NORTH CAPITOL ST NE ND FLR WASHINGTON DC March 8, 2018 … · Board of Dietetics and Nutrition...
Transcript of NORTH CAPITOL ST NE ND FLR WASHINGTON DC March 8, 2018 … · Board of Dietetics and Nutrition...
Board of Dietetics and Nutrition Meeting Agenda – March 8, 2018 Page 1
Government of the District of Columbia
Department of Health
Board of Dietetics and Nutrition
899 NORTH CAPITOL ST. NE – 2ND FLR.
WASHINGTON, DC 20002
March 8, 2018
9:00 am - 11:00 pm
MEETING AGENDA
Board of Dietetics and Nutrition Meeting Agenda – March 8, 2018 Page 2
OPEN SESSION: Call to Order
OS-0308-01 EXECUTIVE DIRECTOR’S REPORT
OS-0308-02 BOARD ATTORNEY’S REPORT
OS-0308-03 CHAIRPERSON’S REPORT
OS-0308-04
OPEN SESSION MINUTES Board Action: To consider the Open Session Minutes of the January 17, 2018 meeting.
OS-0308-05 UPDATE ON REGULATIONS Board Action: To discuss the recommended amendments to the Nutrition regulations.
Upon conclusion of the open session meeting pursuant to
the DC Official Code 2-575(b) and for the purposes set forth
therein, the Board will move into the closed executive
session portion of the meeting to consult with the Board
attorney, discuss disciplinary matters and hear reports
concerning violations of the law or regulations.
Government of the District of Columbia
Department of Health
BOARD OF DIETETICS/NUTRITION
1
OPEN SESSION MINUTES 899 NORTH CAPITOL ST. NE
ROOM 216 WASHINGTON, DC 20002
January 17, 2018 1:30pm-3:30pm
Government of the District of Columbia
Department of Health
BOARD OF DIETETICS/NUTRITION
2
OPEN SESSION MINUTES JANUARY 17, 2018
ATTENDANCE:
BOARD MEMBERS:
DR. ANNINA BURNS, CHAIRPERSON PRESENT
KIMBERLY THOMPSON, BOARD MEMBER PRESENT
STAFF:
ROBIN JENKINS, EXECUTIVE DIRECTOR, BOARDS
OF ALLIED AND BEHAVIORAL HEALTH
PRESENT
ERIC YEAGER, HEALTH LICENSING SPECIALIST PRESENT
REBECCA ODRICK , INVESTIGATOR PRESENT
PANRAVEE VONGJAROENRAT, ESQ., BOARD
ATTORNEY PRESENT
VISITORS FRANK MEYERS, ESQ., EXECUTIVE DIRECTOR, PRESENT
D.C. BOARD OF MEDICINE
The Open Session MINUTES begin on the next page.
Government of the District of Columbia
Department of Health
BOARD OF DIETETICS/NUTRITION
3
OPEN SESSION MINUTES JANUARY 17, 2018
OS-0117-01 SENIOR DEPUTY DIRECTOR’S REPORT Board Action: There was no report.
OS-0117-02 EXECUTIVE DIRECTOR’S REPORT Board Action: There was no report.
OS-0117-03 BOARD ATTORNEY’S REPORT Board Action: There was no report.
OS-0117-04 BOARD CHAIRPERSON’S REPORT Board Action: There was no report.
OS-0117-05 OPEN SESSION MINUTES
Board Action: The Open Session Minutes of the December 14,
2017 meeting were approved.
OS-0117-06 UPDATE ON REGULATIONS
Board Action: The Board discussed the proposed updates and
amendments recommended by the subcommittee and focused
on the areas of telepractice. The Board will continue the review
at the next meeting.
Government of the District of Columbia
Department of Health
BOARD OF DIETETICS/NUTRITION
4
The next meeting is scheduled for 9:00 a.m. on June 14, 2018.
DISTRICT OF
COLUMBIA
MUNICIPAL
REGULATIONS
for
NUTRITION
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 2
CHAPTER 45 NUTRITION Secs. 4500 General Provision 4501 Term of License 4502 Educational and Training Requirements 4503 Applicants Educated in Foreign Countries 4504 Supervised Practice by Students and Graduates 4505 CDR Exam 4506 Continuing Education Requirements 4507 Approved Continuing Education Programs and Activities 4508 Continuing Education Credits 4599 Definitions 4500 GENERAL PROVISIONS
4500.1 This chapter shall apply to applicants for and holders of a license to practice
nutrition.
4500.2 Chapters 40 (Health Occupations: General Rules), 41 (Health Occupations:
Administrative Procedures), and 44 (Dietetics) of this title shall supplement this
chapter.
4501 TERM OF LICENSE
4501.1 Subject to § 4501.2, a license issued pursuant to this chapter shall expire at 12:00
midnight on November 1st
of each odd-numbered year.
4501.2 If the Director changes the renewal system pursuant to § 4006.3 of Chapter 40 of
this title, a license issued pursuant to this chapter shall expire at 12:00 midnight of
the last day of the month of the birthdate of the holder of the license, or other date
established by the Director.
4502 EDUCATIONAL AND TRAINING REQUIREMENTSQUALIFICATION
FOR LICENSURE
4502.1 Except as otherwise provided in this subtitlechapter, an applicant shall furnish
proof satisfactory to the Board, in accordance with § 701(c) of the Act, D.C.
Official Code § 3-1207.01(c) (2001), of one of seeking to qualify for a license to
practice nutrition shall possess the following:
(a) That the applicant holds aA baccalaureate or higher degree, with a major
in human nutrition, foods and nutrition, dietetics, or food systems
management;
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 3
(b) That the applicant holds aA baccalaureate or higher degree with a major in
a course of study found by the Board to be equivalent to one of the courses
of study listed in paragraph (a) of this subsection; or
(c) That the applicant has completed other training, approved by the Board,
which is substantially equivalent to the requirements of paragraphs (a) and
(b)of this subsection and
(c) At least nine hundred (900) hours of supervised practice experience
meeting the requirements of § 4502.3; and
(d) Passage of one of the following examinations:
(1) Certification Examination for Nutrition Specialists offered by the
Board for Certification of Nutrition Specialists (BCNS);
(2) Registration Examination for Dietitians offered by the Commission
on Dietetic Registration (CDR); or
(3) Certification Examination for a Diplomate of the American
Clinical Board of Nutrition (DACBN)..
4502.2 A Ddegrees required in §§ 4502.1(a) and or (b) shall have been received obtained
from an academic institution that was approved by the appropriate accrediting
body recognized by the Council on Postsecondaryfor Higher Education
Accreditation or the United States Department of Education at the time the degree
was conferred.
4502.3 An applicant shall submit a certified transcript of the applicant’s educational
record(s) and an official certificate of graduation to the Board with the completed
application.
4502.34 Except as provided in §§ 4502.64, 4502.5, 4503.6, and 4502.7, 4502.8, and
4502.9, a supervised practice experience required in § 4502.1(d) shall n applicant
shall furnish proof satisfactory to the Board that the applicant has completed
preprofessional experience which meets the following requirements:
(a) The applicant practiced dietetic or nutrition for at least nine hundred (900)
hours under the supervision of a supervisor approved in accordance with §
4504;The experience was obtained in a dietetic or nutrition program
approved by the Board;
(b) The program was under the direction of a registered dietitian or nutritionist
licensed or authorized to practice dietetics or nutrition in the United States;
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 4
(c) The experience consisted of a minimum of nine hundred (900) hours
completed over a period of not less than twenty-two (22) weeks and not
more than forty-five (45) weeks;
(db) At least one (1) hour per week forty (40) hours of experience was under
the immediate supervision of a registered dietitian or nutritionist the
approved supervisor and the remaining experience was under the general
supervision of a registered dietitian or nutritionistthe supervisor; and
(ce) The applicant’s performance was rated as at least satisfactory.
4502.5 An applicant under this section shall demonstrate the experience listed under §
4502.4 by submitting with the application a statement from each supervisor
during the required period of supervision, on the prescribed form, which sets forth
the following:
(a) Locations and time periods of the training;
(b) Hours of supervised practice;
(c) Nature of practice;
(d) Performance rating; and
(e) The supervisor’s license number, if any, and jurisdiction in which
authorized to practice. 4502.64 An applicant who possesses a current certification as a Registered Dietitian (RD)
from the passes the examination sponsored by the Commission on Dietetic
Registration of the American Dietetic Association (CDRADA) (CDR) and who
submits proof of current certification as a registered dietitian by the CDRADA
shall be deemed to have met the educational and experience requirements of §
4502.1.
4502.5 An applicant who possesses a current certification as a Certified Nutrition
Specialist (CNS) from the Board for Certification of Nutrition Specialists (BCNS)
shall be deemed to have met the requirements of § 4502.1.
4502.6 An applicant who possesses a current certification as a Diplomate of American
Clinical Board of Nutrition (DACBN) from the American Clinical Board of
Nutrition (ACBN) shall be deemed to have met the requirements of § 4502.1.this
section.
