House Bill 2173

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    Florida House of Representatives - 1999                HB 2173

        By Representative Greenstein






  1                      A bill to be entitled

  2         An act relating to dietetics and nutrition

  3         practice; revising part X of chapter 468, F.S.,

  4         relating to dietetics and nutrition practice,

  5         to revise terminology and include regulatory

  6         provisions for clinical nutrition practice;

  7         amending s. 468.501, F.S.; revising the short

  8         title; amending s. 468.502, F.S.; revising

  9         purpose and intent; amending s. 468.503, F.S.;

10         revising and providing definitions; amending s.

11         468.504, F.S., relating to the requirement to

12         be licensed, to conform; amending s. 468.505,

13         F.S.; revising and providing exemptions from

14         regulation; correcting a cross reference;

15         amending s. 468.506, F.S.; renaming the

16         Dietetics and Nutrition Practice Council;

17         creating the Clinical Nutrition Practice

18         Council; providing for appointment of members;

19         providing powers and duties; providing for

20         compensation; reenacting s. 468.507, F.S., to

21         provide rulemaking authority to the Board of

22         Medicine for such regulation; reenacting and

23         amending s. 468.508, F.S.; providing rulemaking

24         authority to the board to establish fees;

25         clarifying a fee; amending s. 468.509, F.S.;

26         conforming terminology; amending s. 468.51,

27         F.S.; providing requirements for licensure as a

28         clinical nutritionist; providing for fees;

29         providing for relicensure of nutrition

30         counselors as clinical nutritionists; amending

31         s. 468.511, F.S., relating to temporary permits

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  1         to practice dietetics and nutrition, to

  2         conform; creating s. 468.5115, F.S.; providing

  3         requirements for a temporary permit to practice

  4         clinical nutrition; amending s. 468.512, F.S.;

  5         authorizing the use of specified titles

  6         relating to dietetics/nutrition practice and

  7         clinical nutrition practice; amending s.

  8         468.513, F.S.; conforming terminology; creating

  9         s. 468.5135, F.S.; providing requirements for

10         licensure as a clinical nutritionist by

11         endorsement; providing for fees; amending s.

12         468.514, F.S.; conforming terminology;

13         reenacting and amending s. 468.515, F.S.;

14         granting the board rulemaking authority

15         relating to inactive licenses and the

16         requirements to reactivate them, including

17         continuing education; conforming terminology;

18         amending s. 468.517, F.S.; prohibiting certain

19         acts; providing a penalty; amending s. 468.518,

20         F.S.; providing grounds for disciplinary

21         action; providing penalties; requiring council

22         concurrence for the suspension or revocation of

23         a licensee under its jurisdiction; amending s.

24         20.43, F.S.; conforming terminology; amending

25         ss. 501.0573 and 501.0575, F.S.; correcting

26         cross references; amending ss. 627.6408 and

27         627.65745, F.S.; providing that health

28         insurance policies may require that nutrition

29         counseling required in conjunction with other

30         diabetes treatment services be provided by a

31         licensed dietitian/nutritionist or licensed

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  1         clinical nutritionist; providing an effective

  2         date.

  3

  4  Be It Enacted by the Legislature of the State of Florida:

  5

  6         Section 1.  Section 468.501, Florida Statutes, is

  7  amended to read:

  8         468.501  Short title.--This part may be cited as the

  9  "Dietetics/Nutrition and Clinical Nutrition Practices

10  Dietetics and Nutrition Practice Act."

11         Section 2.  Section 468.502, Florida Statutes, is

12  amended to read:

13         468.502  Purpose and intent.--The Legislature finds

14  that the practice of dietetics/nutrition dietetics and

15  nutrition or clinical nutrition counseling by unskilled and

16  incompetent practitioners presents a danger to the public

17  health and safety. The Legislature further finds that it is

18  difficult for the public to make informed choices about

19  dietitian/nutritionists dietitians and clinical nutritionists

20  and that the consequences of wrong choices could seriously

21  endanger the public health and safety. The sole legislative

22  purpose in enacting this part is to ensure that every person

23  who practices dietetics/nutrition dietetics and nutrition or

24  clinical nutrition counseling in this state meets minimum

25  requirements for safe practice. It is the legislative intent

26  that any person practicing dietetics/nutrition dietetics and

27  nutrition or clinical nutrition counseling who falls below

28  minimum competency or who otherwise presents a danger to the

29  public be prohibited from practicing in this state. It is also

30  the intent of the Legislature that the practice of nutrition

31  counseling be authorized and regulated solely within the

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  1  limits expressly provided by this part and any rules adopted

  2  pursuant thereto.

  3         Section 3.  Section 468.503, Florida Statutes, is

  4  amended to read:

  5         468.503  Definitions.--As used in this part:

  6         (1)  "Agency" means the Agency for Health Care

  7  Administration.

  8         (1)(2)  "Board" means the Board of Medicine.

  9         (2)  "Certified clinical nutritionist" means an

10  individual certified by the Clinical Nutrition Certification

11  Board, or its successor.

12         (3)  "Certified nutritionist" means an individual

13  certified by the Certified Nutritionists International Board

14  of Standards, or its successor.

15         (4)  "Certified nutrition specialist" means an

16  individual certified by the Certification Board of Nutrition

17  Specialists, or its successor.

18         (5)  "Certified specialist in human nutrition" means an

19  individual certified by the American Board of Nutrition, or

20  its successor.

21         (6)  "Clinical nutrition" means the application of the

22  principles of nutrition, biochemistry, physiology, and

23  behavioral and social sciences to achieve, maintain, and

24  restore optimal development and functioning of the human body

25  and to prevent diet-linked illnesses throughout the life cycle

26  for individuals, groups, or both and is based on the concept

27  of biochemical individuality.

