Legislature(1999 - 2000)
03/25/1999 01:35 PM Senate L&C
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SB 88-DIETITIANS AND NUTRITIONISTS
CHAIRMAN MACKIE called the Senate Labor and Commerce Committee
meeting to order at 1:35 p.m. and announced SB 88 to be up for
consideration.
SENATOR DONLEY, sponsor of SB 88, said a proposed committee
substitute codifies professional title licensures for dieticians
and nutritionists and will increase public access to the services
and insure the quality of those services for the consumers.
Pending federal legislation will allow federal reimbursement to
folks who utilize the services if they are provided by licensed
professionals. We currently don't have that professional licensing
available here in Alaska.
SENATOR DONLEY said the CS tries to reduce the fiscal note by
requiring that all professional licensing has to pay for itself and
the original version had more expenses.
MS. BARBARA GABIER, Program Coordinator, Division of Occupational
Licensing, said the committee substitute addressed their concerns.
SENATOR DONLEY moved to adopt the CS to SB 88, Lauterbach 3/24/99.
There were no objections and it was so ordered.
MS. GABIER noted on page 2, line 21 the text talks about "an
accredited or approved college or university..." and she
recommended deleting "or approved" since there is already a
definition for an accredited university in the draft.
CHAIRMAN MACKIE asked if the Department fully supported the bill
without the change.
MS. GABIER reiterated that it did.
Number 93
SENATOR LEMAN asked on page 1, line 10 if there is any restriction
on definition of a dietician or a nutritionist, and could it be
used to limit a midwife, chiropractor, or nurse practitioner, or
similar people who have that as an incidental part of their
practice.
MS. GABIER said that would only prohibit others from advertising
as being a licensed dietician. She didn't think it would apply to
incidental practice of their profession.
SENATOR LEMAN said he would want that clear in the bill.
SENATOR KELLY asked if there was a "grandmother clause" or was it
even necessary.
MS. GABIER said she didn't think it was necessary. All applicants
would have to meet these requirements. She said the restriction
was for using the title and not for the actual practice.
SENATOR MACKIE said some of the federal programs require licensing.
MR. JOHN WRAY, Alaska Dietetic Association, said they strongly
support this legislation. Currently, 39 states, the District of
Columbia, and Puerto Rico have some form of licensing for
nutritionists and dieticians. In Alaska there are over 120
dieticians and nutritionists, all of them with at least
Baccalaureates, many of them with Masters degrees, some with
Ph.D.'s. They work in a wide variety of settings: hospitals,
continuing care facilities, outpatient clinics, school districts,
WIC program, University of Alaska, athletic programs, and the State
government. Some are even in private practice.
There are two reasons for licensing. One is that there is proposed
legislation in congress for coverage for the outpatient portion of
Medicare (Plan B). It would provide for reimbursement from
nutrition therapy services furnished by registered dieticians and
qualified nutrition professionals. Currently, only a portion of
services provided by dieticians are covered under Medicare
reimbursements. The organization that accredits hospitals and
nursing homes in the United State, the Joint Commission for
Accreditation of the Health Care Organization (JAHCO), mandates
that nutrition services be provided by registered dieticians in
hospitals and nursing care facilities. Being able to provide
nutrition care services to citizens would not only be a big step
towards saving money in health care costs, but will also speed
recovery and prevent complications in patients with serious medical
problems.
Inadequate nutrition is widely recognized as a contributing factor
to such diseases as diabetes, heart disease, strokes, and some
cancers, MR. WRAY said. Well nourished patients are more resistant
to disease or are better able to recover from illnesses, surgery,
and trauma. All of these result in lower length of stays at
hospitals which reduces cost to the patients, insurance companies,
and the hospitals.
The federal legislation stipulates that reimbursement services
provided by dieticians and nutritional professionals only are those
who are licensed by the state in which they work.
MR. WRAY said he is part of a health care team at the hospital. It
is comprised of doctors, nurses, physical therapists, respiratory
therapists, and pharmacists. His education credentials matches
theirs, except for physicians. Recognition of his profession is a
logical next step. The second reason they seek licensure is simply
professional recognition. Title licensure does not limit others
from engaging in nutrition care practices as long as they don't
call themselves dieticians or nutritionists.
The committee substitute also deals with exemptions for military
dieticians, he explained. Other states normally do not require
licensure for service people. Military personnel have three-year
rotations and most state have biannual licensing, so they would
"get dinged twice for their fees in their rotation years."
The word "approved" can easily be removed, because it is up to the
American Dietetic Association to verify the nutrition curriculum at
each university.
Number 234
MS. LINDA WILD, Juneau nutritionist, supported previous testimony
and the CS to SB 88. Her own perspective is that she is currently
certified in Washington state, because Alaska doesn't license and
she wanted that because Alaska doesn't license and she wanted that
professional recognition. Washington gets her money every year,
she commented.
When a person looks in a phone book for health care nutrition and
they see the word "licensed", they know that person has met the
minimum requirements for the state.