4502.7 An applicant who has received a master’s or doctoral degree in nutrition from a
university that was accredited by the ADA’s Commission on Accreditation for
Dietetics Education at the time the applicant graduated, shall be deemed to have
met the pre-professional experience requirements of this section.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 5
4502.8 An applicant who has been actively engaged in the practice of nutrition for not
less than two (2) of the five (5) years immediately preceding the date of
application and who meets the requirements of § 4502.1 of this chapter, shall be
deemed to have met the pre-professional experience requirements of this section.
4502.9 An applicant who has been certified by the Certified Board for Nutrition
Specialists as a Certified Nutrition Specialist (CNS), shall be deemed to have met
the pre-professional experience requirements of this section.
4502.10 The Board may require that an applicant submit evidence that documents the
nature of the course work completed.
4502.11 For purposes of this section, a quarter hour of academic credit shall equal two-
thirds (2/3) of a semester hour.
4503 APPLICANTS EDUCATED IN FOREIGN COUNTRIES
4503.1 The Board may grant a license to practice nutrition to an applicant who has
completed an educational program in a foreign country, which program is not
accredited pursuant to this section, if the applicant does as follows if:
(a) Meets all requirements of this chapter except for § 4502.1The applicant
holds at least a bachelor’s degree in science that is determined by the
Board to be equivalent to one obtained from a regionally accredited U.S.
institution; and
(b) Demonstrates to the satisfaction of the Board that the applicant’s
education and training are substantially equivalent to the requirements of
this subtitle and the Act in ensuring that the applicant is qualified to
practice nutrition by submitting the documentation required by § 4502.6 or
§ 4503.2 of this chapterThe applicant has completed at least nine hundred
(900) hours of supervised practice experience that the Board deems to be
equivalent to the requirements § 4502.3 under the supervision of a
supervisor that the Board determines to meet the requirements of or
comparable to § 4504.2.
4503.2 An applicant under this section shall submit with the application a certification
from one of the following that the applicant’s foreign education is equivalent to
the applicable requirements of the Act and this chapter:
(a) A private education evaluation service approved by the Board; or
(b) A college or university approved by an accrediting body recognized by the
Council on Postsecondary Accreditation or the Secretary of the United
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 6
States Department of Education.
4503.3 If a document required by this chapter is in a language other than English, an
applicant shall arrange for its translation into English by a translation service
acceptable to the Board and shall submit a translation signed by the translator
attesting to its accuracy.
4504 APPROVED SUPERVISOR’S QUALIFICATIONS
4504.1 Except as provided in § 4504.2, a supervisor who may be approved to supervise
an applicant’s supervised practice experience shall possess at least one of the
following certifications:
(a) Certified Nutrition Specialist (CNS) from the Board for Certification of
Nutrition Specialists (BCNS);
(b) Registered Dietitian (RD) from the Commission for Dietetic Registration
(CDR); or
(c) Diplomate of the American Clinical Board for Nutrition (DACBN) from
the American Clinical Board for Nutrition (ACBN).
4504.2 A supervisor not meeting the requirement of § 4504.1 may supervise an
applicant’s supervised practice experience if:
(a) The supervisor holds at last a bachelor’s degree in science, dietetics,
nutrition, or a related field;
(b) The Board has reviewed and determined to be satisfactory the following:
(1) That the supervisor has practiced dietetics or nutrition for at least
one (1) year; and
(2) That the supervisor understands and accepts the responsibility to
provide the applicant with a supervised practice experience
equivalent to the CNS standards.
4504.3 The supervisor seeking to provide supervision in accordance with § 4504.2 to a
supervisee accruing his or her practice in the District shall not begin such
supervision or allow the supervisee to practice until the Board has approved the
supervisor.
45054 SUPERVISED PRACTICE BY STUDENTS AND
GRADUATESAUTHORIZED PRACTICE WITHOUT A LICENSE
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 7
45054.1 The following unlicensed persons may practice nutrition under supervision;
(a) A student fulfilling educational requirements in a program that meets the
requirements of §§ 4502.1 and 4502.2; and
(b) A graduate from a nutrition program enrolled in a postgraduate training
program recognized by the Board; or
(c) A graduate from a nutrition program accruing supervised practice
experience required in § 4502.1(d)..
45045.2 Only a supervisor shall be authorized to supervise the practice of a student or
graduate.A supervisor authorized to supervise the practice of persons enumerated
in § 4505.1 shall meet the requirements of § 4504.
45054.3 A student or graduate may practice nutrition only in accordance with the Act and
this title.person authorized to practice under this section shall comply with all
applicable provisions of this chapter and the Act.
4504.4 A student or graduate who practices pursuant to this section shall practice only at
a hospital, nursing home, health facility, health education center, business, or
other health care facility considered appropriate for the practice of nutrition.
45045.5 A student or graduate under this sectionperson authorized to practice under this
section shall not assume administrative or technical responsibility for the
operation of a program of dietetics, clinical service, or unit.
4504.6 All supervised practice shall take place under general or immediate supervision.
45045.7 A student or graduateperson authorized to practice under this section shall
identify himself or herself as a person practicing under supervision such before
practicing under supervision.
45054.8 A supervisor shall be fully responsible for all practice by a student or graduatethe
supervisee during the period of supervision and shall be subject to disciplinary
action for any violation of the Act or this subtitle by the student or
graduatesupervisee.
4504.9 A student or graduate shall not receive compensation of any kind directly or
indirectly from a patient, except for a salary based on hours worked under
supervision.
4504.10 A graduate eligible to practice under § 4504.1(b) may practice for no more than
twelve (12) months or for the duration of the graduate’s postgraduate training
program.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 8
45054.11 A student or graduateperson authorized to practice under this section shall be
subject to all of the applicable provisions of the Act and this chapter. In
accordance with Chapter 41 of this title, the Board may deny an application for a
license by, or may take disciplinary action against, a student or graduate and may
be subject to disciplinary action including the denial of a license if the person who
is found to have violated the Act or this chapter.
4504.12 As used in this section, the following definitions shall apply:
(a) “General supervision” means supervision in which the supervisor is
available on the premises or within vocal communication either directly or
by a communication device at the time the student or graduate is
practicing; (b) “Immediate supervision” means supervision in which the supervisor is
with the student or graduate and is either discussing or observing the
student’s or graduate’s practice; and
(c) “Supervisor” means a registered nutritionist or dietitian licensed under the
Act who is responsible for the supervision of a student or graduate.
4505 CDR EXAM
4505.1 Except as provided in 4505.2 of this chapter, all applicants for licensure in the
District of Columbia shall receive a passing score on the national registration
examination for dietitians offered by the Commission on Dietetic Registration
(“CDR Exam”).
4505.2 The following shall not be required to complete the CDR exam:
(a) An applicant for licensure by endorsement;
(b) An applicant who is currently certified as a registered dietitian by the Commission
on Dietetic Registration of the American Dietetic Association (CDRADA); or
(c) An applicant who is currently certified by the Certified Board for Nutrition
Specialists as a Certified Nutrition Specialist (CNS).
4505.4 An applicant who fails the CDR exam on three (3) consecutive attempts may not
retake the examination for one (1) year. Thereafter, the applicant may not retake
the examination for one (1) year after each failure.
4505.5 An applicant who fails the CDR exam three (3) times is not eligible for licensure
in the District unless the applicant successfully completes a course or courses in
each area of weakness as determined by the CDRADA’s analysis of the previous
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 9
examination before the applicant may reapply for examination.
4505.6 To be eligible to take the CDR exam, an applicant shall submit proof satisfactory
to the Board that he or she has met the educational and preprofessional experience
training requirements of the Act.
4506 CONTINUING EDUCATION REQUIREMENTS
4506.1 Subject to § 4506.2, tThis section shall applyapplies to applicants for the renewal,
reactivation, or reinstatement of a license for a term expiring April 30, 1991, and
for subsequent terms.but does not apply to applicants for an initial license or for
the first renewal of a license.
4506.2 This section does not apply to applicants for an initial license; nor does it apply to
applicants for the first renewal of a license.
4506.3 A continuing education credit shall be valid only if it meets the requirements of §
4507 and is approved by the Board.
4506.4 To qualify for the renewal of a license, an applicant shall have completed thirty
(30) hours of approved continuing education credit during the two (2)-year period
preceding the date the license expires. Beginning with the November 1, 2017 –
October 31, 2019 licensure term, two (2) of the required thirty (30) hours shall be
LGBTQ continuing education.
4506.5 To qualify for the reactivation of a license, a person in inactive status within the
meaning of § 511 of the Act( D.C. Official Code § 3-1205.11(2016 Repl.)) who
submits an application to reactivate a license shall submit proof of having
completed fifteen (15) hours of approved continuing education credit for each
license year that the applicant was in inactive status, up to a maximum of five (5)
years, with at least thirty (30) of those hours having been completed in the two (2)
years immediately preceding the date of applying for reactivation.
