutritionist" means a dietitian nutritionist registered with the
Commission on Dietetic Registration.
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(32) "Therapeutic diet" A diet intervention prescribed by
an authorized licensed practitioner that provides food or
nutrients via oral, enteral or parenteral routes as part of a
treatment for a disease or clinical condition to modify,
eliminate, decrease or increase identified micronutrients and
macronutrients in the diet.
Section 2. Section 2.1(a) of the act is amended to read:
Section 2.1. State Board of Nursing.--(a) The State Board
of Nursing shall consist of the Commissioner of Professional and
Occupational Affairs, three members appointed by the Governor,
with the advice and consent of a majority of the members elected
to the Senate, who shall be persons representing the public at
large, and nine members appointed by the Governor, with the
advice and consent of a majority of the members elected to the
Senate, six of whom shall be registered nurses, graduated from
schools of nursing where practical and theoretical instruction
is given, at least three of whom shall possess Masters' degrees
in nursing, two of whom shall be licensed practical nurses and
one of whom shall be a licensed [dietitian-nutritionist]
dietitian nutritionist, and all of whom shall have been engaged
in nursing or the practice of [dietetics-nutrition] dietetics
and nutrition in this Commonwealth for the five-year period
immediately preceding appointment. The [dietitian-nutritionist]
dietitian nutritionist member of the board initially appointed
need not be licensed by the licensure examination adopted by the
board but, at the time of appointment, must have satisfied the
education and experience requirements of this act for licensure
as a [dietitian-nutritionist] dietitian nutritionist. In making
appointments to the Board, the Governor shall give due
consideration to providing representation from diversified
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fields of nursing or [dietetics-nutrition] dietetics and
nutrition, including, but not limited to, specialized nurses or
[dietitian-nutritionists] dietitian nutritionists of all types.
The persons representing the public at large may not have a
financial interest in the provision of goods and services for
[dietitian-nutritionists] dietitian nutritionists and may not be
a [dietitian-nutritionist] dietitian nutritionist or have a
household member who is a [dietitian-nutritionist] dietitian
nutritionist.
* * *
Section 3. Section 3.1 heading and (a) of the act are
amended and the section is amended by adding subsections to
read:
Section 3.1. [Dietitian-Nutritionist] Dietitian Nutritionist
License Required.--(a) [It shall be unlawful for any individual
to hold himself or herself forth as a licensed dietitian-
nutritionist unless he or she shall first have obtained a
license pursuant to this act. Only individuals who have received
licenses as licensed dietitian-nutritionists pursuant to this
act may use the letters "L.D.N." in connection with their
names.] It shall be unlawful for an individual who is not
licensed under this act to engage in any of the following
actions:
(1) Practice dietetics and nutrition or provide medical
nutrition therapy or other nutrition care.
(2) Use the title or an abbreviation of the title of
"dietitian," "dietician," "dietitian nutritionist,"
"nutritionist," "licensed dietitian nutritionist" or "LDN".
(3) Hold oneself out as a dietitian, dietician, dietitian
nutritionist or nutritionist.
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(4) Imply that the individual is authorized to provide
medical nutrition therapy.
* * *
(c) A licensed dietitian nutritionist may engage in any of
the following practices:
(1) Medical nutrition therapy.
(2) The nutrition care process, including nutrition
assessment, nutrition diagnosis, nutrition or diet intervention
and nutrition monitoring and evaluation.
(3) Dietetics and nutrition.
(4) Nutrition and diet counseling.
(5) Therapeutic diet initiation and counseling.
(6) Diet orders and counseling authorized by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services.
(7) Telehealth services in accordance with the laws of this
Commonwealth.
(d) Subsection (a)(1) shall not apply to the following
individuals:
(1) A licensed health care professional who is acting within
the scope of the individual's licensed profession.
(2) A student working under the direct supervision of a
licensed dietitian nutritionist to satisfy the requirements for
licensure as a dietitian nutritionist under this act.
