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Senate Engrossed House Bill
dietitian nutritionists; licensure |
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State of Arizona House of Representatives Fifty-fifth Legislature First Regular Session 2021
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HOUSE BILL 2820 |
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AN ACT
amending sections 32-1901, 36-414 and 36-416, Arizona Revised Statutes; amending title 36, chapter 4, article 1, Arizona Revised Statutes, by adding section 36-416.01; amending title 36, Arizona Revised Statutes, by adding chapter 40; relating to nutritionists.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 32-1901, Arizona Revised Statutes, is amended to read:
32-1901. Definitions
In this chapter, unless the context otherwise requires:
1. "Administer" means the direct application of directly applying a controlled substance, prescription-only drug, dangerous drug or narcotic drug, whether by injection, inhalation, ingestion or any other means, to the body of a patient or research subject by a practitioner or by the practitioner's authorized agent or the patient or research subject at the direction of the practitioner.
2. "Advertisement" means all representations that are disseminated in any manner or by any means, other than by labeling, for the purpose of inducing, or that are likely to induce, directly or indirectly, the purchase of drugs, devices, poisons or hazardous substances.
3. "Advisory letter" means a nondisciplinary letter to notify a licensee or permittee that either:
(a) While there is insufficient evidence to support disciplinary action, the board believes that continuation of the activities that led to the investigation may result in further board action against the licensee or permittee.
(b) The violation is a minor or technical violation that is not of sufficient merit to warrant disciplinary action.
(c) While the licensee or permittee has demonstrated substantial compliance through rehabilitation, remediation or reeducation that has mitigated the need for disciplinary action, the board believes that repetition of repeating the activities that led to the investigation may result in further board action against the licensee or permittee.
4. "Antiseptic", if a drug is represented as such on its label, means a representation that it is a germicide, except in the case of a drug purporting to be, or represented as, an antiseptic for inhibitory use as a wet dressing, ointment or dusting powder or other use that involves prolonged contact with the body.
5. "Authorized officers of the law" means legally empowered peace officers, compliance officers of the board of pharmacy and agents of the division of narcotics enforcement and criminal intelligence of the department of public safety.
6. "Automated prescription-dispensing kiosk" means a mechanical system that is operated as an extension of a pharmacy, that maintains all transaction information within the pharmacy operating system, that is separately permitted from the pharmacy and that performs operations that either:
(a) Accept a prescription or refill order, store prepackaged or repackaged medications, label and dispense patient-specific prescriptions and provide counseling on new or refilled prescriptions.
(b) Dispense or deliver a prescription or refill that has been prepared by or on behalf of the pharmacy that oversees the automated prescription-dispensing kiosk.
7. "Board" or "board of pharmacy" means the Arizona state board of pharmacy.
8. "Certificate of composition" means a list of a product's ingredients.
9. "Certificate of free sale" means a document that authenticates a product that is generally and freely sold in domestic or international channels of trade.
10. "Color additive" means a material that either:
(a) Is any dye, pigment or other substance that is made by a process of synthesis or similar artifice, or that is extracted, isolated or otherwise derived, with or without intermediate or final change of identity, from any vegetable, animal, mineral or other source.
(b) If added or applied to a drug, or to the human body or any part of the human body, is capable of imparting color, except that color additive does not include any material that has been or may be exempted under the federal act. Color includes black, white and intermediate grays.
11. "Compounding":
(a) Means the preparation preparing, mixing, assembling, packaging or labeling of a drug by a pharmacist or an intern or pharmacy technician under the pharmacist's supervision, for the purpose of dispensing to a patient based on a valid prescription order. Compounding
(b) Includes the preparation of Preparing drugs in anticipation of prescription orders prepared on routine, regularly observed prescribing patterns and the preparation of Preparing drugs as an incident to research, teaching or chemical analysis or for administration by a medical practitioner to the medical practitioner's patient and not for sale or dispensing. Compounding
(c) Does not include the preparation of Preparing commercially available products from bulk compounds or the preparation of drugs for sale to pharmacies, practitioners or entities for the purpose of dispensing or distribution.
12. "Compressed medical gas distributor" means a person who that holds a current permit issued by the board to distribute compressed medical gases pursuant to a compressed medical gas order to compressed medical gas suppliers and other entities that are registered, licensed or permitted to use, administer or distribute compressed medical gases.