4506.6 To qualify for the reinstatement of a license, an applicant shall submit proof of
having completed fifteen (15) hours of approved continuing education credit for
each year that the applicant was not licensed, up to a maximum of five (5) years,
with at least thirty (30) of those hours having been completed in the two (2) years
immediately preceding the submission of the reinstatement application.
4506.7 An applicant may prove completion of the required continuing education by
establishing to the Board’s satisfaction that the applicant did complete the
continuing education program or activity and that the program or activity meets
the relevant requirements of § 4507.Except as provided in § 4506.8, an applicant
under this section shall prove completion of required continuing education credits
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 10
by submitting with the application the following information with respect to each
program:
(a) The name and address of the sponsor of the program;
(b) The name of the program, its location, a description of the subject matter covered,
and the names of the instructors;
(c) The dates on which the applicant attended the program;
(d) The hours of credit claimed; and
(e) Verification by the sponsor of completion, by signature or stamp.
4506.8 Applicants for renewal of a license shall only be required to prove completion of
the required continuing education credits by submitting proof pursuant to §
4506.7 if requested to do so as part of the random audit, or if otherwise requested
to do so by the Board.
4506.9 In lieu of requiring proof of completion of the required continuing education with
a renewal application, Tthe Board relies on a renewal applicant’s attestation to his
or her compliance and may periodically conduct a random audit of its active
licensees to determine continuing education compliance. Any licensee selected for
the audit shall submit proof of his or her continuing education compliance to the
Board within thirty (30) days of receiving notification of the audit. Failure to
timely respond to the audit notice may subject the licensee to disciplinary action
by the Board.
4507 APPROVED CONTINUING EDUCATION PROGRAMS ANDOR
ACTIVITIES
4507.1 The Board may, in its discretion, approve a continuing education programs and or
activitiesy that meets the following requirements:
(a) The subject matter is current and relevant to the practice of dietetics or
nutrition;
(b) The program or activity meets the following requirements:
(1) Developed and administered or taught by individuals with
appropriate qualifications and credentials;
(2) Determined to contribute to the growth of an applicant in
professional competence in the practice of nutrition; and
(3) thatDetermined to meet the other applicable requirements of this
section.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 11
4507.2 The Board may approve the following types of continuing education programs or
activities:, if the programs meet the requirements of § 4507.3:
(a) An undergraduate or graduate course given at an accredited college or
universityParticipating as a learner in a professional and structured
education activity such as, but not limited to:
(1) An undergraduate or graduate course related to the discipline of
human nutrition offered at an accredited college or university; or
(2) A class, workshop, seminar, or teaching activity offered by one or
more of the providers enumerated in § 4507.3;
(b) Teaching a nutrition course at an accredited college or university;
(c) Serving as an instructor or presenter at a professional education program
at a professional conference, workshop, or in-service training;
(d) Authoring or co-authoring an original published professional or peer-
reviewed book or article or review article in the field of nutrition;
(e) Serving as an editor or co-editor of a professional nutrition journal,
advanced professional book or textbook in the field of nutrition; or
(f) Participating as a researcher in a published research project.
(b) A seminar related to the discipline of human nutrition;
(c) A training or technical assistance workshop in nutrition or a nutrition
related field;
(d) An educational program given at a conference specifically related to the
discipline of nutrition; and
(e) Nutrition related presentations or poster board sessions in professional
meetings.
4507.3 Programs or activities sponsored, offered, or approved by the following organizations shall be approved for continuing education credits:
(a) Board for Certification of Nutrition Specialists (BCNS);
(b) Commission on Dietetic Registration;
(c) A health care facility accredited by the Joint Commission for the Accreditation of hospitals; or
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 12
(d) A national, state, or local dietetic, nutrition, public health, medical, or educational organization approved or recognized by the Board;
4507.3 To qualify for approval by the Board, a continuing education program shall meet
the following requirements:
(a) Be current and relevant to the practice of nutrition and dietetics in its
subject matter;
(b) Be developed and taught by individuals with appropriate qualifications
and credentials; and
(c) Be administered or approved by one of the following:
(1) A national, state, or local dietetics organization recognized by the
Board;
(2) A health care facility accredited by the Joint Commission for the
Accreditation of Hospitals; or
(3) A college or university approved by an accrediting body
recognized by the Council on Postsecondary Accreditation or the
Secretary of the United Stated Department of Education. 4507.4 The Board may issue and update a list of approved continuing education
programs.
4507.5 An applicantperson seeking continuing education credits shall have the burden of
verifying whether a program is approved by the Board pursuant to this section
prior to attending the program. The applicant person shall also have the burden of
verifying the number of continuing education credits the Board will accept for a
program under this section.
4507.6 The Board may approve the following continuing education activities by an
applicant:
(a) Serving as an instructor or speaker at a conference, a seminar, workshop,
or in-service training;
(b) Publishing a book or a chapter in a book, or publishing a book review,
article, abstract, or paper in a professional journal or bulletin; or
(c) Participating in research as a principal investigator or research assistant.
4508 CONTINUING EDUCATION CREDITS
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 13
4508.1 The Board may grant continuing education credit for whole hours only, with a
One (1) continuing education credit hour (“CEU”) consists of at least minimum of
fifty (50) minutes constituting one (1) credit hour, which shall equal one (1)
continuing education unit (CEU)of learning time.
4508.2 For approved undergraduate or graduate course, each semester hour of credit shall
constitute fifteen (15) hours of continuing education credit, and each quarter hour
of credit shall constitute ten (10) hours of continuing education credit.
4508.3 The Board may grant credit to an applicant who serves as an instructor or speaker
at an approved program for both preparation and presentation time, subject to the
restrictions under §§ 4508.4 through 4508.7.
4508.4 The maximum amount of credit which may be granted for preparation time shall
be twice the amount of the associated presentation time.
4508.5 The maximum amount of credit which may be granted pursuant to § 4508.3 shall
be fifty percent (50%) of an applicant’s continuing education requirement.
4508.6 If an applicant has previously received credit in connection with a particular
presentation, the Board shall not grant credit for a subsequent presentation unless
it involves either a different subject or substantial additional research concerning
the same subject.
4508.7 The presentation shall be completed during the period for which credit is claimed.
4508.8 The Board may grant an applicant who is an author or editor of a published book
fifteen (15) continuing education credits, if the book has been published or
accepted for publication during the period for which credit is claimed, and the
applicant submits proof of this fact with the application.
4508.9 The Board may grant an applicant who is an author of a published original paper
six (6) continuing education credits, subject to the same restrictions set forth for
books in § 4508.8.
4508.10 The Board may grant an applicant who is the sole author of a published book
review, article, or abstract, six (6) continuing education credits, subject to the
same restrictions set forth for books in § 4508.8.
4508.11 The Board may grant an applicant who is able to demonstrate participation in
research, either as a principal investigator or as a research assistant, six (6)
continuing education credits.
4508.12 The Board may grant an applicant who is a co-author of a published book review,
article, abstract, or original paper two (2) continuing education credits, subject to
the same restrictions set forth for books in § 4508.9. A maximum of four (4)
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 14
continuing education credits per year may be granted to this section.
4509 LICENSURE BY ENDORSEMENTPROFESSIONAL STANDARDS
4509.1 A nutritionist shall conduct him- or herself with honesty, integrity and fairness.
4509.2 A nutritionist shall support and promote high standard of professional practice,
embody high ethical standards and adhere to all applicable local, state, and federal
laws and regulations in the choices he or she makes.
4509.3 A nutritionist shall not misrepresent or fail to prevent misrepresentation of his or
her professional qualifications or credentials.
4509.4 A nutritionist shall not permit the use of his or her name for the purpose of
certifying that nutrition services have been rendered unless the nutritionist has
provided or supervised the provision of those services.
4509.5 A nutritionist shall maintain knowledge and skills required for professional
competence and shall provide services or care within their own scope of practice
and competence.
4509.6 A nutritionist shall respect the rights of patients or clients to self-determination
and make his or her best good faith efforts to provide unbiased information and
facilitate understanding to enable the patient or client to make informed choices in
regard to all recommended plans of care or assessment.
4509.7 A nutritionist shall not promote or endorse products in a manner that is false or
misleading and shall disclose to a patient, client, or a person under the
nutritionist’s supervision any personal gain or profit from any item, procedure, or
profit used with or promoted to a patient or client. A personal gain or profit
subject to disclosure under this subsection does not include compensation
received as a consultant or employee, a research grant or corporate sponsorship
program, a gift of nominal value, or attendance at educational programs.
4509.8 A nutritionist shall not aid or abet the practice or misrepresentation of an
unlicensed person.
An applicant, holding an active license, in good standing, to practice nutrition in another state, shall
in addition to meeting all the requirements of this chapter:
(a) Submit a copy of his or her current license with the application; and
(b) Obtain verification from each state in which the applicant holds or has ever held a
professional health occupation license, that the license is current and in good
standing, or if the license is no longer active, that it was in good standing
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 15
immediately prior to its expiration. The licensure verification form must be sent
directly to the Board, by the verifying Board.