28         (7)  "Clinical nutrition practice" shall include

29  assessing an individual's wellness status as it relates to his

30  or her individual metabolic-biochemical, psychosocial, and

31  physiological responses to the environment; maintaining the

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  1  supply to the body of all the nutrients required for optimal

  2  health and prevention of disease; utilizing laboratory tests

  3  and other relevant information to assess nutritional

  4  deficiencies and excesses; developing eating plans to meet

  5  individual nutritional needs; and recommending food, food

  6  products, and nutrients to optimize health and prevent

  7  disease.

  8         (8)  "Council" means the Dietetics/Nutrition Practice

  9  Council or the Clinical Nutrition Practice Council, as the

10  context requires.

11         (9)  "Department" means the Department of Health.

12         (10)(3)  "Dietetics" means the integration and

13  application of the principles derived from the sciences of

14  nutrition, biochemistry, food, physiology, and management and

15  from the behavioral and social sciences to achieve and

16  maintain a person's health throughout the person's life. It is

17  an integral part of preventive, diagnostic, curative, and

18  restorative health care of individuals, groups, or both.

19         (11)(4)  "Dietetics/nutrition Dietetics and nutrition

20  practice" shall include assessing nutrition needs and status

21  using appropriate data; recommending appropriate dietary

22  regimens, nutrition support, and nutrient intake; improving

23  health status through nutrition research, counseling, and

24  education; and developing, implementing, and managing

25  nutrition care systems, which includes, but is not limited to,

26  evaluating, modifying, and maintaining appropriate standards

27  of high quality in food and nutrition care services.

28         (12)(5)  "Dietetic technician" means a person who

29  assists in the provision of dietetic and nutrition services

30  under the supervision of a qualified professional.

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  1         (13)  "Licensed clinical nutritionist" means a person

  2  licensed under this part to practice clinical nutrition.

  3         (14)(6)  "Licensed dietitian/nutritionist" means a

  4  person licensed under this part to practice dietetics and

  5  nutrition pursuant to s. 468.509.

  6         (15)(7)  "Licensed nutrition counselor" means a person

  7  licensed as such during the period from July 1, 1988, to March

  8  30, 1997 pursuant to s. 468.51.

  9         (16)(8)  "Nutrition assessment" means the evaluation of

10  the nutrition needs of individuals or groups, using

11  appropriate data to determine nutrient needs or status and

12  make appropriate nutrition recommendations.

13         (17)(9)  "Nutrition counseling" means advising and

14  assisting individuals or groups on appropriate nutrition

15  intake by integrating information from the nutrition

16  assessment.

17         (18)(10)  "Preprofessional experience component" means

18  a planned and continuous supervised practice experience in

19  dietetics/nutrition or in clinical nutrition, during which

20  dietitian/nutritionists are supervised by licensed

21  dietitian/nutritionists and clinical nutritionists are

22  supervised by licensed clinical nutritionists or by other

23  health professionals approved by the Clinical Nutrition

24  Practice Council who have practiced clinical nutrition for at

25  least 3 of the 5 years immediately preceding such supervision

26  dietetics or nutrition.

27         (19)(11)  "Registered dietitian" means an individual

28  registered with the Commission on Dietetic Registration, the

29  accrediting body of the American Dietetic Association.

30         Section 4.  Section 468.504, Florida Statutes, is

31  amended to read:

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  1         468.504  License required.--No person may engage for

  2  remuneration in dietetics/nutrition dietetics and nutrition

  3  practice or clinical nutrition practice counseling or hold

  4  himself or herself out as a practitioner of

  5  dietetics/nutrition dietetics and nutrition practice or

  6  clinical nutrition practice counseling unless the person is

  7  licensed in accordance with the provisions of this part.

  8         Section 5.  Subsections (1) and (2) of section 468.505,

  9  Florida Statutes, 1998 Supplement, are amended, and subsection

10  (5) is added to said section, to read:

11         468.505  Exemptions; exceptions.--

12         (1)  Nothing in this part may be construed as

13  prohibiting or restricting the practice, services, or

14  activities of:

15         (a)  A person licensed in this state under chapter 457,

16  chapter 458, chapter 459, chapter 460, chapter 461, chapter

17  462, chapter 463, chapter 464, chapter 465, chapter 466,

18  chapter 480, chapter 490, or chapter 491, when engaging in the

19  profession or occupation for which he or she is licensed, or

20  of any person employed by and under the supervision of the

21  licensee when rendering services within the scope of the

22  profession or occupation of the licensee.

23         (b)  A person employed as a dietitian by the government

24  of the United States, if the person engages in dietetics

25  solely under direction or control of the organization by which

26  the person is employed.

27         (c)  A person employed as a cooperative extension home

28  economist.

29         (d)  A person pursuing a course of study leading to a

30  degree in dietetics/nutrition dietetics and nutrition from a

31  program or school accredited pursuant to s. 468.509(2) or to a

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  1  degree including coursework in clinical nutrition from a

  2  program or school accredited pursuant to s. 468.51(2), if the

  3  activities and services constitute a part of a supervised

  4  course of study and if the person is designated by a title

  5  that clearly indicates the person's status as a student or

  6  trainee.

  7         (e)  A person fulfilling the supervised experience

  8  component of s. 468.509 or s. 489.51, if the activities and

  9  services constitute a part of the experience necessary to meet

10  the requirements of s. 468.509 or s. 489.51.

11         (f)  Any dietitian/nutritionist dietitian or

12  nutritionist from another state practicing dietetics/nutrition

13  dietetics or nutrition incidental to a course of study when

14  taking or giving a postgraduate course or other course of

15  study in this state, provided such dietitian/nutritionist

16  dietitian or nutritionist is licensed in another jurisdiction

17  or is a registered dietitian or holds an appointment on the

18  faculty of a school accredited pursuant to s. 468.509(2).

19         (g)  Any nutrition counselor or clinical nutritionist

20  from another state practicing clinical nutrition incidental to

21  a course of study when taking or giving a postgraduate course

22  or other course of study in this state, provided such

23  nutrition counselor or clinical nutritionist is licensed in

24  another jurisdiction or holds an appointment on the faculty of

25  a school accredited pursuant to s. 468.51(2).

