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

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

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.



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




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.




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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.




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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;



(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;



(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.



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



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



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.



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



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



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.



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



(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



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)



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



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:



(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



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



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


nutrition.


Administrative Procedures), and 44 (Dietetics) of this title shall supplement this

chapter.



midnight on November 1st






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;



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.



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.


4503.1 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:



(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;


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 .



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.



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.


4506.1 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.







meaning of § 511 of the Act( D.C. Official Code § 3-1205.11(2016 Repl.)) who



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.



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.

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;



(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.


4508.1 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.



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.




applicant submits proof of this fact with the application.



books in § 4508.8.


review, article, or abstract, six (6) continuing education credits, subject to the

same restrictions set forth for books in § 4508.8.




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.



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.



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:



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.


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


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


dietetics.


Administrative Procedures), and 45 (Nutrition) of this title shall supplement this

chapter.



midnight of November 1st






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



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.


4403.1 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?



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:


requirements of §§ 4402.1, 4402.2, and 4402.3; and

(b) A graduate enrolled in a postgraduate training program recognized by the



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.



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?



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.


4406.1 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.







meaning of § 511 of the Act (D.C. Official Code § 3-1205.11 (2016 Repl.)), who



license year that the applicant was in inactive status, up to a maximum of thirty

(30) hours.



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?



(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



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.


4408.1 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.\



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;



(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.




applicant submits proof of this fact in the application.



books in § 4408.4.


review, review paper, or abstract, two (2) continuing education credits, subject to

the same restrictions set forth for books in § 4408.4.




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).



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.


and are made applicable to this chapter.

NORTH CAPITOL ST NE ND FLR WASHINGTON DC March 8, 2018 … · Board of Dietetics and Nutrition...

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