13. "Compressed medical gases" means gases and liquid oxygen that a compressed medical gas distributor or manufacturer has labeled in compliance with federal law.
14. "Compressed medical gas order" means an order for compressed medical gases that is issued by a medical practitioner.
15. "Compressed medical gas supplier" means a person who That holds a current permit issued by the board to supply compressed medical gases pursuant to a compressed medical gas order and only to the consumer or the patient.
16. "Controlled substance" means a drug, substance or immediate precursor that is identified, defined or listed in title 36, chapter 27, article 2.
17. "Corrosive" means any substance that when it comes in contact with living tissue will cause destruction of the tissue by chemical action.
18. "Counterfeit drug" means a drug that, or the container or labeling of which, without authorization, bears the trademark, trade name or other identifying mark, imprint, number or device, or any likeness of these, of a manufacturer, distributor or dispenser other than the person who that in fact manufactured, distributed or dispensed that drug.
19. "Dangerous drug" has the same meaning prescribed in section 13-3401.
20. "Day" means a business day.
21. "Decree of censure" means an official action that is taken by the board and that may include a requirement for restitution of fees to a patient or consumer.
22. "Deliver" or "delivery" means the actual, constructive or attempted transfer from one person to another whether or not there is an agency relationship.
23. "Deputy director" means a pharmacist who is employed by the board and selected by the executive director to perform duties as prescribed by the executive director.
24. "Device", except as used in paragraph 18 of this section, section 32-1965, paragraph 4 and section 32-1967, subsection A, paragraph 15 and subsection C, means instruments, apparatuses and contrivances an instrument, apparatus or contrivance, including their its components, parts and accessories, including all such items under the federal act, that is intended either:
(a) For use To be used in the diagnosis, cure, mitigation, treatment Diagnosing, curing, mitigating, treating or prevention of Preventing disease in the human body or other animals.
(b) To affect the structure or any function of the human body or other animals.
25. "Director" means the director of the division of narcotics enforcement and criminal investigation of the department of public safety.
26. "Direct supervision of a pharmacist" means that the pharmacist is present. If relating to the sale of certain items, direct supervision of a pharmacist means that a pharmacist determines the legitimacy or advisability of a proposed purchase of those items.
27. "Dispense" means to deliver to an ultimate user or research subject by or pursuant to the lawful order of a practitioner, including the prescribing, administering, packaging, labeling or compounding necessary to prepare for that delivery.
28. "Dispenser" means a practitioner who dispenses.
29. "Distribute" means to deliver, other than by administering or dispensing.
30. "Distributor" means a person who distributes.
31. "Drug" means:
(a) Articles that are recognized, or for which standards or specifications are prescribed, in the official compendium.
(b) Articles that are intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in the human body or other animals.
(c) Articles other than food that are intended to affect the structure or any function of the human body or other animals.
(d) Articles that are intended for use as a component of any articles specified in subdivision (a), (b) or (c) of this paragraph but does not include devices or their components, parts or accessories.
32. "Drug enforcement administration" means the drug enforcement administration of the United States department of justice or its successor agency.
33. "Drug or device manufacturing" means the production, preparation, propagation producing, preparing, propagating or processing of a drug or device, either directly or indirectly, by extraction from substances of natural origin or independently by means of chemical synthesis and includes any packaging or repackaging of substances or labeling or relabeling of its container and the promotion Promoting and marketing of the same. Drug or device manufacturing does not include compounding.
34. "Economic poison" means any substance that alone, in chemical combination with or in formulation with one or more other substances is a pesticide within the meaning of the laws of this state or the federal insecticide, fungicide and rodenticide act and that is used in the production, storage Producing, storing or transportation of Transporting raw agricultural commodities.
35. "Enteral feeding" means nourishment that is provided by means of a tube inserted into the stomach or intestine.
36. "Established name", with respect to a drug or ingredient of a drug, means any of the following:
(a) The applicable official name.
(b) If there is no such name and the drug or ingredient is an article recognized in an official compendium, the official title in an official compendium.
(c) If neither subdivision (a) nor (b) of this paragraph applies, the common or usual name of the drug.
37. "Executive director" means the executive director of the board of pharmacy.
38. "Federal act" means the federal laws and regulations that pertain to drugs, devices, poisons and hazardous substances and that are official at the time any drug, device, poison or hazardous substance is affected by this chapter.