26         (h)(g)  A person who markets or distributes food, food

27  materials, or dietary supplements, or any person who engages

28  in the explanation of the use and benefits of those products

29  or the preparation of those products, if that person does not

30  engage for a fee in dietetics/nutrition dietetics and

31  nutrition practice or clinical nutrition practice counseling.

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  1         (i)(h)  A person who markets or distributes food, food

  2  materials, or dietary supplements, or any person who engages

  3  in the explanation of the use of those products or the

  4  preparation of those products, as an employee of an

  5  establishment permitted pursuant to chapter 465.

  6         (j)(i)  An educator who is in the employ of a nonprofit

  7  organization approved by either the council; a federal, state,

  8  county, or municipal agency, or other political subdivision;

  9  an elementary or secondary school; or an accredited

10  institution of higher education the definition of which, as

11  provided in s. 468.509(2) or s. 489.51(2), as applicable,

12  applies to other sections of this part, insofar as the

13  activities and services of the educator are part of such

14  employment.

15         (k)(j)  Any person who provides weight control services

16  or related weight control products, provided the program has

17  been reviewed by, consultation is available from, and no

18  program change can be initiated without prior approval by a

19  licensed dietitian/nutritionist, a dietitian or nutritionist

20  licensed in another state that has licensure requirements

21  considered by the Dietetics/Nutrition Practice Council to be

22  at least as stringent as the requirements for licensure under

23  this part, or a registered dietitian.

24         (l)(k)  A person employed by a hospital licensed under

25  chapter 395, or by a nursing home or assisted living facility

26  licensed under part II or part III of chapter 400, or by a

27  continuing care facility certified under chapter 651, if the

28  person is employed in compliance with the laws and rules

29  adopted thereunder regarding the operation of its dietetic

30  department.

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  1         (m)(l)  A person employed by a nursing facility exempt

  2  from licensing under s. 395.002(13)(14), or a person exempt

  3  from licensing under s. 464.022.

  4         (n)(m)  A person employed as a dietetic technician.

  5         (2)  Nothing in this part may be construed to prohibit

  6  or limit any person from the free dissemination of

  7  information, or from conducting a class or seminar or giving a

  8  speech, related to nutrition.

  9         (5)  Nothing in this part may be construed to prevent

10  qualified members of other professions or occupations such as

11  physicians, osteopathic physicians, nurses, acupuncturists,

12  chiropractic physicians, social workers, massage therapists,

13  or naturopathic, homeopathic, macrobiotic, ayurvedic, or

14  herbal practitioners from doing work of a clinical nutrition

15  nature consistent with the accepted standards of their

16  respective professions or occupations, provided they do not

17  hold themselves out to the public by any title stating or

18  implying that they are dietitian/nutritionists or clinical

19  nutritionists or are licensed to practice dietetics/nutrition

20  or clinical nutrition unless they are licensed accordingly.

21         Section 6.  Section 468.506, Florida Statutes, 1998

22  Supplement, is amended to read:

23         468.506  Dietetics/Nutrition Dietetics and Nutrition

24  Practice Council and Clinical Nutrition Practice Council.--

25         (1)(a)  There are is created the Dietetics/Nutrition

26  Dietetics and Nutrition Practice Council and the Clinical

27  Nutrition Practice Council, both under the supervision of the

28  board. The Dietetics/Nutrition Practice Council shall advise

29  the board only on matters relating to dietetics/nutrition

30  practice, and the Clinical Nutrition Practice Council shall

31  advise the board only on matters relating to clinical

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  1  nutrition practice. Each The council shall consist of four

  2  persons licensed under this part in the applicable practice

  3  and one consumer who is 60 years of age or older. Council

  4  members shall be appointed by the board from nominations made

  5  by the respective professional associations whose members are

  6  licensed under this part in the practice covered by the

  7  council. Licensed members shall be appointed based on the

  8  proportion of licensees within each of the respective

  9  disciplines. Members shall be appointed for 4-year staggered

10  terms. In order to be eligible for appointment, each licensed

11  member must have been a practicing licensee under this part

12  for at least 3 years immediately prior to his or her

13  appointment. No council member shall serve more than two

14  successive terms.

15         (b)  Notwithstanding paragraph (a), with respect to the

16  initial members of the Clinical Nutrition Practice Council, in

17  order to stagger terms the board shall appoint the consumer

18  member and one licensee member for terms of 4 years each, two

19  licensee members for terms of 3 years each, and one licensee

20  member for a term of 2 years. Thereafter, members shall be

21  appointed to the council for 4-year terms. Each of the initial

22  members, except the consumer member, must be eligible to be

23  licensed at the time of appointment and must become licensed

24  by October 1, 2000. Effective on or after October 1, 2003, in

25  order to be eligible for appointment, each licensee member

26  must have been a practicing licensee under this part in

27  clinical nutrition practice for at least 3 years immediately

28  prior to his or her appointment. This paragraph is repealed

29  October 1, 2004.

30         (2)  The board may delegate such powers and duties to

31  each the council as it may deem proper to carry out the

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  1  operations and procedures necessary to effectuate the

  2  provisions of this part. However, the powers and duties

  3  delegated to the council by the board must encompass both

  4  dietetics and nutrition practice and nutrition counseling.

  5         (3)  Any time there is a vacancy on a the council, any

  6  professional association composed of persons licensed under

  7  this part in the practice covered by that council may

  8  recommend licensees to fill the vacancy to the board in a

  9  number equal to at least twice the number of vacancies to be

10  filled, and the board may appoint from the submitted list, in

11  its discretion, any of those persons so recommended. Any

12  professional association composed of persons licensed under

13  this part in the practice covered by a council may file an

14  appeal regarding an a council appointment to that council with

15  the secretary director of the department agency, whose

16  decision shall be final.

