What's happening
This bill allows qualified dietetic and nutrition professionals to manage therapeutic diet orders, including parenteral and enteral nutrition, in certain healthcare facilities under specified conditions.
Why it matters
Expands access to specialized nutrition care. By letting qualified dietetic and nutrition professionals directly manage complex diet orders (including IV and tube feeding), patients in hospitals, nursing homes, and other healthcare settings may get more timely and tailored nutrition interventions, which can be crucial for recovery and managing chronic illness.
Establishes safeguards and oversight. The bill requires that these professionals act according to facility protocols and under physician-written orders for parenteral and enteral nutrition. It also allows physicians and facilities to override or restrict their authority, prioritizing patient safety and maintaining physician oversight.
Clarifies professional boundaries. The legislation specifically prohibits dietetic and nutrition professionals from making or changing medical diagnoses and does not automatically grant them hospital privileges, ensuring that their expanded role remains within a defined scope and does not encroach on medical practice.
Potentially improves workflow and efficiency. Allowing dietitians and nutritionists to order relevant lab tests and monitor patients for nutrition-related interventions could reduce delays and ease the workload on physicians, possibly leading to more efficient patient care in facilities that choose to implement these changes.
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Who cares
Headline styles
Let Dietitians Manage Diet Orders
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to higher education
- Referred to higher education
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2628
2017-2018 Regular Sessions
IN SENATE
January 13, 2017
Introduced by Sens. LAVALLE, HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Higher Education
AN ACT to amend the education law, in relation to management of therapeutic diet orders in a facility
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The education law is amended by adding a new section 8007 to read as follows:
§ 8007. Management of therapeutic diet orders in a facility. 1. As used in this section, the following terms shall have the following meanings:
(a) "Qualified dietetic professional" or "qualified nutrition professional" shall be an individual who meets the following requirements:
(i) holds a valid license and current registration as a certified dietician or certified nutritionist in accordance with this article; and
(ii) has net the requirements of paragraph (a) of subdivision two of section eight thousand four of this article and subdivision three of section eight thousand four of this article; and
(iii) holds a registration or certification from a national registration or certifying association, with standards acceptable to the department, that provides education and training in parenteral and enteral nutrition acceptable to the department and in accordance with the commissioner's regulations.
(b) "Therapeutic diet" is a diet intervention that provides food or nutrients via oral, enteral and parenteral routes as a part of treatment of disease or clinical conditions to modify, eliminate, decrease, or increase identified micro- and macro-nutrients in the diet.
(c) "Facility" shall mean a hospital, including any diagnostic center, treatment center, or hospital-based outpatient department, residential health care facility or nursing home or any facility as defined in section twenty-eight hundred one of the public health law, a home care
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08038-01-7
S. 2628 2
agency as defined in section thirty-six hundred two of the public health law or other entity that provides direct patient care under the auspices of a medical director.
2. (a) The management of therapeutic diets performed by a qualified dietetic professional or qualified nutrition professional includes a review, evaluation, order and management of a therapeutic diet, including the ordering of food and nutrition supplements, and the management of parenteral or enteral nutrition, as defined in this subdivision, to a patient who is being treated in a facility by a physician for specific diseases or disease states, in accordance with the policies, procedures, and protocols of the facility.
(b) The management of parenteral nutrition as part of a therapeutic diet order by a qualified dietetic professional or qualified nutrition professional may include prescribing, adjusting and managing a diet or nutrition regimen of a patient pursuant to a patient specific written order or protocol for parenteral nutrition access made by the patient's physician. Implementation or adjustments shall be made after the review by the pharmacists responsible to the facility for the care of the patient. The physician or facility may prohibit, by written instruction, any adjustment or change in the patient's diet or nutrition regimen by the qualified dietetic professional or qualified nutrition professional.
In the event that a treating physician or pharmacist may disagree with the exercise of professional judgment by the qualified dietetic professional or qualified nutrition professional as it relates to the management of parenteral nutrition, the judgment of the treating physician or pharmacist shall prevail.
(c) The management of enteral nutrition as part of a therapeutic diet order by a qualified dietetic professional or qualified nutrition professional may include adjusting and managing a diet or nutrition regimen of a patient pursuant to a patient specific written order or protocol for enteral nutrition access made by the patient's physician. The physician or facility may prohibit, by written instruction, any adjustment or change in the patient's diet or nutrition regimen by the qualified dietetic professional or qualified nutrition professional.
In the event that a treating physician may disagree with the exercise of professional judgment by the qualified dietetic professional or qualified nutrition professional as it relates to the management of enteral nutrition, the judgment of the treating physician shall prevail.