4510 USE OF TITLE REGISTERED DIETITIONSCOPE OF PRACTICE
4510.1 A nutritionist licensed or authorized to practice under this chapter may provide
general nutrition services or medical nutrition therapy.
4510.2 Medical nutrition therapy includes:
(a) Completion of individualized nutritional assessment, evaluation, or
diagnosis for a patient or client, using anthropometric, biochemical,
nutrition physical or clinical examination, genomics, nutritional genomics,
or demographic data;
(b) Creation of patient or client-specific treatment plan or protocol;
(c) Creation of therapeutic diet orders or therapeutic menus; or
(d) Monitoring and evaluating an patient’s or client’s progress based on the
treatment plan or therapeutic diet orders.
4510.3 A nutritionist may order and assess laboratory tests related to dietetics or nutrition
care including, but not limited to, standard lab testing, in-office testing, functional
testings, or nutrigenomics.
(c) An individual licensed under the Act to practice nutrition in the District of
Columbia shall not use the title dietitian or registered dietitian unless the
individual is licensed under the Act to practice dietetics in the District of
Columbia.
4510.4 In order to engage in the tele-practice of dietetics or nutrition for a client or
patient located within the District of Columbia, a license to practice dietetics or
nutrition in the District is required, except as specified in D.C. Official Code § 3-
1205.02. A nutritionist engaging in tele-practice for a client or patient outside the
District shall meet any licensure or practice requirements of the jurisdiction in
which the client or patient is physically located.
4501.5 A nutritionist may utilize health information and technology communications to
supervise the practice of a student or person accruing authorized supervised
practice experience provided that the existing standards of care and conduct are
maintained and the nutritionist complies with the licensure and practice
requirements of the jurisdiction in which the supervised practice occurs.
4510.5 A nutritionist may delegate the following tasks to an aide who has been
adequately trained and performs such tasks under the nutritionist’s supervision:
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 16
(a) Collects physical and clinical data pertaining to individuals or groups for
the purpose of diagnosis or assessment; or
(b) Reviews and provides basic nutritional guidance to individuals or groups
in accordance with the established procedures and guidelines developed or
approved by the supervising nutritionist.
4510.6 It shall not constitute the practice of dietetic or nutrition for a person to provide
general nutrition services through the following activities, provided that such
activities do not constitute medical nutrition:
(a) Educating individuals or groups in the selection of food to meet normal
nutrition needs;
(b) Planning, organizing, coordinating, or evaluating the nutritional
components of community health services; or
(c) Providing food or nutrition information to promote general wellness.
4599 DEFINITIONS
4599.1 When used in this chapter, the following terms and phrases shall have the
meanings ascribed:
Act – the District of Columbia Health Occupations Revision Act of 1985, effective March 25,
1986 (D.C. Law 6-99, D.C. Official Code §§ 3-1201 et seq. (2016 Repl.)).
Applicant – a person applying for a license to practice nutrition under this chapter.
Board – the Board of Dietetics and Nutrition, established by § 202 of the Act, D.C. Official
Code § 3-1202.02 (2001).
CDRADA – the Commission on Dietetic Registration of the American Dietetic Association.
Dietitian – a person licensed to practice dietetics under the Act. Licensure to practice dietetics
pursuant to this chapter shall also entitle the licensee to use the title of nutritionist.
General Supervision – supervision in which the supervisor is within the same facility as the
supervisee and immediately available upon request or is not within the same
facility but immediately available by telephoneavailable to supervise or give
guidance or feedback to the supervisee by any telecommunication means or
device.
Immediate Supervision – supervision in which the supervisor is physicallymeets with the
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 17
supervisee and eitherin person or via telecommunication technology in order to
provide reviews or guidance on practice, or discusses or observes the supervisee’s
practice.
Nutritionist – a person licensed or authorized to practice nutrition under the Act and this
chapter.
LGBTQ continuing education – continuing education focusing on patients or clients who
identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or
question their sexual orientation or gender identity and expression (“LGBTQ”)
meeting the requirements of § 510(b)(5) of the Act (D.C. Official Code § 3-
1205.10 (b)(5) (2016 Repl.)).
Medical nutrition therapy - the use of specific nutrition services to prevent, treat, or rehabilitate
an illness, injury, or condition. Medical nutrition therapy includes nutrition
assessment, intervention, education, and counseling.
Tele-practice of dietetics or nutrition - the practice of dietetics or nutrition by a nutritionist to
provide client or patient care, treatment, or services while the nutritionist is
phsycially in one location and the client or patient in another location with or
without an intervening healthcare provider, through the use of health information
and technology communications, subject to the existing standards of care and
conduct.
4599.2 The definitions in § 4099 of Chapter 40 of this title are incorporated by reference
into and are applicable to this title.
DISTRICT OF
COLUMBIA
MUNICIPAL
REGULATIONS
for
NUTRITION
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 2
CHAPTER 45 NUTRITION Secs. 4500 General Provision 4501 Term of License 4502 Educational and Training Requirements 4503 Applicants Educated in Foreign Countries 4504 Supervised Practice by Students and Graduates 4505 CDR Exam 4506 Continuing Education Requirements 4507 Approved Continuing Education Programs and Activities 4508 Continuing Education Credits 4599 Definitions 4500 GENERAL PROVISIONS
4500.1 This chapter shall apply to applicants for and holders of a license to practice
nutrition.
4500.2 Chapters 40 (Health Occupations: General Rules), 41 (Health Occupations:
Administrative Procedures), and 44 (Dietetics) of this title shall supplement this
chapter.
4501 TERM OF LICENSE
4501.1 Subject to § 4501.2, a license issued pursuant to this chapter shall expire at 12:00
midnight on November 1st
of each odd-numbered year.
4501.2 If the Director changes the renewal system pursuant to § 4006.3 of Chapter 40 of
this title, a license issued pursuant to this chapter shall expire at 12:00 midnight of
the last day of the month of the birthdate of the holder of the license, or other date
established by the Director.
4502 QUALIFICATION FOR LICENSURE
4502.1 Except as otherwise provided in this chapter, an applicant seeking to qualify for a
license to practice nutrition shall possess the following:
(a) A baccalaureate or higher degree, with a major in human nutrition, foods
and nutrition, dietetics, or food systems management;
(b) A baccalaureate or higher degree with a major in a course of study found
by the Board to be equivalent to one of the courses of study listed in
paragraph (a) of this subsection;
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 3
and
(c) At least nine hundred (900) hours of supervised practice experience
meeting the requirements of § 4502.3; and
(d) Passage of one of the following examinations:
(1) Certification Examination for Nutrition Specialists offered by the
Board for Certification of Nutrition Specialists (BCNS);
(2) Registration Examination for Dietitians offered by the Commission
on Dietetic Registration (CDR); or
(3) Certification Examination for a Diplomate of the American
Clinical Board of Nutrition (DACBN).
4502.2 A degree required in §§ 4502.1(a) or (b) shall have been obtained from an
academic institution that was approved by the appropriate accrediting body
recognized by the Council for Higher Education Accreditation or the United
States Department of Education at the time the degree was conferred.
4502.3 Except as provided in §§ 4502.4, 4502.5, 4503.6, and 4502.7 a supervised
practice experience required in § 4502.1(d) shall meet the following
requirements:
(a) The applicant practiced dietetic or nutrition for at least nine hundred (900)
hours under the supervision of a supervisor approved in accordance with §
4504;
(b) At least one (1) hour per forty (40) hours of experience was under the
immediate supervision of the approved supervisor and the remaining
experience was under the general supervision of the supervisor; and
(c) The applicant’s performance was rated as at least satisfactory.
4502.4 An applicant who possesses a current certification as a Registered Dietitian (RD)
from the Commission on Dietetic Registration (CDR) shall be deemed to have
met the requirements of § 4502.1.
4502.5 An applicant who possesses a current certification as a Certified Nutrition
Specialist (CNS) from the Board for Certification of Nutrition Specialists (BCNS)
shall be deemed to have met the requirements of § 4502.1.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 4
4502.6 An applicant who possesses a current certification as a Diplomate of American
Clinical Board of Nutrition (DACBN) from the American Clinical Board of
Nutrition (ACBN) shall be deemed to have met the requirements of § 4502.1..
4502.7 An applicant who has received a master’s or doctoral degree in nutrition from a
university that was accredited by the ADA’s Commission on Accreditation for
Dietetics Education at the time the applicant graduated, shall be deemed to have
met the pre-professional experience requirements of this section.