17         (4)  The board shall fix council members' compensation

18  and pay their expenses in the same manner as provided in s.

19  455.534.

20         Section 7.  Section 468.507, Florida Statutes, 1998

21  Supplement, is reenacted to read:

22         468.507  Authority to adopt rules.--The board has

23  authority to adopt rules pursuant to ss. 120.536(1) and 120.54

24  to implement the provisions of this part and part II of

25  chapter 455 conferring duties upon it. The powers and duties

26  of the board as set forth in this part shall in no way limit

27  or interfere with the powers and duties of the board as set

28  forth in chapter 458. All powers and duties of the board set

29  forth in this part shall be supplemental and additional powers

30  and duties to those conferred upon the board by chapter 458.

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  1         Section 8.  Section 468.508, Florida Statutes, is

  2  reenacted and amended to read:

  3         468.508  Fees.--The board shall, by rule, establish

  4  fees to be paid for applications and examination,

  5  reexamination, licensing and renewal, licensure by

  6  endorsement, temporary permits, renewal of temporary permits,

  7  renewal of inactive licenses, reactivation of inactive

  8  licenses, recordmaking, and recordkeeping. The board shall

  9  establish fees which are adequate to administer and implement

10  the provisions of this part.

11         (1)  The application fee shall not exceed $100 and

12  shall not be refundable.

13         (2)  The examination fee shall not exceed $500 and

14  shall be refundable if the applicant is found to be ineligible

15  to take the licensure examination.

16         (3)  The initial licensure fee shall not exceed $500.

17         (4)  The fee for reexamination shall not exceed $250.

18         (5)  The biennial renewal fee shall not exceed $500.

19         (6)  The fee for licensure by endorsement shall not

20  exceed $350.

21         (7)  The fee for a temporary permit shall not exceed

22  $200.

23         (8)  The fee for reactivation of an inactive license

24  shall not exceed $50.

25         Section 9.  Section 468.509, Florida Statutes, is

26  amended to read:

27         468.509  Dietitian/nutritionist; requirements for

28  licensure.--

29         (1)  Any person desiring to be licensed as a

30  dietitian/nutritionist shall apply to the department agency to

31  take the licensure examination.

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  1         (2)  The department agency shall examine any applicant

  2  for licensure as a dietitian/nutritionist who the board

  3  certifies has completed the application form and remitted the

  4  application and examination fees specified in s. 468.508 and

  5  who:

  6         (a)1.  Possesses a baccalaureate or postbaccalaureate

  7  degree with a major course of study in human nutrition, food

  8  and nutrition, dietetics, or food management, or an equivalent

  9  major course of study, from a school or program accredited, at

10  the time of the applicant's graduation, by the appropriate

11  accrediting agency recognized by the Commission on Recognition

12  of Postsecondary Accreditation and the United States

13  Department of Education; and

14         2.  Has completed a preprofessional experience

15  component of not less than 900 hours or has education or

16  experience determined to be equivalent by the board; or

17         (b)1.  Has an academic degree, from a foreign country,

18  that has been validated by an accrediting agency approved by

19  the United States Department of Education as equivalent to the

20  baccalaureate or postbaccalaureate degree conferred by a

21  regionally accredited college or university in the United

22  States;

23         2.  Has completed a major course of study in human

24  nutrition, food and nutrition, dietetics, or food management;

25  and

26         3.  Has completed a preprofessional experience

27  component of not less than 900 hours or has education or

28  experience determined to be equivalent by the board.

29         (3)  The board shall waive the examination requirement

30  for an applicant for licensure as a dietitian/nutritionist who

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  1  presents evidence satisfactory to the board that the applicant

  2  is a registered dietitian.

  3         (4)  The department agency shall license as a

  4  dietitian/nutritionist any applicant who has remitted the

  5  initial licensure fee and has passed the examination in

  6  accordance with this section.

  7         Section 10.  Section 468.51, Florida Statutes, is

  8  amended to read:

  9         468.51  Clinical nutritionist; requirements of

10  licensure; relicensure of nutrition counselor as clinical

11  nutritionist; renewal of licensure.--

12         (1)  Any person desiring to be licensed as a clinical

13  nutritionist shall apply to the department to take the

14  licensure examination.

15         (2)  The department shall examine any applicant for

16  licensure as a clinical nutritionist who the board certifies

17  has completed the application form and remitted the

18  application and examination fees specified in s. 468.508 and

19  who:

20         (a)1.  Possesses a baccalaureate or postbaccalaureate

21  degree, which includes at least 15 semester hours in science

22  and 15 semester hours in human nutrition, or the equivalent in

23  quarter hours, as approved by the American Council on

24  Education, from a school or program accredited, at the time of

25  the applicant's graduation, by the appropriate accrediting

26  agency recognized by the Commission on Recognition of

27  Postsecondary Accreditation and the United States Department

28  of Education; and

29         2.  Has completed any of the following experience

30  requirements:

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  1         a.  A preprofessional experience component of not less

  2  than 900 hours, focused on nutrition knowledge, assessment and

  3  evaluation, counseling, and professional practice management

  4  and responsibility, under a licensed clinical nutritionist or

  5  under a licensed nutrition counselor who has practiced for at

  6  least 3 of the 5 years immediately preceding such supervision;

  7         b.  At least 2 years of postbaccalaureate paid

  8  professional experience in the field of clinical nutrition;

  9         c.  At least 1 year of post-master's degree or

10  postdoctoral degree paid professional experience in the field

11  of clinical nutrition; or

12         d.  Comparable experience to the satisfaction of the

13  board that the applicant is competent to practice as a

14  licensed clinical nutritionist; or

15         (b)1.  Has an academic degree, from another state or

16  foreign country, that has been validated by an accrediting

17  agency approved by the United States Department of Education

18  as equivalent to the baccalaureate or postbaccalaureate degree

19  conferred by an accredited college or university in the United

20  States;

21         2.  Has completed a course of study, as recommended by

22  the Clinical Nutrition Practice Council and approved by the

23  board, which is substantially equivalent to the course of

24  study required for a degree under subparagraph (a)1.; and

25         3.a.  Has completed a preprofessional experience

26  component of not less than 900 hours with a licensed clinical

27  nutritionist, a licensed nutrition counselor, a clinical

28  nutritionist, a physician licensed under chapter 458, chapter

29  459, or chapter 460 who is trained in clinical nutrition, or

30  any other comparably trained person approved by the board; or

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  1         b.  Has education or experience determined by the board

  2  to be equivalent.