39. "Full service wholesale permittee":
(a) Means a permittee who may distribute prescription-only drugs and devices, controlled substances and over-the-counter drugs and devices to pharmacies or other legal outlets from a place devoted in whole or in part to wholesaling these items.
(b) Includes a virtual wholesaler as defined in rule by the board.
40. "Good manufacturing practice" means a system for ensuring that products are consistently produced and controlled according to quality standards and covering all aspects of design, monitoring and control of manufacturing processes and facilities to ensure that products do not pose any risk to the consumer or public.
41. "Highly toxic" means any substance that falls within any of the following categories:
(a) Produces death within fourteen days in half or more than half of a group of ten or more laboratory white rats each weighing between two hundred and three hundred grams, at a single dose of fifty milligrams or less per kilogram of body weight, when orally administered.
(b) Produces death within fourteen days in half or more than half of a group of ten or more laboratory white rats each weighing between two hundred and three hundred grams, if inhaled continuously for a period of one hour or less at an atmospheric concentration of two hundred parts per million by volume or less of gas or vapor or two milligrams per liter by volume or less of mist or dust, provided the concentration is likely to be encountered by humans if the substance is used in any reasonably foreseeable manner.
(c) Produces death within fourteen days in half or more than half of a group of ten or more rabbits tested in a dosage of two hundred milligrams or less per kilogram of body weight, if administered by continuous contact with the bare skin for twenty-four hours or less.
If the board finds that available data on human experience with any substance indicate results different from those obtained on animals in the dosages or concentrations prescribed in this paragraph, the human data shall take precedence.
42. "Hospital" means any institution for the care and treatment of the sick and injured that is approved and licensed as a hospital by the department of health services.
43. "Intern" means a pharmacy intern.
44. "Internship" means the practical, experiential, hands-on training of a pharmacy intern under the supervision of a preceptor.
45. "Irritant" means any substance, other than a corrosive, that on immediate, prolonged or repeated contact with normal living tissue will induce a local inflammatory reaction.
46. "Jurisprudence examination" means a board-approved pharmacy law examination that is written and administered in cooperation with the national association of boards of pharmacy or another board-approved pharmacy law examination.
47. "Label" means a display of written, printed or graphic matter on the immediate container of any article that, unless easily legible through the outside wrapper or container, also appears on the outside wrapper or container of the article's retail package. For the purposes of this paragraph, the immediate container does not include package liners.
48. "Labeling" means all labels and other written, printed or graphic matter that either:
(a) Are on any article or any of its containers or wrappers.
(b) Accompanying Accompany that article.
49. "Letter of reprimand" means a disciplinary letter that is a public document issued by the board and that informs a licensee or permittee that the licensee's or permittee's conduct violates state or federal law and may require the board to monitor the licensee or permittee.
50. "Limited service pharmacy" means a pharmacy that is approved by the board to practice a limited segment of pharmacy as indicated by the permit issued by the board.
51. "Manufacture" or "manufacturer":
(a) Means every person who prepares, derives, produces, compounds, processes, packages or repackages or labels any drug in a place, other than a pharmacy, that is devoted to manufacturing the drug.
(b) Includes a virtual manufacturer as defined in rule by the board.
52. "Marijuana" has the same meaning prescribed in section 13-3401.
53. "Medical practitioner" means any medical doctor, doctor of osteopathic medicine, dentist, podiatrist, veterinarian or other person who is licensed and authorized by law to use and prescribe drugs and devices for the treatment of To treat sick and injured human beings or animals or for the diagnosis To diagnose or prevention of Prevent sickness in human beings or animals in this state or any state, territory or district of the United States.
54. "Medication order" means a written or verbal order from a medical practitioner or that person's authorized agent to administer a drug or device.
55. "Narcotic drug" has the same meaning prescribed in section 13-3401.
56. "New drug" means either:
(a) Any drug of which the composition of which is such that the drug is not generally recognized among experts qualified by scientific training and experience to evaluate the safety and effectiveness of drugs as safe and effective for use under the conditions prescribed, recommended or suggested in the labeling.
(b) Any drug of which the composition of which is such that the drug, as a result of investigations to determine its safety and effectiveness for use under such conditions, has become so recognized, but that has not, other than in the investigations, been used to a material extent or for a material time under those conditions.
57. "Nonprescription drug" or "over-the-counter drug" means any nonnarcotic medicine or drug that may be sold without a prescription and that is prepackaged and labeled for use by the consumer in accordance with the requirements of the laws of this state and federal law. Nonprescription drug does not include:
(a) A drug that is primarily advertised and promoted professionally to medical practitioners and pharmacists by manufacturers or primary distributors.
