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LEGISLATURE OF NEBRASKA
ONE HUNDRED EIGHTH LEGISLATURE
FIRST SESSION
LEGISLATIVE BILL 572
Introduced by Riepe, 12.
Read first time January 17, 2023
Committee: Health and Human Services
1 A BILL FOR AN ACT relating to the Medical Nutrition Therapy Practice Act;
2 to amend sections 38-1801, 38-1802, 38-1803, 38-1806, 38-1807,
3 38-1808, 38-1809, 38-1810, 38-1811, 38-1812, and 38-1816, Reissue
4 Revised Statutes of Nebraska, and section 38-1813, Revised Statutes
5 Cumulative Supplement, 2022; to provide, change, and eliminate
6 definitions; to restate intent; to change membership on a board; to
7 provide and change licensure requirements; to change provisions
8 regarding scope of practice; to harmonize provisions; to repeal the
9 original sections; and to outright repeal section 38-1804, Reissue
10 Revised Statutes of Nebraska.
11 Be it enacted by the people of the State of Nebraska,
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1 Section 1. Section 38-1801, Reissue Revised Statutes of Nebraska, is
2 amended to read:
3 38-1801 Sections 38-1801 to 38-1816 and sections 4, 7, 9, 11 to 17,
4 and 22 to 27 of this act shall be known and may be cited as the Medical
5 Nutrition Therapy Practice Act.
6 Sec. 2. Section 38-1802, Reissue Revised Statutes of Nebraska, is
7 amended to read:
8 38-1802 (1) The Legislature finds that:
9 (a) The unregulated practice of medical nutrition therapy can
10 clearly harm or endanger the health, safety, and welfare of the public;
11 (b) The public can reasonably be expected to benefit from an
12 assurance of initial and continuing professional ability; and
13 (c) The public cannot be effectively protected by a less cost-
14 effective means than state regulation of the practice of medical
15 nutrition therapy. The Legislature also finds that dietitians and
16 nutritionists medical nutrition therapists must exercise independent
17 judgment and that professional education, training, and experience are
18 required to make such judgment.
19 (2) The Legislature further finds that the practice of medical
20 nutrition therapy in the State of Nebraska is not sufficiently regulated
21 for the protection of the health, safety, and welfare of the public. It
22 declares that this is a matter of statewide concern and it shall be the
23 policy of the State of Nebraska to promote high standards of professional
24 performance by those persons representing themselves as licensed
25 dietitian nutritionists and licensed nutritionists medical nutrition
26 therapists.
27 Sec. 3. Section 38-1803, Reissue Revised Statutes of Nebraska, is
28 amended to read:
29 38-1803 For purposes of the Medical Nutrition Therapy Practice Act
30 and elsewhere in the Uniform Credentialing Act, unless the context
31 otherwise requires, the definitions found in sections 38-1805 38-1804 to
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1 38-1810 and sections 4, 7, 9, and 11 to 17 of this act apply.
2 Sec. 4. Appropriate supervision means the specific type, intensity,
3 and frequency of supervision determined by an assessment of a combination
4 of factors, which include discipline, level of education and experience
5 of the supervisee, and assigned level of responsibility.
6 Sec. 5. Section 38-1806, Reissue Revised Statutes of Nebraska, is
7 amended to read:
8 38-1806 Consultation means conferring with a physician, nurse
9 practitioner, or physician assistant regarding the provision of medical
10 nutrition therapy activities of the licensed medical nutrition therapist.
11 In the inpatient setting, consultation may be satisfied by practicing
12 under clinical privileges or following facility-established protocols. In
13 the outpatient setting, consultation may be satisfied by conferring with
14 a consulting physician or the referring primary care practitioner or
15 physician of the patient.
16 Sec. 6. Section 38-1807, Reissue Revised Statutes of Nebraska, is
17 amended to read:
18 38-1807 General nonmedical nutrition information means information
19 on any of the following:
20 (1) Principles of good nutrition and food preparation;
21 (2) Food that should be included in the normal diet;
22 (3) Essential nutrients needed by the human body;
23 (4) Recommended amounts of essential nutrients required by the human
24 body;
25 (5) Actions of nutrients in the human body; and
26 (6) Food and supplements that are good sources of essential
27 nutrients required by the human body.