  3         (3)  The department shall license as a clinical

  4  nutritionist any applicant who has remitted the initial

  5  licensure fee and has passed the examination in accordance

  6  with this section.

  7         (4)  Notwithstanding any provision of this section or

  8  part to the contrary, any person previously certified as

  9  qualified by the board and holding a current, valid license to

10  practice as a nutrition counselor in this state which was

11  issued during the period from July 1, 1988, to March 30, 1997,

12  based upon documentation that the person was employed as a

13  practitioner of nutrition counseling previous to and on April

14  1, 1988, shall be eligible to renew his or her license as a

15  clinical nutritionist pursuant to s. 468.514 or apply for

16  licensure as a clinical nutritionist pursuant to s.

17  468.5135(3). An actively licensed nutrition counselor on and

18  after the effective date of this act shall be considered the

19  equivalent of a licensed clinical nutritionist for all

20  purposes of this part until failure to apply for relicensure

21  pursuant to s. 468.5135(3) within the time allowed or failure

22  to renew the license pursuant to s. 468.514, whichever occurs

23  last.

24         Section 11.  Section 468.511, Florida Statutes, is

25  amended to read:

26         468.511  Dietitian/nutritionist; temporary permit.--

27         (1)  A temporary permit to practice dietetics/nutrition

28  dietetics and nutrition may be issued by the board on the

29  filing of an application, payment of a temporary permit fee,

30  and the submission of evidence of the successful completion of

31

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  1  the educational requirement under s. 468.509.  The initial

  2  application shall be signed by the supervising licensee.

  3         (2)  A person practicing dietetics/nutrition under a

  4  temporary permit shall be under the supervision and direction

  5  of a licensed dietitian/nutritionist.

  6         (3)  A temporary permit to practice dietetics/nutrition

  7  shall expire 1 year from the date of issuance.

  8         (4)  One extension of a temporary permit to practice

  9  dietetics/nutrition may be granted for good cause shown.

10         (5)  If the board determines that an applicant is

11  qualified to be licensed by endorsement under s. 468.513, the

12  board may issue the applicant a temporary permit to practice

13  dietetics/nutrition dietetics and nutrition until the next

14  board meeting at which license applications are to be

15  considered, but not for a longer period of time.

16         (6)  If the board determines that an applicant has not

17  passed an examination recognized by the board and is not

18  qualified to be licensed by endorsement, but has otherwise met

19  all the requirements of s. 468.509 and has made application

20  for the next scheduled examination, the board may issue the

21  applicant a temporary permit allowing him or her to practice

22  dietetics/nutrition dietetics and nutrition under the

23  supervision of a licensed dietitian/nutritionist until

24  notification of the results of the examination.

25         Section 12.  Section 468.5115, Florida Statutes, is

26  created to read:

27         468.5115  Clinical nutritionist; temporary permit.--

28         (1)  A temporary permit to practice clinical nutrition

29  may be issued by the board on the filing of an application,

30  payment of a temporary permit fee, and the submission of

31  evidence of the successful completion of the educational

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  1  requirement under s. 468.51. The initial application shall be

  2  signed by the supervising licensee.

  3         (2)  A person practicing clinical nutrition under a

  4  temporary permit shall be under the supervision and direction

  5  of a licensed clinical nutritionist.

  6         (3)  A temporary permit to practice clinical nutrition

  7  shall expire 1 year from the date of issuance.

  8         (4)  One extension of a temporary permit to practice

  9  clinical nutrition may be granted for good cause shown.

10         (5)  If the board determines that an applicant is

11  qualified to be licensed by endorsement under s. 468.5135, the

12  board may issue the applicant a temporary permit to practice

13  clinical nutrition until the next board meeting at which

14  license applications are to be considered, but not for a

15  longer period of time.

16         (6)  If the board determines that an applicant has not

17  passed the examination required by the board and is not

18  qualified to be licensed by endorsement, but has otherwise met

19  all the requirements of s. 468.51 and has made application for

20  the next scheduled examination, the board may issue the

21  applicant a temporary permit allowing him or her to practice

22  clinical nutrition under the supervision of a licensed

23  clinical nutritionist until notification of the results of the

24  examination.

25         Section 13.  Subsection (1) of section 468.512, Florida

26  Statutes, is amended to read:

27         468.512  License to be displayed.--

28         (1)(a)  A licensed dietitian/nutritionist may use the

29  words "dietitian/nutritionist," "licensed

30  dietitian/nutritionist," "dietitian," "licensed dietitian,"

31  "nutritionist," or "licensed nutritionist," in connection with

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  1  the licensee's name or place of business, to denote licensure

  2  under this part.

  3         (b)  A licensed clinical nutritionist nutrition

  4  counselor may use the words "clinical nutritionist," "licensed

  5  clinical nutritionist," "nutrition counselor," "licensed

  6  nutrition counselor," "nutritionist," or "licensed

  7  nutritionist," in connection with the licensee's name or place

  8  of business, to denote licensure under this part.

  9         Section 14.  Section 468.513, Florida Statutes, 1998

10  Supplement, is amended to read:

11         468.513  Dietitian/nutritionist; licensure by

12  endorsement.--

13         (1)  The department agency shall issue a license to

14  practice dietetics/nutrition dietetics and nutrition by

15  endorsement to any applicant who the board certifies as

16  qualified, upon receipt of a completed application and the

17  fees specified in s. 468.508.