(3) An individual who has completed the educational and
pre-professional experiential requirements as specified by the
Commission on Dietetic Registration or Board for Certification
of Nutrition Specialists and has not received notice of passing
the examinations required to apply for licensure as a dietitian
nutritionist under this act. An individual who meets the
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criteria under this paragraph may practice under the supervision
of a licensed dietitian nutritionist for no more than one year.
(4) A dietitian nutritionist or nutritionist serving in the
United States Armed Forces, United States Public Health Service
or United States Department of Veterans Affairs when performing
duties associated with the service.
(5) An employee of the Commonwealth, a local political
subdivision or a local school administrative unit or an
individual who contracts with the Commonwealth, a local
political subdivision or a local school administrative unit who
is engaged in the practice of dietetics or nutrition within the
scope of the employment or contract.
(6) A retailer who furnishes general nonmedical nutrition
information to customers on food, food materials, dietary
supplements and other goods sold at his or her retail
establishment with the marketing and distribution of those goods
at his or her retail establishment.
(7) An individual who provides weight control services if
the services, including changes to services, are being reviewed
and approved by any of the following:
(i) A licensed dietitian nutritionist under this act or
other licensed independent practitioner.
(ii) A dietitian nutritionist licensed or certified in
another state that has licensure or certification requirements
which are equivalent to the requirements under this act.
(iii) A dietitian nutritionist registered by the Commission
on Dietetic Registration or certified by the Board for
Certification of Nutrition Specialist.
(8) An individual who provides nutrition care without
remuneration to family or household members.
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Section 4. Section 5(b), (c) and (e) of the act are amended
to read:
Section 5. Examinations and Certificates.--* * *
(b) The Board may admit to examination any person who has
satisfactorily completed an approved nursing education program
for the preparation of registered professional nurses or an
approved [dietetics-nutrition] dietetics and nutrition
education program in Pennsylvania or such a program in any other
state, territory or possession of the United States, considered
by the Board to be equivalent to that required in this
Commonwealth at the time such program was completed, and who
meets the requirements of character and preliminary education.
(c) The Board may admit to examination any person who has
satisfactorily completed a nursing education program for the
preparation of registered professional nurses or an approved
[dietetics-nutrition] dietetics and nutrition education program
in a country or territory not mentioned above who has been
licensed, registered, or duly recognized there as a professional
nurse, dietitian-nutritionist, dietitian or nutritionist
provided such a program is considered by the Board to be equal
to that required in this Commonwealth at the time such program
was completed and who meets the requirements of character and
preliminary education.
* * *
(e) A person who meets the requirements of section 6 and
who, in addition, has been engaged in the practice of
[dietetics-nutrition] dietetics and nutrition for a period of
five (5) years during the seven (7) years immediately preceding
the effective date of this subsection or a person who provides
evidence of current registration as a registered [dietitian-
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nutritionist] dietitian nutritionist by the Commission [of
Dietetic Registration of the American Dietetic Association] on
Dietetic Registration shall be considered to meet the
requirements of this act. This person shall be licensed without
the necessity of taking the examination if an application is
made to the Board within one (1) year of the effective date of
this subsection and the appropriate fee is paid.
Section 5. Section 6(b) of the act is amended and the
section is amended by adding a subsection to read:
Section 6. Fees; Qualifications for Licensure.--* * *
(b) [An] Except as specified under subsection (b.1), an
applicant applying for licensure as a [dietitian-nutritionist]
dietitian nutritionist shall submit a written application on
forms provided by the Board evidencing and insuring to the
satisfaction of the Board that the applicant:
(1) Is of good moral character.
(2) Has received a baccalaureate or higher degree from a
Board-approved, regionally accredited college or university,
including a major course of study in human nutrition, food and
nutrition, dietetics or food systems management.
(3) Has completed a planned continuous [preprofessional]
pre-professional experience component in dietetic practice of
not less than nine hundred (900) hours under the supervision of
a [registered dietitian, a dietitian-nutritionist] dietitian
nutritionist licensed under this act or an individual with a
doctoral degree conferred by a regionally accredited college or
university in the United States with a major course of study in
human nutrition, food and nutrition, nutrition education,
dietetics or food systems management as approved by the Board.