(d) A qualified dietetic professional or qualified nutrition professional may evaluate and, only if specifically authorized by the policies, procedures, or protocol of the facility and only to the extent necessary to discharge the responsibilities set forth in this section, order clinical laboratory tests related to the management of a therapeutic diet order for the specific diseases or disease states specified within the written order or protocol, and order or perform routine patient monitoring functions as may be necessary for the management of parenteral and enteral nutrition.
3. Nothing herein shall authorize a qualified dietetic professional or qualified nutrition professional to establish or modify a medical diagnosis.
4. The authorization of any qualified dietetic professional or qualified nutrition professional to engage in the management of a therapeutic diet order, including the management of parenteral and enteral nutrition, shall be at the discretion of the facility.
5. Nothing herein contained shall be deemed to authorize, grant, or extend hospital privileges to individuals certified under this article.
S. 2628 3
§ 2. This act shall take effect on the one hundred eightieth day after it shall have become a law; provided, however, that effective immediately the department of education may promulgate any rule or regulation necessary for the timely implementation of this act on its effective date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the education law, in relation to management of therapeutic diet orders in a facility
Purpose
To allow hospitals to take advantage of the Centers for Medicare &Medicaid Services (CMS) rule (Vol.79/No.91 May 12, 2014) which allows a hospital to permit qualified dietitians or nutritionists the authority to order therapeutic diets.
Summary of provisions
Section 1. Amends the education law to add a new section 8007 that provides for management of therapeutic diet orders in a facility. Subdivision 1 of the section provides definitions for "qualified dietetic professional" or qualified nutrition professional", "therapeutic diet", and "facility".
Read the full memo (662 words)
Subdivision 2 of the section provides that the management of therapeutic diets performed by a qualified dietetic or nutrition professional includes a review, evaluation, order and management of a therapeutic diet to a patient who is being treated in a facility by a physician for specific diseases or disease states in accordance with facility policies. This section further states that the management of parenteral and enteral nutrition was part of a therapeutic diet order may include adjustment of a diet or nutrition regimen, however, if the treating physician disagrees with the protocol made by the dietitian or nutritionist, the physician will prevail. This also provides that a qualified dietetic or nutrition professional may evaluate and if authorized by the facility, order clinical laboratory test related to the therapeutic diet order and order or perform routine patient monitoring as necessary for parenteral and enteral nutrition management.
Subdivision 3 of the section states that nothing in this section shall authorize a qualified dietetic or nutrition professional to establish or modify a medical diagnosis.
Subdivision 4 of the section provides that authorization of any qualified dietetic or nutrition professionals to engage in the management of a therapeutic diet order shall be at the discretion of the facility.
Subdivision 5 of the section provides that nothing in this section shall be deemed to authorize, grant or extend hospital privileges to individuals certified as dietitians or nutritionists under this Article.
Section 2. Sets for the effective date.
Existing law
The education law currently provides for the certification of dietitians and nutritionists (CDN).
Justification
Legislation is required to allow hospitals to permit a qualified dietitian or nutritionist to order therapeutic diets.
Previously, the CMS rue was interpreted to require physicians to be responsible for therapeutic diet orders. However, recent CMS rule now indicates that qualified dietitians or nutritionists are "the professionals who are best qualified to assess a patient's nutritional status and to design and implement a nutritional treatment plan in consultation with the patient's interdisciplinary care team".
In addition, the CMS rules state that the qualified dietitian or nutritionist "must be viewed as an integral member of the hospital interdisciplinary care team, one who as the team's clinical nutrition expert is responsible for a patient's nutritional diagnosis and treatment in light of a patient's medical diagnosis.
Finally, the CMS rules state that "we consider all patient diets to be therapeutic in nature, regardless of the modality used to support the nutritional needs o the patient and that the term would most certainly include parenteral and enteral nutrition support".
However, New York State law does not permit CDNs to make an order. In addition, since parenteral nutrition is dispensed by a pharmacist within the facility, current law does not allow CDNs to order nutrition via the parenteral dispensing process.
Language is needed to provide the authority and establish parameters for responsible practice; acknowledging the responsibilities and oversight of physician or pharmacist in the process of delivering nutrition care.
Legislative history
2016 S.7692
Fiscal implications
None to the State.
Effective date
This act shall take effect on the one hundred eightieth day after it shall have become a law; provided, however, that effective immediately the Department of Education may promulgate any rule or regulation necessary for the timely implementation of this act on its effective date.
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