18         (2)  The board shall certify as qualified for licensure

19  by endorsement under this section any applicant who:

20         (a)  Presents evidence satisfactory to the board that

21  he or she is a registered dietitian; or

22         (b)  Holds a valid license to practice

23  dietetics/nutrition dietetics or nutrition issued by another

24  state, district, or territory of the United States, if the

25  criteria for issuance of such license are determined by the

26  board to be substantially equivalent to or more stringent than

27  those of this state.

28         (3)  The department agency shall not issue a license by

29  endorsement under this section to any applicant who is under

30  investigation in any jurisdiction for any act which would

31  constitute a violation of this part or part II of chapter 455

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  1  until such time as the investigation is complete and

  2  disciplinary proceedings have been terminated.

  3         Section 15.  Section 468.5135, Florida Statutes, is

  4  created to read:

  5         468.5135  Clinical nutritionist; licensure by

  6  endorsement.--

  7         (1)  The department shall issue a license to practice

  8  clinical nutrition by endorsement to any applicant who the

  9  board certifies as qualified, upon receipt of a completed

10  application and the fees specified in s. 468.508.

11         (2)  The board shall certify as qualified for licensure

12  by endorsement under this section any applicant who holds a

13  valid license to practice as a clinical nutritionist or a

14  nutrition counselor issued by another state, district, or

15  territory of the United States, if the criteria for issuance

16  of such license are determined by the board to be

17  substantially equivalent to or more stringent than those of

18  this state.

19         (3)  The department shall issue a license without

20  examination to any applicant for licensure as a clinical

21  nutritionist who held a valid, active license in this state as

22  a nutrition counselor on the effective date of this act and

23  remained actively licensed until issued the new license as a

24  clinical nutritionist. This subsection is repealed October 1,

25  2004.

26         (4)  The department, upon recommendation of the

27  Clinical Nutrition Practice Council, may issue a license

28  without examination to an applicant who otherwise meets the

29  requirements for licensure as a clinical nutritionist under s.

30  468.51 or provides to the council satisfactory evidence that

31  he or she is and has been in paid professional practice in the

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  1  field of clinical nutrition for 3 of the 5 years immediately

  2  preceding the effective date of this act. The council, in its

  3  discretion, may waive the educational requirements for a

  4  applicant if it determines that an applicant's combined

  5  professional credentials and experience meet the intent of

  6  this part. This subsection is repealed October 1, 2004.

  7         (5)  The department shall not issue a license by

  8  endorsement under this section to any applicant who is under

  9  investigation in any jurisdiction for any act which would

10  constitute a violation of this part or chapter 455 until such

11  time as the investigation is complete and disciplinary

12  proceedings have been terminated.

13         Section 16.  Section 468.514, Florida Statutes, is

14  amended to read:

15         468.514  Renewal of license.--

16         (1)  The department agency shall renew a license under

17  this part upon receipt of the renewal application, fee, and

18  proof of the successful completion of continuing education

19  requirements as determined by the board.

20         (2)  The department agency shall adopt rules

21  establishing a procedure for the biennial renewal of licenses

22  under this part.

23         Section 17.  Section 468.515, Florida Statutes, is

24  reenacted and amended to read:

25         468.515  Inactive status.--

26         (1)  A license under this part which has become

27  inactive may be reactivated pursuant to this section.

28         (2)  The department agency shall reactivate a license

29  under this part upon receipt of the reactivation application,

30  fee, and proof of the successful completion of continuing

31  education prescribed by the board.

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  1         (3)  The board shall adopt rules relating to licenses

  2  under this part which have become inactive and for the

  3  reactivation of inactive licenses. The board shall prescribe,

  4  by rule, continuing education requirements for reactivating a

  5  license.  The continuing education requirements for

  6  reactivating a license may not exceed 20 classroom hours for

  7  each year the license was inactive.

  8         Section 18.  Section 468.517, Florida Statutes, is

  9  amended to read:

10         468.517  Prohibitions; penalties.--

11         (1)  A person may not knowingly:

12         (a)  Engage in dietetics/nutrition dietetics and

13  nutrition practice or clinical nutrition practice nutrition

14  counseling for remuneration unless the person is licensed

15  under this part;

16         (b)  Use the name or title "dietitian," "licensed

17  dietitian," "nutritionist," "licensed nutritionist,"

18  "dietitian/nutritionist," "licensed dietitian/nutritionist,"

19  "nutrition counselor," or "licensed nutrition counselor,"

20  "clinical nutritionist," or "licensed clinical nutritionist,"

21  or any other words, letters, abbreviations, or insignia

22  indicating or implying that he or she is a dietitian,

23  nutritionist, dietitian/nutritionist, clinical nutritionist,

24  or nutrition counselor, or otherwise hold himself or herself

25  out as such, unless the person is the holder of a valid

26  license issued under this part;

27         (c)  Present as his or her own the license of another;

28         (d)  Give false or forged evidence to the board or a

29  member thereof;

30

31

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  1         (e)  Use or attempt to use a license that has been

  2  suspended, revoked, or placed on inactive or delinquent

  3  status;

  4         (f)  Employ unlicensed persons to engage in

  5  dietetics/nutrition dietetics and nutrition practice or

  6  clinical nutrition practice nutrition counseling; or

  7         (g)  Conceal information relative to any violation of

  8  this part.

  9         (2)  A person who violates any provision of this

10  section commits a misdemeanor of the first degree, punishable

11  as provided in s. 775.082 or s. 775.083.

12         Section 19.  Section 468.518, Florida Statutes, 1998

13  Supplement, is amended to read:

14         468.518  Grounds for disciplinary action.--

15         (1)  The following acts constitute grounds for which

16  the disciplinary actions in subsection (2) may be taken:

17         (a)  Violating any provision of this part, any board or

18  department agency rule adopted pursuant thereto, or any lawful

19  order of the board or department agency previously entered in

20  a disciplinary hearing held pursuant to this part, or failing

21  to comply with a lawfully issued subpoena of the department

22  agency. The provisions of this paragraph also apply to any

23  order or subpoena previously issued by the Agency for Health

24  Care Administration Department of Health during its period of

25  regulatory control over this part.