(4) Has satisfactorily completed [an examination] a
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registration examination for dietitians prescribed by the
Commission on Dietetic Registration or the certification
examination for nutrition specialists prescribed by the Board
for Certification of Nutrition Specialist as approved by the
Board. [The Board shall contract with a professional testing
organization for the examination of qualified applicants for
licensure.] All written, oral and practical examinations shall
be prepared and administered by a qualified and approved
professional testing organization in the manner prescribed for
written examinations by section 812.1 of the act of April 9,
1929 (P.L.177, No.175), known as "The Administrative Code of
1929."
(b.1) An applicant of good moral character shall not be
required to satisfy the requirements under subsection (b) if the
applicant is a registered dietitian nutritionist or registered
dietitian with the Commission on Dietetic Registration and
authorized to use the letters "RDN" or "RD" to indicate that the
applicant is a registered dietitian nutritionist or registered
dietitian.
Section 6. Sections 8(b), 11(c) and 11.1 of the act are
amended to read:
Section 8. Persons Entitled to Practice.--* * *
(b) The Board shall issue to each person who meets the
[dietitian-nutritionist] dietitian nutritionist licensure
requirements of this act a certificate setting forth that such
person is licensed as a [dietitian-nutritionist] dietitian
nutritionist and entitled to use the title ["licensed dietitian-
nutritionist"] "licensed dietitian nutritionist" and the letters
["L.D.N."] LDN and authorized to practice dietetics and
nutrition and medical nutrition therapy. A record of all persons
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licensed as [dietitian-nutritionists] dietitian nutritionists in
this Commonwealth shall be kept in the office of the Board and
shall be open to public inspection and copying upon payment of a
nominal fee for copying the record.
Section 11. Licenses; Duration; Renewal Fee; Inactive
Status.--* * *
(c) A [dietetics-nutrition] dietitian nutritionist license
issued under this act shall not be renewed unless the licensee
applying for renewal submits proof to the Board that during the
two (2) calendar years immediately preceding the application for
renewal the licensee has satisfactorily completed a minimum of
thirty (30) hours of continuing [dietetic-nutrition] dietetic
and nutrition education approved by the Board by regulation.
Section 11.1. Reporting of Multiple Licensure.--Any licensed
professional nurse or [dietitian-nutritionist] dietitian
nutritionist of this Commonwealth who is also licensed to
practice nursing or [dietetics-nutrition] dietetics and
nutrition in any other state, territory, possession or country
shall report this information to the Board on the biennial
registration application. Any disciplinary action taken in other
states shall be reported to the Board on the biennial
registration application or within ninety (90) days of final
disposition, whichever is sooner. Multiple licensure shall be
noted by the Board on the licensee's record, and such state,
territory, possession or country shall be notified by the Board
of any disciplinary actions taken against said licensee in this
Commonwealth.
Section 7. Section 11.2 of the act is amended by adding a
subsection to read:
Section 11.2. Setting of Fees and Disposition of Fees, Fines
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and Civil Penalties.--* * *
(e) A member of the United States Armed Forces or the
member's spouse who is licensed as a dietitian nutritionist in
another state that has licensing requirements equivalent to the
requirements under this act may be licensed as a dietitian
nutritionist in this Commonwealth by providing a proof of
licensure in the other state as determined by regulations
promulgated by the board. An individual who qualifies for
licensure in this Commonwealth under this subsection shall be
exempt from paying the initial licensure application fee. An
individual residing in a state that does not have license
requirements for a dietitian nutritionist shall apply for
licensure in this Commonwealth as specified by this act and
shall be exempt from paying the initial licensure application
fee.
Section 8. Sections 12.1(g)(1), 13(b), 14(a)(1), (2.1), (4),
(b) introductory paragraph and (6) and 15.4 of the act are
amended to read:
Section 12.1. Continuing Nursing Education.--* * *
(g) In lieu of meeting the requirements of this section:
(1) Certified registered nurse practitioners and
[dietetics-nutrition] dietitian nutritionist licensees shall
fulfill the requirements for continuing education in
accordance with sections 8.1 and 11, respectively.
