HB 449

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