28 General nutrition services includes, but is not limited to:
29 (1) Identifying the nutritional needs of individuals and groups in
30 relation to normal nutritional requirements; and
31 (2) Planning, implementing, and evaluating nutrition education
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1 programs for individuals and groups in the selection of food to meet
2 normal nutritional needs throughout the life cycle.
3 Sec. 7. General supervision for the purpose of post-degree clinical
4 practice experience means the qualified supervisor is onsite and present
5 at the location where nutrition-care services are provided or is
6 immediately available by means of electronic communications to the
7 supervisee providing the services and both maintains continued
8 involvement in the appropriate aspects of patient care and has primary
9 responsibility for all nutrition-care services rendered by the
10 supervisee.
11 Sec. 8. Section 38-1808, Reissue Revised Statutes of Nebraska, is
12 amended to read:
13 38-1808 Licensed dietitian nutritionist medical nutrition therapist
14 means a person who is licensed to practice medical nutrition therapy
15 pursuant to the Uniform Credentialing Act and who holds a current license
16 issued by the department pursuant to section 38-1813 the Medical
17 Nutrition Therapy Practice Act.
18 Sec. 9. Licensed nutritionist means a person who is licensed to
19 practice medical nutrition therapy pursuant to the Uniform Credentialing
20 Act and who holds a current license issued by the department pursuant to
21 section 22 of this act.
22 Sec. 10. Section 38-1809, Reissue Revised Statutes of Nebraska, is
23 amended to read:
24 38-1809 Medical nutrition therapy means the assessment of the
25 nutritional status of patients and the provision of the following
26 nutrition-care services for the treatment or management of a disease or
27 medical condition by: assessment of the nutritional status of patients.
28 Medical nutrition therapy involves the assessment of patient nutritional
29 status followed by treatment, ranging from diet modification to
30 specialized nutrition support, such as determining nutrient needs for
31 enteral and parenteral nutrition, and monitoring to evaluate patient
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1 response to such treatment.
2 (1) Assessing and evaluating the nutritional needs of people and
3 groups and determining resources and constraints in the practice setting,
4 including ordering laboratory tests to check and track nutrition status,
5 creating dietary plans and orders, and monitoring the effectiveness of
6 such plans and orders;
7 (2) Establishing priorities, goals, and objectives that meet
8 nutritional needs and are consistent with available resources and
9 constraints;
10 (3) Providing nutrition counseling; and
11 (4) Ordering therapeutic diets.
12 Sec. 11. Nutrition-care services means any or all of the following
13 services provided within a systematic process:
14 (1) Assessing and evaluating the nutritional needs of people and
15 groups and determining resources and constraints in the practice setting,
16 including ordering laboratory tests to check and track nutrition status,
17 creating dietary plans and orders, and monitoring the effectiveness of
18 such plans and orders;
19 (2) Establishing priorities, goals, and objectives that meet
20 nutritional needs and are consistent with available resources and
21 constraints;
22 (3) Providing nutrition counseling, including in health and disease;
23 (4) Developing, implementing, and managing nutrition-care systems;
24 (5) Evaluating, changing, and maintaining appropriate standards of
25 quality in food and nutrition services; and
26 (6) Ordering therapeutic diets.
27 Sec. 12. Nutrition counseling means a supportive process,
28 characterized by a collaborative counselor-patient or counselor-client
29 relationship with individuals or groups, to establish food and nutrition
30 priorities, goals, and individualized action plans and general physical
31 activity guidance that acknowledge and foster responsibility for self-
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1 care to treat or mange an existing disease or medical condition or to
2 promote health and wellness.
3 Sec. 13. Practice of dietetics and nutrition means the integration
4 and application of scientific principles derived from the study of food,
5 nutrition, biochemistry, metabolism, nutrigenomics, physiology, food
6 management, and behavioral and social sciences in achieving and
7 maintaining health throughout the life span and in providing nutrition
8 care in person or by telehealth, including medical nutrition therapy, for
9 the purpose of disease management and prevention, or to treat or
10 rehabilitate an illness, injury, or condition. The primary functions of
11 the practice of dietetics and nutrition are the provision of medical
12 nutrition therapy for the purpose of disease management or to treat or
13 rehabilitate an illness, injury, or condition and the provision of other
14 nutrition-care services for health and wellness and as primary prevention
15 of chronic disease.