4503 APPLICANTS EDUCATED IN FOREIGN COUNTRIES
4503.1 The Board may grant a license to practice nutrition to an applicant who has
completed an educational program in a foreign country if:
(a) The applicant holds at least a bachelor’s degree in science that is
determined by the Board to be equivalent to one obtained from a
regionally accredited U.S. institution; and
(b) The applicant has completed at least nine hundred (900) hours of
supervised practice experience that the Board deems to be equivalent to
the requirements § 4502.3 under the supervision of a supervisor that the
Board determines to meet the requirements of or comparable to § 4504.2.
4504 APPROVED SUPERVISOR’S QUALIFICATIONS
4504.1 Except as provided in § 4504.2, a supervisor who may be approved to supervise
an applicant’s supervised practice experience shall possess at least one of the
following certifications:
(a) Certified Nutrition Specialist (CNS) from the Board for Certification of
Nutrition Specialists (BCNS);
(b) Registered Dietitian (RD) from the Commission for Dietetic Registration
(CDR); or
(c) Diplomate of the American Clinical Board for Nutrition (DACBN) from
the American Clinical Board for Nutrition (ACBN).
4504.2 A supervisor not meeting the requirement of § 4504.1 may supervise an
applicant’s supervised practice experience if:
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 5
(a) The supervisor holds at last a bachelor’s degree in science, dietetics,
nutrition, or a related field;
(b) The Board has reviewed and determined to be satisfactory the following:
(1) That the supervisor has practiced dietetics or nutrition for at least
one (1) year; and
(2) That the supervisor understands and accepts the responsibility to
provide the applicant with a supervised practice experience
equivalent to the CNS standards.
4504.3 The supervisor seeking to provide supervision in accordance with § 4504.2 to a
supervisee accruing his or her practice in the District shall not begin such
supervision or allow the supervisee to practice until the Board has approved the
supervisor.
4505 AUTHORIZED PRACTICE WITHOUT A LICENSE
4505.1 The following unlicensed persons may practice nutrition under supervision;
(a) A student fulfilling educational requirements in a program that meets the
requirements of §§ 4502.1 and 4502.2;
(b) A graduate from a nutrition program enrolled in a postgraduate training
program recognized by the Board; or
(c) A graduate from a nutrition program accruing supervised practice
experience required in § 4502.1(d).
4505.2 A supervisor authorized to supervise the practice of persons enumerated in §
4505.1 shall meet the requirements of § 4504.
4505.3 A person authorized to practice under this section shall comply with all applicable
provisions of this chapter and the Act.
4505.5 A person authorized to practice under this section shall not assume administrative
or technical responsibility for the operation of a program of dietetics, clinical
service, or unit.
4505.7 A person authorized to practice under this section shall identify himself or herself
as a person practicing under supervision .
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 6
4505.8 A supervisor shall be fully responsible for all practice by the supervisee during
the period of supervision and shall be subject to disciplinary action for any
violation of the Act or this subtitle by the supervisee.
4504.10 A graduate eligible to practice under § 4504.1(b) may practice for no more than
twelve (12) months or for the duration of the graduate’s postgraduate training
program.
4505.11 A person authorized to practice under this section shall be subject to all of the
applicable provisions of the Act and this chapter and may be subject to
disciplinary action including the denial of a license if the person is found to have
violated the Act or this chapter.
4506 CONTINUING EDUCATION REQUIREMENTS
4506.1 This section applies to applicants for the renewal, reactivation, or reinstatement of
a license but does not apply to applicants for an initial license or for the first
renewal of a license.
4506.3 A continuing education credit shall be valid only if it meets the requirements of §
4507 and is approved by the Board.
4506.4 To qualify for the renewal of a license, an applicant shall have completed thirty
(30) hours of approved continuing education credit during the two (2)-year period
preceding the date the license expires. Beginning with the November 1, 2017 –
October 31, 2019 licensure term, two (2) of the required thirty (30) hours shall be
LGBTQ continuing education.
4506.5 To qualify for the reactivation of a license, a person in inactive status within the
meaning of § 511 of the Act( D.C. Official Code § 3-1205.11(2016 Repl.)) who
submits an application to reactivate a license shall submit proof of having
completed fifteen (15) hours of approved continuing education credit for each
license year that the applicant was in inactive status, up to a maximum of five (5)
years, with at least thirty (30) of those hours having been completed in the two (2)
years immediately preceding the date of applying for reactivation.
4506.6 To qualify for the reinstatement of a license, an applicant shall submit proof of
having completed fifteen (15) hours of approved continuing education credit for
each year that the applicant was not licensed, up to a maximum of five (5) years,
with at least thirty (30) of those hours having been completed in the two (2) years
immediately preceding the submission of the reinstatement application.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 7
4506.7 An applicant may prove completion of the required continuing education by
establishing to the Board’s satisfaction that the applicant did complete the
continuing education program or activity and that the program or activity meets
the relevant requirements of § 4507.
4506.9 In lieu of requiring proof of completion of the required continuing education with
a renewal application, the Board relies on a renewal applicant’s attestation to his
or her compliance and may periodically conduct a random audit of its active
licensees to determine continuing education compliance. Any licensee selected for
the audit shall submit proof of his or her continuing education compliance to the
Board within thirty (30) days of receiving notification of the audit. Failure to
timely respond to the audit notice may subject the licensee to disciplinary action
by the Board.
4507 APPROVED CONTINUING EDUCATION PROGRAMS OR ACTIVITIES
4507.1 The Board may, in its discretion, approve a continuing education program or
activity that meets the following requirements:
(a) The subject matter is current and relevant to the practice of dietetics or
nutrition;
(b) The program or activity meets the following requirements:
(1) Developed and administered or taught by individuals with
appropriate qualifications and credentials;
(2) Determined to contribute to the growth of professional competence
in the practice of nutrition; and
(3) Determined to meet other applicable requirements of this section. 4507.2 The Board may approve the following types of continuing education programs or
activities:
(a) Participating as a learner in a professional and structured education
activity such as, but not limited to:
(1) An undergraduate or graduate course related to the discipline of
human nutrition offered at an accredited college or university; or
(2) A class, workshop, seminar, or teaching activity offered by one or
more of the providers enumerated in § 4507.3;
(b) Teaching a nutrition course at an accredited college or university;
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 8
(c) Serving as an instructor or presenter at a professional education program
at a professional conference, workshop, or in-service training;
(d) Authoring or co-authoring an original published professional or peer-
reviewed book or article or review article in the field of nutrition;
(e) Serving as an editor or co-editor of a professional nutrition journal,
advanced professional book or textbook in the field of nutrition; or
(f) Participating as a researcher in a published research project.
4507.3 Programs or activities sponsored, offered, or approved by the following organizations shall be approved for continuing education credits:
(a) Board for Certification of Nutrition Specialists (BCNS);
(b) Commission on Dietetic Registration;
(c) A health care facility accredited by the Joint Commission for the Accreditation of hospitals; or
(d) A national, state, or local dietetic, nutrition, public health, medical, or educational organization approved or recognized by the Board;
4507.5 Aperson seeking continuing education credits shall have the burden of verifying
whether a program is approved by the Board pursuant to this section prior to
attending the program. The person shall also have the burden of verifying the
number of continuing education credits the Board will accept for a program under
this section.
4508 CONTINUING EDUCATION CREDITS
4508.1 One (1) continuing education credit hour (“CEU”) consists of at least fifty (50)
minutes of learning time.
4508.2 For approved undergraduate or graduate course, each semester hour of credit shall
constitute fifteen (15) hours of continuing education credit, and each quarter hour
of credit shall constitute ten (10) hours of continuing education credit.
4508.3 The Board may grant credit to an applicant who serves as an instructor or speaker
at an approved program for both preparation and presentation time, subject to the
restrictions under §§ 4508.4 through 4508.7.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 9
4508.4 The maximum amount of credit which may be granted for preparation time shall
be twice the amount of the associated presentation time.
4508.5 The maximum amount of credit which may be granted pursuant to § 4508.3 shall
be fifty percent (50%) of an applicant’s continuing education requirement.
4508.6 If an applicant has previously received credit in connection with a particular
presentation, the Board shall not grant credit for a subsequent presentation unless
it involves either a different subject or substantial additional research concerning
the same subject.
4508.7 The presentation shall be completed during the period for which credit is claimed.
4508.8 The Board may grant an applicant who is an author or editor of a published book
fifteen (15) continuing education credits, if the book has been published or
accepted for publication during the period for which credit is claimed, and the
applicant submits proof of this fact with the application.
4508.9 The Board may grant an applicant who is an author of a published original paper
six (6) continuing education credits, subject to the same restrictions set forth for
books in § 4508.8.
4508.10 The Board may grant an applicant who is the sole author of a published book
review, article, or abstract, six (6) continuing education credits, subject to the
same restrictions set forth for books in § 4508.8.
4508.11 The Board may grant an applicant who is able to demonstrate participation in
research, either as a principal investigator or as a research assistant, six (6)
continuing education credits.
4508.12 The Board may grant an applicant who is a co-author of a published book review,
article, abstract, or original paper two (2) continuing education credits, subject to
the same restrictions set forth for books in § 4508.9. A maximum of four (4)
continuing education credits per year may be granted to this section.
