Legislature(1999 - 2000)

03/25/1999 01:35 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
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               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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