MS. WILD said she is glad that this legislation includes
nutritionists as well as dieticians for licensure, because that
recognizes there are other health care professionals who, for one
reason or another, didn't choose to become registered dieticians
and it would be inappropriate to give one organization a "lock" on
who could become a qualified nutrition professional.
She said over the years it has become clear to her that the real
key to establishment and maintenance of good health is good
nutrition. It helps people recover from illnesses more quickly
and helps prevent a lot of chronic diseases that people are subject
to.
CHAIRMAN MACKIE asked her how much her fees in Washington are each
year.
MS. WILD replied that they are $100 per year.
MS. GABIER said the proposed fees are $200 per year.
MS. WILD explained that there are many more people in the state of
Washington and the fees have to cover the cost of the program.
CHAIRMAN MACKIE asked how many people she anticipated would become
licensed in Alaska.
MS. WILD answered about 100 people.
MS. ELIZABETH NOBMANN, Alaska Diabetic Association, has worked in
Alaska for 25 years. She has a Masters Degree from the School of
Public Health at the University of California, Berkeley, as a
registered dietician. She has earned a Ph.D. from the University
of Alaska Fairbanks in Human Nutrition through their
interdisciplinary degree program. She supported SB 88 as it
provides a tool for citizens who want to know a nutrition care
providers credibility, but it does not restrict people in other
fields from giving dietary advice that may be incidental to their
scope of practice. It will give the consumer assistance in
determining who may be offering legitimate nutritional advice and
who might be calling himself a nutritionist simply by virtue of
becoming a salesperson in the latest pyramid sales scheme for food
or supplements.
Recognition of the role of nutrition has been increasing over the
years, especially with the increase of diabetes which is on the
increase among Alaska natives, especially. Providers who can best
address this issue are not licensed by the State of Alaska and this
should be changed.
MS. DEBRA MESTAS, Alaska Kidney Center, said she has been a
registered dietician since 1980 and supported SB 88. She has
worked as a nutrition expert for people of all ages from birth to
death and has had patients over 90 on dialysis and she is very
familiar with almost every health problem and disease and their
nutritional implications. She supported this bill, because
dieticians should be recognized as those who go for expertise and
research, finding out facts about prevention and ways to deal with
it if it's not curable, and to support those cures. They are very
committed to patient health care and to their continuing health
care (often at their own expense). Most of them pay dues to
several organizations such as the National Kidney Foundation and
the Diabetes Educator Association, and strive to stay current with
all kinds of medical and consumer research. They act as a strong
advocate for their clients overall health as well as their pocket
books. Registered dieticians are supportive of disease prevention
to save lives as well as billions of dollars in health care. She
noted that diabetes is rapidly growing in this state and her
practice at the Kidney Center has exploded. Huge numbers of
diabetics need dialysis which has astronomical costs being one of
the biggest burdens on the health care industry.
SENATOR KELLY asked why diabetes is growing in Alaska.
MS. MESTAS answered there are lots of reasons, but the fastest
growing population is the native population which is genetically
more predisposed, because there is a lot of obesity and poor diets.
They have more upper body fat and the way they carry their
overweight causes more diabetes. There are explosions of kidney
centers being built on reservations. Up here, all her patients
have to move to Anchorage from their villages to receive dialysis
and they need much support from qualified professionals.
SENATOR KELLY asked if diabetes was genetically based.
MS. MESTAS answered that there is a genetic component, but it is
also environmentally caused as in the native population where there
is a rapid change in their diet. Dieticians strongly believe in
prevention and licensed professionals can provide that.
MS. ALISON HALL, public health nutritionist, said she has been
licensed in the state of New Mexico and District of Columbia. She
is the past National President of the National Renal Dietetic
Practice Group and has a specialty in development disabilities.
She supported SB 88 as it would identify them to the public and the
insurers as qualified providers of nutrition care. Good nutrition
can prevent a patient from sliding further into complications.
MS. CINDY SALMON, Alaska Dietetics Association and registered
dietician in private practice in Fairbanks, said her practice
focuses on prevention. She emphatically supported previous
statements. She believed it fostered public protection and
guidance. Also, when a client finds that their insurance company
will not provide coverage, the majority of them do not make the
referred appointments. This could empower them to get the
education and make the change and stay away from renal centers
altogether or at least reduce their length of stay and the
incidence.
SENATOR DONLEY moved to adopt amendment # 1 which was recommended
by the Division of Occupational Licensing to delete "or approved".
There were no objections and the amendment carried.
SENATOR DONLEY move to adopt amendment # 2 to delete "advertise or
otherwise hold out as being a dietitian or nutritionist." - also
suggested by the Division. There were no objections and the
amendment was adopted.
SENATOR LEMAN moved on page 3, line 30 to insert "or national"
following the word "regional". He has learned that some
institutions that are nationally accredited, but not regionally in
Alaska and he wanted to be consistent. There were no objections
and the amendment was adopted.
SENATOR DONLEY moved to pass CSSB 88(L&C) from committee with
fiscal notes and individual recommendations. There were no
objections and it was so ordered.
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