4509 PROFESSIONAL STANDARDS
4509.1 A nutritionist shall conduct him- or herself with honesty, integrity and fairness.
4509.2 A nutritionist shall support and promote high standard of professional practice,
embody high ethical standards and adhere to all applicable local, state, and federal
laws and regulations in the choices he or she makes.
4509.3 A nutritionist shall not misrepresent or fail to prevent misrepresentation of his or
her professional qualifications or credentials.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 10
4509.4 A nutritionist shall not permit the use of his or her name for the purpose of
certifying that nutrition services have been rendered unless the nutritionist has
provided or supervised the provision of those services.
4509.5 A nutritionist shall maintain knowledge and skills required for professional
competence and shall provide services or care within their own scope of practice
and competence.
4509.6 A nutritionist shall respect the rights of patients or clients to self-determination
and make his or her best good faith efforts to provide unbiased information and
facilitate understanding to enable the patient or client to make informed choices in
regard to all recommended plans of care or assessment.
4509.7 A nutritionist shall not promote or endorse products in a manner that is false or
misleading and shall disclose to a patient, client, or a person under the
nutritionist’s supervision any personal gain or profit from any item, procedure, or
profit used with or promoted to a patient or client. A personal gain or profit
subject to disclosure under this subsection does not include compensation
received as a consultant or employee, a research grant or corporate sponsorship
program, a gift of nominal value, or attendance at educational programs.
4509.8 A nutritionist shall not aid or abet the practice or misrepresentation of an
unlicensed person.
4510 SCOPE OF PRACTICE
4510.1 A nutritionist licensed or authorized to practice under this chapter may provide
general nutrition services or medical nutrition therapy.
4510.2 Medical nutrition therapy includes:
(a) Completion of individualized nutritional assessment, evaluation, or
diagnosis for a patient or client, using anthropometric, biochemical,
nutrition physical or clinical examination, genomics, nutritional genomics,
or demographic data;
(b) Creation of patient or client-specific treatment plan or protocol;
(c) Creation of therapeutic diet orders or therapeutic menus; or
(d) Monitoring and evaluating an patient’s or client’s progress based on the
treatment plan or therapeutic diet orders.
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 11
4510.3 A nutritionist may order and assess laboratory tests related to dietetics or nutrition
care including, but not limited to, standard lab testing, in-office testing, functional
testings, or nutrigenomics.
(c) 4510.4 In order to engage in the tele-practice of dietetics or nutrition for a client
or patient located within the District of Columbia, a license to practice dietetics or
nutrition in the District is required, except as specified in D.C. Official Code § 3-
1205.02. A nutritionist engaging in tele-practice for a client or patient outside the
District shall meet any licensure or practice requirements of the jurisdiction in
which the client or patient is physically located.
4501.5 A nutritionist may utilize health information and technology communications to
supervise the practice of a student or person accruing authorized supervised
practice experience provided that the existing standards of care and conduct are
maintained and the nutritionist complies with the licensure and practice
requirements of the jurisdiction in which the supervised practice occurs.
4510.5 A nutritionist may delegate the following tasks to an aide who has been
adequately trained and performs such tasks under the nutritionist’s supervision:
(a) Collects physical and clinical data pertaining to individuals or groups for
the purpose of diagnosis or assessment; or
(b) Reviews and provides basic nutritional guidance to individuals or groups
in accordance with the established procedures and guidelines developed or
approved by the supervising nutritionist.
4510.6 It shall not constitute the practice of dietetic or nutrition for a person to provide
general nutrition services through the following activities, provided that such
activities do not constitute medical nutrition:
(a) Educating individuals or groups in the selection of food to meet normal
nutrition needs;
(b) Planning, organizing, coordinating, or evaluating the nutritional
components of community health services; or
(c) Providing food or nutrition information to promote general wellness.
4599 DEFINITIONS
4599.1 When used in this chapter, the following terms and phrases shall have the
meanings ascribed:
Title 17 District of Columbia Municipal Regulations
Updated August 18, 2017 12
Act – the District of Columbia Health Occupations Revision Act of 1985, effective March 25,
1986 (D.C. Law 6-99, D.C. Official Code §§ 3-1201 et seq. (2016 Repl.)).
Board – the Board of Dietetics and Nutrition, established by § 202 of the Act, D.C. Official
Code § 3-1202.02 (2001).
General Supervision – supervision in which the supervisor is available to supervise or give
guidance or feedback to the supervisee by any telecommunication means or
device.
Immediate Supervision – supervision in which the supervisor meets with the supervisee in
person or via telecommunication technology in order to provide reviews or
guidance on practice, or discuss or observe the supervisee’s practice.
Nutritionist – a person licensed or authorized to practice nutrition under the Act and this
chapter.
LGBTQ continuing education – continuing education focusing on patients or clients who
identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or
question their sexual orientation or gender identity and expression (“LGBTQ”)
meeting the requirements of § 510(b)(5) of the Act (D.C. Official Code § 3-
1205.10 (b)(5) (2016 Repl.)).
Medical nutrition therapy - the use of specific nutrition services to prevent, treat, or rehabilitate
an illness, injury, or condition. Medical nutrition therapy includes nutrition
assessment, intervention, education, and counseling.
Tele-practice of dietetics or nutrition - the practice of dietetics or nutrition by a nutritionist to
provide client or patient care, treatment, or services while the nutritionist is
phsycially in one location and the client or patient in another location with or
without an intervening healthcare provider, through the use of health information
and technology communications, subject to the existing standards of care and
conduct.
4599.2 The definitions in § 4099 of Chapter 40 of this title are incorporated by reference
into and are applicable to this title.
.·
DEPARTMENT OF HEALTH
NOTICE OF FINAL RULEMAKING
The Director of the Department of Health ("Department"), pursuant to District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code§ 3-1203.02(14) (2016 Repl.)), and Mayor' s Order 98-140, dated August 20, 1998, hereby gives notice of the adoption of the following new Section 4618 of Chapter 46 (Medicine) of Title 17 (Business, Occupations, and Professionals) of the District of Columbia Municipal Regulations (DCMR), entitled "Telemedicine."
The adoption of Section 4618 is necessary to establish rules specific to the practice of telemedicine. The amendments to Section 4699 (Definitions) are necessary to explain the terms used in Section 4618.
A Notice of Proposed Rulemaking was published in the D.C. Register on February 26, 2016 at 63 DCR 2253 , and a Notice of Second Proposed Rulemaking for this section was published in the D. C. Register on July 7, 2017, at 64 DCR 006411. The Department received comments from the three entities: Children ' s National Health System (CNMC); the District of Columbia Association of Health Plans (DCAHP) and Kaiser Permanente (Kaiser). The Board of Medicine ("Board") considered the comments at the September 27, 2017 Board meeting.
CNMC proposed a number of changes to the proposed rule. CNMC suggested adding specific mention of Electronic Medical Records (EMR), video recording and consent to Subsection 4618 .2(b ), which lists the requirement of creating and maintain adequate medical records in accordance with the standards of care required of all medical treatment. The Board felt that such specificity was unnecessary, first, given the requirement for consent listed in Subsection 4618.2(a), and secondly, a belief that general references are better given the changing nature of technology. The second comment from CNMC asked that the phrase "and in compliance with HIPAA [Health Insurance Portability and Accountability Act] regulations and cyber-security protocol" be added to the end of Subsection 4618.10. The Board recognizes the need for compliance with HIP AA but decided to add reference to HIP AA law and regulations to Subsection 4618.2( c), which states the requirement of compliance with federal laws and regulations related to protected health information and medical records . Finally, CNMC asked that additional language be added to the definition of telemedicine to allow for the "provision of direct medical advice from licensee to licensee . .. " However, because the definition of telemedicine already includes the provision of services "with or without an intervening healthcare provider", the Board determined that such an amendment was unnecessary.
Kaiser and DCAHP also provided comments regarding the definition of telemedicine. Both suggested that audio-only telephone, electronic mail message (e-mail), online questionnaires, or facsimile transmissions (FAX) be excluded as telemedicine services. The Board declined to amend the definition, as the technology used may include such mechanisms, although the substance of the encounter has to be the practice of medicine in order to qualify as telemedicine. Kaiser provided three additional comments. First, they recommended moving proposed Subsection 4618.8 adjacent to proposed Subsection 4618.3, as both are related to the
-·
establishment of the physician-patient relationship, which the Board accepted. However, the Board declined to eliminate the term "real-time" from Subsection 4618.8. Similarly, the Board did not accept Kaiser' s recommendation to eliminate the term "real-time" from the definition of interpretive services. The Board also declined to eliminate the term "Notice of privacy practices" from the definition section.
Based upon the review of the public comments, the Board made three minor changes to the proposed rulemaking: specifying the Health Insurance Portability and Accountability Act (HIP AA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) as two of the federal laws that must be complied with; re-ordering some sections for greater clarity; and correcting the numbering of the sections. No substantive changes to the proposed rulemaking published on July 7, 2017 have been made. These rules were adopted as final on October 23 , 2017 and will be effective upon publication of this notice in the D. C. Register.