26         (b)  Being unable to engage in dietetics/nutrition

27  dietetics and nutrition practice or clinical nutrition

28  practice nutrition counseling with reasonable skill and safety

29  to patients by reason of illness or use of alcohol, drugs,

30  narcotics, chemicals, or any other type of material or as a

31  result of any mental or physical condition.

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  1         1.  A licensee whose license is suspended or revoked

  2  pursuant to this paragraph shall, at reasonable intervals, be

  3  given an opportunity to demonstrate that he or she can resume

  4  the competent practice of dietetics/nutrition dietetics and

  5  nutrition or clinical nutrition counseling with reasonable

  6  skill and safety to patients.

  7         2.  Neither the record of the proceeding nor the orders

  8  entered by the board in any proceeding under this paragraph

  9  may be used against a licensee in any other proceeding.

10         (c)  Attempting to procure or procuring a license to

11  practice dietetics/nutrition dietetics and nutrition or

12  clinical nutrition counseling by fraud or material

13  misrepresentation of material fact.

14         (d)  Having a license to practice dietetics/nutrition

15  dietetics and nutrition or clinical nutrition counseling

16  revoked, suspended, or otherwise acted against, including the

17  denial of licensure by the licensing authority of another

18  state, district, territory, or country.

19         (e)  Being convicted or found guilty of, or entering a

20  plea of nolo contendere to, regardless of adjudication, a

21  crime in any jurisdiction which directly relates to the

22  practice of dietetics/nutrition dietetics and nutrition or

23  clinical nutrition counseling or the ability to practice

24  dietetics/nutrition dietetics and nutrition or clinical

25  nutrition counseling.

26         (f)  Making or filing a report or record that the

27  licensee knows to be false, willfully failing to file a report

28  or record required by state or federal law, willfully impeding

29  or obstructing such filing, or inducing another person to

30  impede or obstruct such filing. Such reports or records

31  include only those that are signed in the capacity of a

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  1  licensed dietitian/nutritionist or licensed clinical

  2  nutritionist nutrition counselor.

  3         (g)  Advertising goods or services in a manner that is

  4  fraudulent, false, deceptive, or misleading in form or

  5  content.

  6         (h)  Committing an act of fraud or deceit, or of

  7  negligence, incompetency, or misconduct in the practice of

  8  dietetics/nutrition dietetics and nutrition or clinical

  9  nutrition counseling.

10         (i)  Practicing with a revoked, suspended, inactive, or

11  delinquent license.

12         (j)  Treating or undertaking to treat human ailments by

13  means other than by dietetics/nutrition dietetics and

14  nutrition practice or clinical nutrition practice nutrition

15  counseling.

16         (k)  Failing to maintain acceptable standards of

17  practice as set forth by the board and the council in rules

18  adopted pursuant to this part.

19         (l)  Engaging directly or indirectly in the dividing,

20  transferring, assigning, rebating, or refunding of fees

21  received for professional services, or profiting by means of a

22  credit or other valuable consideration, such as an unearned

23  commission, discount, or gratuity, with any person referring a

24  patient or with any relative or business associate of the

25  referring person. Nothing in this part prohibits the members

26  of any regularly and properly organized business entity that

27  is composed of licensees under this part and recognized under

28  the laws of this state from making any division of their total

29  fees among themselves as they determine necessary.

30         (m)  Advertising, by or on behalf of a licensee under

31  this part, any method of assessment or treatment which is

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  1  experimental or without generally accepted scientific

  2  validation, as determined by the respective councils and the

  3  board.

  4         (2)  When the board finds any licensee guilty of any of

  5  the grounds set forth in subsection (1), it may enter an order

  6  imposing one or more of the following penalties:

  7         (a)  Denial of an application for licensure;

  8         (b)  Revocation or suspension of a license;

  9         (c)  Imposition of an administrative fine not to exceed

10  $1,000 for each violation;

11         (d)  Issuance of a reprimand or letter of guidance;

12         (e)  Placement of the licensee on probation for a

13  period of time and subject to such conditions as the board may

14  specify, including requiring the licensee to attend continuing

15  education courses or to work under the supervision of a

16  licensed dietitian/nutritionist or licensed clinical

17  nutritionist nutrition counselor; or

18         (f)  Restriction of the authorized scope of practice of

19  the licensee.

20         (3)  The department agency shall reissue the license of

21  a disciplined dietitian/nutritionist or clinical nutritionist

22  nutrition counselor upon certification by the board that the

23  disciplined dietitian/nutritionist or clinical nutritionist

24  nutrition counselor has complied with all of the terms and

25  conditions set forth in the final order.

26         (4)  No action may be taken with respect to the

27  revocation or suspension of a license under this part without

28  the concurrence of at least four members of the applicable

29  council.

30         Section 20.  Paragraph (g) of subsection (3) of section

31  20.43, Florida Statutes, 1998 Supplement, is amended to read:

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  1         20.43  Department of Health.--There is created a

  2  Department of Health.

  3         (3)  The following divisions of the Department of

  4  Health are established:

  5         (g)  Division of Medical Quality Assurance, which is

  6  responsible for the following boards and professions

  7  established within the division:

  8         1.  Nursing assistants, as provided under s. 400.211.

  9         2.  Health care services pools, as provided under s.

10  402.48.

11         3.  The Board of Acupuncture, created under chapter

12  457.

13         4.  The Board of Medicine, created under chapter 458.

14         5.  The Board of Osteopathic Medicine, created under

15  chapter 459.

16         6.  The Board of Chiropractic Medicine, created under

17  chapter 460.

18         7.  The Board of Podiatric Medicine, created under

19  chapter 461.