16 Sec. 14. Primary care practitioner means a physician licensed
17 pursuant to section 38-2026 or sections 38-2029 to 38-2033 who provides
18 primary care services, a nurse practitioner licensed pursuant to section
19 38-2317 who provides primary care services, or a physician assistant
20 licensed pursuant to section 38-2049 who provides primary care services
21 under a collaborative agreement with the supervision of a physician.
22 Sec. 15. (1) Qualified supervisor means:
23 (a) When supervising the provision of medical nutrition therapy by a
24 person who is completing post-degree clinical practice experience, a
25 person who either:
26 (i) Is a licensed dietitian nutritionist, a licensed nutritionist,
27 or a health care provider licensed in any state or territory, including
28 licensed or certified dietitian nutritionists and licensed nutritionists,
29 whose scope of practice includes the provision of medical nutrition
30 therapy; or
31 (ii) In the case of a person in a state that does not provide for
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1 such licensure or certification, meets such other criteria as the board
2 may establish, including by a registered dietitian nutritionist or a
3 certified nutrition specialist, or is a health care provider authorized
4 in another state or territory to provide medical nutrition therapy; and
5 (b) When supervising the provision of nutrition-care services that
6 does not constitute medical nutrition therapy, a person who:
7 (i) Meets the qualifications of subdivision (1)(a) of this section;
8 or
9 (ii) Has worked in the field of clinical nutrition for at least
10 three of the last five years immediately preceding commencement of the
11 applicant's supervised practice experience and holds a master's or
12 doctoral degree with a major course of study in dietetics, human
13 nutrition, foods and nutrition, clinical nutrition, applied clinical
14 nutrition, community nutrition, public health nutrition, naturopathic
15 medicine, nutrition education, nutrition counseling, nutrition science,
16 nutrition and functional medicine, nutritional biochemistry, or nutrition
17 and integrative health, or an equivalent course of study as approved by
18 the board.
19 (2) In order to qualify as a qualified supervisor in Nebraska, a
20 supervisor obtaining a doctoral degree outside the United States or its
21 territories shall have such degree validated by the board as equivalent
22 to the doctoral degree conferred by an accredited college or university
23 in the United States or its territories.
24 (3) A qualified supervisor shall be licensed under the Uniform
25 Credentialing Act to provide medical nutrition therapy if supervising an
26 applicant providing medical nutrition therapy to a person in this state.
27 Sec. 16. Registered dietitian or registered dietitian nutritionist
28 means a person who is currently registered as a registered dietitian or a
29 registered dietitian nutritionist by the Commission on Dietetic
30 Registration of the Academy of Nutrition and Dietetics or a similar
31 successor entity approved by the department.
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1 Sec. 17. Therapeutic diet means a diet intervention prescribed by a
2 physician or other health care professional that provides food or
3 nutrients via oral, enteral, or parenteral routes as part of the
4 treatment of a disease or diagnosed clinical condition to modify,
5 eliminate, decrease, or increase identified micronutrients or
6 macronutrients in the diet or to provide mechanically altered food when
7 indicated.
8 Sec. 18. Section 38-1810, Reissue Revised Statutes of Nebraska, is
9 amended to read:
10 38-1810 Patient means an individual recipient of medical nutrition
11 therapy, whether in the outpatient or inpatient setting a person with a
12 disease, illness, injury, or medical condition for which nutritional
13 interventions are an essential component of standard care.
14 Sec. 19. Section 38-1811, Reissue Revised Statutes of Nebraska, is
15 amended to read:
16 38-1811 (1) The board shall consist of three professional members,
17 one physician, and one public member appointed pursuant to section 38-158
18 until December 1, 2023.
19 (2) Beginning on December 1, 2023, the board shall consist of five
20 members as follows: Three professional members, of which one shall be a
21 licensed nutritionist or a licensed dietitian nutritionist and two shall
22 be licensed dietitian nutritionists; one physician; and one public
23 member.
24 (3) The members shall meet the requirements of sections 38-164 and
25 38-165.
26 Sec. 20. Section 38-1812, Reissue Revised Statutes of Nebraska, is
27 amended to read:
28 38-1812 No person shall practice medical nutrition therapy unless he
29 or she is licensed for such purpose pursuant to the Uniform Credentialing
30 Act. The practice of medical nutrition therapy shall be provided with the
31 consultation of a physician licensed pursuant to section 38-2026 or