Chapter 46, MEDICINE, of Title 17 DCMR, BUSINESS, OCCUPATIONS, AND PROFESSIONALS, is amended as follows:
A new Section 4618, TELEMEDICINE, is added to read as follows:
4618
4618 .1
4618.2
TELEMEDICINE
In order to practice telemedicine for a patient located within the District of Columbia, a license to practice medicine in the District of Columbia is required, except as specified in §§ 3-1205.01 and 3-1205.02 of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq.) . For any services rendered outside the District of Columbia, the provider of the services shall meet any licensure requirement of the jurisdiction in which the patient is physically located.
In making medical decisions regarding a patient through the use of telemedicine, a physician shall adhere to the same standards of care as when making medical decisions in an in-person encounter with a patient. This includes, but shall not be limited to, the following:
(a) Obtaining and documenting patient consent, except when providing interpretive services;
(b) Creating and maintaining adequate medical records;
(c) Following requirements of the District of Columbia and federal laws and regulations, including the Health Insurance Portability and Accountability Act (HIP AA) and Health Information Technology for Economic and Clinical Health Act (HITECH), with respect to the confidentiality and disclosure of protected health information and medical records; and
2
4618.3
4618.4
4618.5
4618.6
4618.7
4618.8
4618.9
4618.10
4618.11
(d) Adhering to requirements and prohibitions found in the Health Occupations Revision Act (D.C. Official Code§§ 3-1201.01 et seq.).
A physician shall perform a patient evaluation to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication for a patient utilizing the appropriate standards of care, except when performing interpretive services.
If a physician-patient relationship does not include a prior in-person interaction with a patient, the physician may use real-time telemedicine to allow a free exchange of protected health information between the patient and the physician to establish the physician-patient relationship and perform the patient evaluation.
When providing interpretive services, the physician shall ensure that there is no clinically significant loss of data from image acquisition through transmission to final image display.
A District of Columbia-licensed physician may rely on a patient evaluation performed by another District of Columbia-licensed physician if the former is providing coverage for the latter.
In order to deliver services or treatment through telemedicine, a licensed practitioner shall have the current minimal technological capabilities to meet all standard of care requirements.
Adequate security measures shall be implemented to ensure that all patient communications, recordings and records remain confidential.
All relevant patient-physician, communications, including those done via an electronic method such as email or other electronic messaging system, shall be documented and filed in the patient's medical record.
Patients shall be informed of alternate forms of communication between the patient and a physician for urgent matters.
All licensees shall continue to be subject to the requirements of the Health Occupations Revision Act (D.C. Official Code, §§ 3-1201 et seq.), and the District of Columbia Municipal Regulations (17 DCMR §§ 4600 et seq.).
Section 4699, DEFINITIONS, Subsection 4699.1, is amended to add the definitions as follows:
In-person - Within the physical sight and presence of another person or persons.
Interpretive Services - Official readings of images, tracings, or specimens through telemedicine. Interpretive services include remote, real-time
3
monitoring of a patient being cared for within a health care facility or home-based setting.
Notice of privacy practices - A written statement that complies with all District and Federal laws.
Physician - A licensed physician.
Physician-patient relationship - A relationship between a physician and a patient in which there is an exchange of an individual ' s protected health information for the purpose of providing patient care treatment or services.
Real-time - A system in which information is provided in such a way as to allow near immediate feedback.
Telemedicine - The practice of medicine by a licensed practitioner to provide patient care, treatment or services, between a licensee in one location and a patient in another location with or without an intervening healthcare provider, through the use of health information and technology communications, subject to the existing standards of care and conduct.
4
Updated August 18, 2017
1
DISTRICT OF
COLUMBIA
MUNICIPAL
REGULATIONS
for
DIETETICS
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
CHAPTER 44DIETETICS Secs.
4400 General Provisions
4401 Term of License
4402 Educational and Experience Requirements
4403 Applicants Educated in Foreign Countries
4404 National Examination
4405 Supervised Practice by Students and Graduates (Registered Dietitians Eligible (RDE)) 4406 Continuing Education Requirements
4407 Approved Continuing Education Programs and Activities 4408 Continuing Education Credits
4409 Definitions
4400 GENERAL PROVISIONS
4400.1 This chapter shall apply to applicants for and holders of a license to practice
dietetics.
4400.2 Chapters 40 (Health Occupations: General Rules), 41 (Health Occupations:
Administrative Procedures), and 45 (Nutrition) of this title shall supplement this
chapter.
4401 TERM OF LICENSE
4401.1 Subject to § 4401.2, a license issued pursuant to this chapter shall expire at 12:00
midnight of November 1st
of each odd-numbered year.
4401.2 If the Director changes the renewal system pursuant to § 4006.3 of Chapter 40 of
this title, a license issued pursuant to this chapter shall expire at 12:00 midnight of
the last day of the month of the birthdate of the holder of the license, or other date
established by the Director.
4402 EDUCATIONAL AND EXPERIENCE REQUIREMENTS
4402.1 Except as provided in § 4403, an applicant for a license shall furnish proof
satisfactory to the Board that the applicant holds a baccalaureate or higher degree,
with a major in human nutrition, foods and nutrition, dietetics, or food systems
management, from an institution that was approved by an accrediting body
recognized by the Council on Postsecondary Accreditation or the Secretary of the
United States Department of Education at the time the applicant graduated, in
accordance with § 702(a) of the Act, D.C. Official Code § 3-1207.01(a) (2001).
4402.2 An applicant shall have completed an American Dietetic Association approved,
planned, continuous, preprofessional experience component in dietetic practice of
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
not less than nine hundred (900) hours under the supervision of a registered
dietitian or licensed dietitian authorized to practice in the jurisdiction where the
preprofessional experience occurs.
4402.3 An applicant who provides evidence of current registration as a registered
dietitian with the Commission on Dietetic Registration of the American dietetic
Association (CDRADA) shall be deemed to have met the education and
experience requirements of this section.
4402.4 An applicant, including a registered dietitian deemed to be qualified under §
4402.3, shall submit a certified transcript of the applicant’s educational record(s)
and an official certificate of graduation to the Board with the completed
application.
4403 APPLICANTS EDUCATED IN FOREIGN COUNTRIES
4403.1 The Board may grant a license to practice dietetics to an applicant who completed
an educational program in a foreign country, if the applicant meets all
requirements of this chapter except § 4402.1.
4403.2 An applicant under this section shall submit with the application a certification
from one of the following that the applicant’s foreign education is equivalent to
the applicable requirements of the Act and this chapter:
(a) A private education evaluation service approved by the Board; or
(b) A college or university approved by an accrediting body recognized by
the Council on Postsecondary Accreditation or the Secretary of the
United States Department of Education.
4403.3 If a document required by this chapter is in a language other than English, an
applicant shall arrange for its translation into English by a translation service
acceptable to the Board and shall submit a translation signed by the translator
attesting to its accuracy.
4404 NATIONAL EXAMINATION
4404.1 To qualify for a license by examination, an applicant shall receive a passing score
on the certification examination sponsored by the CDRADA.
4404.2 Except as provided in § 4404.3, an applicant shall submit the applicant’s
examination results, which have been certified or validated by CDRADA, to the
Board with the completed examination.
4404.3 An applicant who provides written verification of current registration as a
Comment [PV1]: Do you wish to add CNS exam here also?
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
registered dietitian from CDRADA shall be deemed to have met the requirements
of this section.
4404.4 The Board shall waive the examination requirements of the Act and this section
for any applicant who presents evidence satisfactory to the Board of the
following:
(a) That the applicant meets the educational requirements of the Act and
this chapter; and
(b) That the applicant was employed in the practice of dietetics on a
substantially full-time basis for at least three (3) of the five (5) years
immediately preceding March 25, 1986.
4404.5 The application for the waiver shall be received by the Board prior to
March 1988.
4404.6 An applicant under this section shall demonstrate the experience
qualifications under §§ 4404.4 and 4404.5 by submitting the following:
(a) Evidence documenting that at least four thousand five hundred (4,500)
hours of substantially full-time practice were completed over at least
three (3) of the five (5) years immediately preceding March 25, 1986;
(b) Locations and time periods;
(c) Hours of supervised practice;
(d) Nature of practice;
(e) Performance rating or letter of reference from a supervisor; and
(f) The supervisor’s name and position.
4404.7 For purposes of this section, the term “substantially full-time” means at least
thirty (30) hours per week.
4405 SUPERVISED PRACTICE BY STUDENTS AND GRADUATES
(REGISTERED DIETITIANS ELIGIBLE (RDE))
4405.1 The following unlicensed persons may practice dietetics under supervision:
(a) A student fulfilling educational requirements in a program that meets the
requirements of §§ 4402.1, 4402.2, and 4402.3; and
(b) A graduate enrolled in a postgraduate training program recognized by the
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
Board.