20         8.  Naturopathy, as provided under chapter 462.

21         9.  The Board of Optometry, created under chapter 463.

22         10.  The Board of Nursing, created under chapter 464.

23         11.  The Board of Pharmacy, created under chapter 465.

24         12.  The Board of Dentistry, created under chapter 466.

25         13.  Midwifery, as provided under chapter 467.

26         14.  The Board of Speech-Language Pathology and

27  Audiology, created under part I of chapter 468.

28         15.  The Board of Nursing Home Administrators, created

29  under part II of chapter 468.

30         16.  The Board of Occupational Therapy, created under

31  part III of chapter 468.

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  1         17.  Respiratory therapy, as provided under part V of

  2  chapter 468.

  3         18.  Dietetics/nutrition Dietetics and nutrition

  4  practice, as provided under part X of chapter 468.

  5         19.  Athletic trainers, as provided under part XIII of

  6  chapter 468.

  7         20.  The Board of Orthotists and Prosthetists, created

  8  under part XIV of chapter 468.

  9         21.  Electrolysis, as provided under chapter 478.

10         22.  The Board of Massage Therapy, created under

11  chapter 480.

12         23.  The Board of Clinical Laboratory Personnel,

13  created under part III of chapter 483.

14         24.  Medical physicists, as provided under part IV of

15  chapter 483.

16         25.  The Board of Opticianry, created under part I of

17  chapter 484.

18         26.  The Board of Hearing Aid Specialists, created

19  under part II of chapter 484.

20         27.  The Board of Physical Therapy Practice, created

21  under chapter 486.

22         28.  The Board of Psychology, created under chapter

23  490.

24         29.  School psychologists, as provided under chapter

25  490.

26         30.  The Board of Clinical Social Work, Marriage and

27  Family Therapy, and Mental Health Counseling, created under

28  chapter 491.

29

30  The department may contract with the Agency for Health Care

31  Administration who shall provide consumer complaint,

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  1  investigative, and prosecutorial services required by the

  2  Division of Medical Quality Assurance, councils, or boards, as

  3  appropriate.

  4         Section 21.  Subsection (4) of section 501.0573,

  5  Florida Statutes, is amended to read:

  6         501.0573  Weight-loss provider requirements.--Each

  7  weight-loss provider shall:

  8         (4)  Provide the name, address, and qualifications of

  9  the person who has reviewed and approved the weight-loss

10  program according to s. 468.505(1)(k)(j).

11         Section 22.  Paragraph (E) of subsection (1) of section

12  501.0575, Florida Statutes, is amended to read:

13         501.0575  Weight-Loss Consumer Bill of Rights.--

14         (1)  The Weight-Loss Consumer Bill of Rights shall

15  consist of the following provisions:

16         (E)  YOU HAVE A RIGHT TO:

17         1.  ASK QUESTIONS ABOUT THE POTENTIAL HEALTH RISKS OF

18  THIS PROGRAM AND ITS NUTRITIONAL CONTENT, PSYCHOLOGICAL

19  SUPPORT, AND EDUCATIONAL COMPONENTS.

20         2.  RECEIVE AN ITEMIZED STATEMENT OF THE ACTUAL OR

21  ESTIMATED PRICE OF THE WEIGHT-LOSS PROGRAM, INCLUDING EXTRA

22  PRODUCTS, SERVICES, SUPPLEMENTS, EXAMINATIONS, AND LABORATORY

23  TESTS.

24         3.  KNOW THE ACTUAL OR ESTIMATED DURATION OF THE

25  PROGRAM.

26         4.  KNOW THE NAME, ADDRESS, AND QUALIFICATIONS OF THE

27  DIETITIAN OR NUTRITIONIST WHO HAS REVIEWED AND APPROVED THE

28  WEIGHT-LOSS PROGRAM ACCORDING TO s. 468.505(1)(k)(j), FLORIDA

29  STATUTES.

30         Section 23.  Subsection (2) of section 627.6408,

31  Florida Statutes, is amended to read:

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  1         627.6408  Diabetes treatment services.--

  2         (2)  The policy may require that diabetes outpatient

  3  self-management training and educational services be provided

  4  under the direct supervision of a certified diabetes educator

  5  or a board-certified endocrinologist. The policy may further

  6  require that nutrition counseling be provided by a licensed

  7  dietitian/nutritionist or licensed clinical nutritionist

  8  dietitian.

  9         Section 24.  Subsection (2) of section 627.65745,

10  Florida Statutes, is amended to read:

11         627.65745  Diabetes treatment services.--

12         (2)  The policy or health benefit plan may require that

13  diabetes outpatient self-management training and educational

14  services be provided under the direct supervision of a

15  certified diabetes educator or a board-certified

16  endocrinologist. The policy or health benefit plan may further

17  require that nutrition counseling be provided by a licensed

18  dietitian/nutritionist or licensed clinical nutritionist

19  dietitian.

20         Section 25.  This act shall take effect October 1,

21  1999.

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  1            *****************************************

  2                          HOUSE SUMMARY

  3
      Revises part X of chapter 468, F.S., relating to
  4    dietetics and nutrition practice, to revise terminology
      and include regulatory provisions for clinical nutrition
  5    practice. Creates the Clinical Nutrition Practice Council
      to advise the Board of Medicine on the practice. Provides
  6    rulemaking authority to the board for such regulation.
      Provides applicability with respect to currently licensed
  7    nutrition counselors, and provides for relicensure of
      such counselors as clinical nutritionists. Provides that
  8    health insurance policies may require that nutrition
      counseling required in conjunction with other diabetes
  9    treatment services be provided by a licensed
      dietitian/nutritionist or licensed clinical nutritionist.
10    Renames the Dietetics and Nutrition Practice Council as
      the Dietetics/Nutrition Practice Council, and revises
11    references to the practice to conform. Replaces obsolete
      references to the Agency for Health Care Administration
12    with references to the Department of Health. See bill for
      details.
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