Legislature(1999 - 2000)
03/25/1999 01:35 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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.