* * *
Section 13. Punishment for Violations.--* * *
(b) In addition to any other civil remedy or criminal
penalty provided for in this act, the Board, by a vote of the
majority of the maximum number of the authorized membership of
the Board as provided by law or by a vote of the majority of the
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duly qualified and confirmed membership or a minimum of five (5)
members, whichever is greater, may levy a civil penalty of up to
one thousand dollars ($1,000) on any current licensee who
violates any provision of this act or on any person who
practices nursing or holds himself or herself forth as a
licensed [dietitian-nutritionist] dietitian nutritionist,
dietitian, nutritionist or other individual qualified to
practice dietetics or medical nutrition therapy without being
properly licensed to do so under this act or on the responsible
officers or employes of any corporation, copartnership,
institution or association violating any of the provisions of
this act. The Board shall levy this penalty only after affording
the accused party the opportunity for a hearing, as provided in
Title 2 of the Pennsylvania Consolidated Statutes (relating to
administrative law and procedure).
Section 14. Refusal, Suspension or Revocation of Licenses.--
(a) The Board may refuse, suspend or revoke any license in any
case where the Board shall find that--
(1) The licensee is on repeated occasions negligent or
incompetent in the practice of professional nursing or
[dietetics-nutrition] dietetics and nutrition.
* * *
(2.1) The licensee is unable to practice [dietetics-
nutrition] dietetics and nutrition with reasonable skill and
safety to individuals or groups by reason of mental or physical
illness or condition or physiological or psychological
dependence upon alcohol, hallucinogenic or narcotic drugs or
other drugs which tend to impair judgment or coordination so
long as such dependence shall continue. In enforcing this clause
(2.1), the Board shall upon probable cause have authority to
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compel a licensee to submit to a mental or physical examination
as designated by it. After notice, hearing, adjudication and
appeal as provided for in section 15, failure of a licensee to
submit to such examination when directed shall constitute an
admission of the allegations against him or her unless failure
is due to circumstances beyond his or her control, consequent
upon which a default and final order may be entered without the
taking of testimony or presentation of evidence. A licensee
affected under this paragraph shall at reasonable intervals be
afforded an opportunity to demonstrate that he or she can resume
a competent practice of [dietetics-nutrition] dietetics and
nutrition with reasonable skill and safety to individuals or
groups.
* * *
(4) The licensee has committed fraud or deceit in:
(i) the practice of nursing, or in securing his or her
admission to such practice or nursing school; or
(ii) the practice of [dietetics-nutrition] dietetics and
nutrition or in securing his or her license as a [dietitian-
nutritionist] dietitian nutritionist.
* * *
(b) When the Board finds that the license of any nurse or
[dietitian-nutritionist] dietitian nutritionist may be refused,
revoked or suspended under the terms of subsection (a), the
Board may:
* * *
(6) Restore or reissue, in its discretion, a suspended
license to practice professional or practical nursing or
[dietetics-nutrition] dietetics and nutrition and impose any
disciplinary or corrective measure which it might originally
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have imposed.
Section 15.4. Injunction or Other Process.--It shall be
unlawful for any person to practice or attempt to offer to
practice nursing or practice or attempt to offer to practice
dietetics and nutrition or hold himself or herself forth as a
licensed [dietitian-nutritionist] dietitian nutritionist, as
defined in this act, without having at the time of so doing a
valid, unexpired, unrevoked and unsuspended license issued under
this act. The unlawful practice of nursing as defined in this
act may be enjoined by the courts on petition of the Board or
the Commissioner of Professional and Occupational Affairs. In
any such proceeding, it shall not be necessary to show that any
person is individually injured by the actions complained of. If
it is determined that the respondent has engaged in the unlawful
practice of nursing or the unlawful practice of dietetics and
nutrition, the court shall enjoin him or her from so practicing
unless and until he or she has been duly licensed. Procedure in
such cases shall be the same as in any other injunction suit.
The remedy by injunction hereby given is in addition to any
other civil or criminal prosecution and punishment.
Section 9. This act shall take effect in 60 days.
20180HB2721PN4256 - 17 -
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