4405.2 Only a supervisor shall be authorized to supervise the practice of a student or
graduate.
4405.3 A student or graduate may practice dietetics only in accordance with the Act and
this subtitle.
4405.4 A student or graduate who practices pursuant to this section shall practice only at
a hospital, nursing home, health facility, health education center, business, or
other health care facility considered appropriate for the practice of dietetics.
4405.5 A student or graduate under this section shall not assume administrative or
technical responsibility for the operation of a program dietetics, clinical
service, or unit.
4405.6 All supervised practice shall take place under general or immediate supervision.
4405.7 A student or graduate shall identify himself or herself as such before practicing
under supervision.
4405.8 A supervisor shall be fully responsible for all practice by a student or graduate
during the period of supervision and shall be subject to disciplinary action for any
violation of the Act of this subtitle by the student or graduate.
4405.9 A student or graduate shall not receive compensation of any kind directly or
indirectly from a patient, except for a salary based on hours worked under
supervision.
4405.10 A graduate eligible to practice under § 4405.1(b) may practice for no more than
twelve (12) months or for the duration of the graduate’s postgraduate training
program.
4405.11 A student or graduate shall be subject to all of the applicable provisions of the Act
and this chapter. In accordance with Chapter 41 of this title, the Board may deny
an application for a license by, or take disciplinary action against, a student or
graduate who is found to have violated the Act of this chapter.
4405.12 As used in this section:
(a) “General supervision” means supervision in which the supervisor is
available on the premises or within vocal communication either directly
or by a communication device at the time the student or graduate is
practicing.
(b) “Immediate supervision” means supervision in which the supervisor is
Comment [PV2]: This makes no sense. Do you wish to identify possible supervisors? Dietitian, nutritionist, health care professionals?
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
with the student or graduate and is either discussing or observing the
student’s or graduate’s practice.
(c) “Supervisor” means a registered dietitian licensed under the Act who is
responsible for the supervision of a student or graduate.
4406 CONTINUING EDUCATION REQUIREMENTS
4406.1 Subject to § 4406.2, this section shall apply to applicants for the renewal,
reactivation, or reinstatement of a license for a term expiring April 30, 1991, and
for subsequent terms.
4406.2 This section shall not apply to applicants for an initial license by examination,
reciprocity, or endorsement, nor shall it apply to applicants for the first renewal of
a license.
4406.3 A continuing education credit shall be valid only if it is part of a program or
activity approved by the Board in accordance with § 4407.
4406.4 To qualify for the renewal of a license, an applicant shall have completed thirty
(30) hours of approved continuing education credit during the two (2)-year period
preceding the date the license expires. Beginning with the November 1, 2017 –
October 31, 2019 licensure term, two (2) of the required thirty (30) hours shall be
LGBTQ continuing education.
4406.5 To qualify for the reactivation of a license, a person in inactive status within the
meaning of § 511 of the Act (D.C. Official Code § 3-1205.11 (2016 Repl.)), who
submits an application to reactivate a license shall submit proof of having
completed fifteen (15) hours of approved continuing education credit for each
license year that the applicant was in inactive status, up to a maximum of thirty
(30) hours.
4406.6 To qualify for the reinstatement of a license, an applicant shall submit proof of
having completed fifteen (15) hours of approved continuing education credit for
each year after that the applicant was not licensed, up to a maximum of thirty (30)
hours.
4406.7 An applicant under this section shall prove completion of required continuing
education credits by submitting with the application the following information
with respect to each program:
(a) The name and address of the sponsor of the program;
(b) The name of the program, its location, a description of the subject matter
covered, and the names of the instructors;
Comment [PV3]: Do you wish to include the same changes to this section as in Chapter 45?
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
(c) The dates on which the applicant attended the program;
(d) The hours of credit claimed; and
(e) Verification by the sponsor of completion by signature or stamp.
4406.8 The Board may periodically conduct a random audit of its active licensees to
determine continuing education compliance. Any licensee selected for the audit
shall submit proof of his or her continuing education compliance to the Board
within thirty (30) days of receiving notification of the audit. Failure to timely
respond to the audit notice may subject the licensee to disciplinary action by the
Board.
4407 APPROVED CONTINUING EDUCATION PROGRAMS AND
ACTIVITIES
4407.1 The Board, in its discretion, may approve continuing education programs and
activities that contribute to the growth of an applicant in professional competence
in the practice of dietetics and that meet the other requirements of this section.
4407.2 The Board may approve the following types of continuing education programs, if
the program meets the requirements of § 4407.3:
(a) An undergraduate or graduate course given at an accredited college or
university;
(b) A seminar or workshop;
(c) An educational program given at a conference.
4407.3 To qualify for approval by the Board, a continuing education program shall do the
following:
(a) Be current in its subject matter;
(b) Be developed and taught by qualified individuals; and
(c) Meet one of the following requirements:
(1) Be administered or approved by:
(A) A national, state or local dietetics organization recognized
by the Board;
(B) A health care facility accredited by the Joint Commission
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
for the Accreditation of Hospitals; or
(C) A college or university approved by an accrediting body
recognized by the Council on Postsecondary Accreditation
or the Secretary of the United States Department of
Education; or
(2) Be submitted by the program sponsors to the Board for review no
less than sixty (60) days prior to the date of the presentation and be
approved by the Board.
4407.4 The Board may issue an update a list of approved continuing education programs.
4407.5 An applicant shall have the burden of verifying whether a program is approved by
the Board pursuant to this section prior to attending the program. The applicant
shall also have the burden of verifying the number of continuing education credits
the Board will accept for a program under this section.
4407.6 The Board may approve the following continuing education activities by an
applicant:
(a) Serving as an instructor or speaker at a conference, seminar, workshop, or
in- service training;
(b) Publication of an article in a professional journal or publication of a book
or a chapter in a book or publication of a book review in a professional
journal or bulletin;
(c) Participation in research as a principal investigator or research assistant.
4408 CONTINUING EDUCATION CREDITS
4408.1 The Board may grant continuing education credit in whole hours only, with a
minimum of fifty (50) minutes constituting one (1) credit hour.
4408.2 For approved undergraduate or graduate courses, each semester hour of credit
shall constitute fifteen (15) hours of continuing education credit, and each quarter
hour of credit shall constitute ten (10) hours of continuing education credit.\
4408.3 The Board may grant credit to an applicant who serves as an instructor or speaker
at an approved program for both preparation and presentation time, subject to the
following restrictions:
(a) The maximum amount of credit which may be granted for preparation
time shall be twice the amount of the associated presentation time;
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
(b) The maximum amount of credit which may be granted pursuant to this
subsection shall be fifty percent (50%) of an applicant’s continuing
education requirement;
(c) If an applicant has previously received credit in connection with a
particular presentation, the Board shall not grant credit for a subsequent
presentation unless it involves either a different subject or substantial
additional research concerning the same subject; and
(d) The presentation shall have been completed during the period for which
credit is claimed.
4408.4 The Board may grant an applicant who is an author or editor of a published book
fifteen (15) continuing education credits, if the book has been published or
accepted for publication during the period for which credit is claimed, and the
applicant submits proof of this fact in the application.
4408.5 The Board may grant an applicant who is an author of a published original paper
six (6) continuing education credits, subject to the same restrictions set forth for
books in § 4408.4.
4408.6 The Board may grant an applicant who is the sole author of a published book
review, review paper, or abstract, two (2) continuing education credits, subject to
the same restrictions set forth for books in § 4408.4.
4408.7 The Board may grant an applicant who is able to demonstrate participation in
research, either as a principal investigator or as a research assistant, six (6)
continuing education credits.
4408.8 The Board may grant an applicant who is the co-author of a published book
review, review paper, abstract, or original paper two (2) continuing education
credits, subject to the same restrictions set forth for books in § 4408.5. A
maximum of four (4) continuing education credits per year may be granted
pursuant to this subsection.
4499 DEFINITIONS
4499.1 As used in this chapter, the following terms and phrases shall have the meanings
ascribed:
Applicant – a person applying for a license to practice dietetics under this chapter.
Board – the Board of Dietetics and Nutrition established by § 202 of the Act, D.C. Official
Code § 3-1202.02 (2001).
Title 17 District of Columbia Municipal Regulations
Updated August 18/ 2017
CDRADA – Commissioner on dietetic Registration of the American Dietetic Association.
Dietitian – a person licensed authorized to practice dietetics under the Act. Licensure to practice
dietetics pursuant to this chapter shall also entitle the licensee to use the title of
nutritionist.in the relevant jurisdiction
Nutritionist – a person licensed authorized to practice nutrition under the Act in the relevant
jurisdiction.
Registered dietitian – a person registered as a dietitian by the Commission on Dietetic
Registration of the American Dietetic Association.
4499.2 The definitions in § 4099 of Chapter 40 of this title are incorporated by reference
and are made applicable to this chapter.