(b) A controlled substance.
(c) A drug that is required to bear a label that states "Rx only".
(d) A drug that is intended for human use by hypodermic injection.
58. "Nonprescription drug wholesale permittee":
(a) Means a permittee who may distribute only over-the-counter drugs and devices to pharmacies or other lawful outlets from a place devoted in whole or in part to wholesaling these items.
(b) Includes a virtual wholesaler as defined in rule by the board.
59. "Notice" means personal service or the mailing of a copy of the notice by certified mail addressed either to the person at the person's latest address of record in the board office or to the person's attorney.
60. "Nutritional supplementation" means vitamins, minerals and caloric supplementation. Nutritional supplementation does not include medication or drugs.
61. "Official compendium" means the latest revision of the United States pharmacopeia and the national formulary or any current supplement.
62. "Other jurisdiction" means one of the other forty-nine states, the District of Columbia, the Commonwealth of Puerto Rico or a territory of the United States of America.
63. "Package" means a receptacle that is defined or described in the United States pharmacopeia and the national formulary as adopted by the board.
64. "Packaging" means the act or process of placing a drug item or device in a container for the purpose or intent of dispensing or distributing the item or device to another.
65. "Parenteral nutrition" means intravenous feeding that provides a person an individual with fluids and essential nutrients the person Individual needs while the person Individual is unable to receive adequate fluids or feedings by mouth or by enteral feeding.
66. "Person" means an individual, partnership, corporation and association, and their duly authorized agents.
67. "Pharmaceutical care" means the provision of drug therapy and other pharmaceutical patient care services.
68. "Pharmacist" means an individual who is currently licensed by the board to practice the profession of pharmacy in this state.
69. "Pharmacist in charge" means the pharmacist who is responsible to the board for a licensed establishment's compliance with the laws and administrative rules of this state and of the federal government pertaining to the practice of pharmacy, the manufacturing of drugs and the distribution of drugs and devices.
70. "Pharmacist licensure examination" means a board-approved examination that is written and administered in cooperation with the national association of boards of pharmacy or any other board-approved pharmacist licensure examination.
71. "Pharmacy":
(a) Means:
(i) Any place where drugs, devices, poisons or related hazardous substances are offered for sale at retail.
(ii) Any place in which the profession of pharmacy is practiced or where prescription orders are compounded and dispensed.
(iii) Any place that has displayed on it or in it the words "pharmacist", "pharmaceutical chemist", "apothecary", "druggist", "pharmacy", "drugstore", "drugs" or "drug sundries" or any of these words or combinations of these words, or words of similar import either in English or any other language, or that is advertised by any sign containing any of these words.
(iv) Any place where the characteristic symbols of pharmacy or the characteristic prescription sign "Rx" is exhibited.
(v) Any place or a portion of any building or structure that is leased, used or controlled by the permittee to conduct the business authorized by the board at the address for which the permit was issued and that is enclosed and secured when a pharmacist is not in attendance.
(vi) A remote dispensing site pharmacy where a pharmacy technician or pharmacy intern prepares, compounds or dispenses prescription medications under remote supervision by a pharmacist.
(b) Includes a satellite pharmacy.
72. "Pharmacy intern" means a person who has all of the qualifications and experience prescribed in section 32-1923.
73. "Pharmacy technician" means a person who is licensed pursuant to this chapter.
74. "Pharmacy technician trainee" means a person who is licensed pursuant to this chapter.
75. "Poison" or "hazardous substance" includes, but is not limited to, any of the following if intended and suitable for household use or use by children:
(a) Any substance that, according to standard works on medicine, pharmacology, pharmacognosy or toxicology, if applied to, introduced into or developed within the body in relatively small quantities by its inherent action uniformly produces serious bodily injury, disease or death.
(b) A toxic substance.
(c) A highly toxic substance.
(d) A corrosive substance.
(e) An irritant.
(f) A strong sensitizer.
(g) A mixture of any of the substances described in this paragraph, if the substance or mixture of substances may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion by children.
(h) A substance that is designated by the board to be a poison or hazardous substance. This subdivision does not apply to radioactive substances, economic poisons subject to the federal insecticide, fungicide and rodenticide act or the state pesticide act, foods, drugs and cosmetics subject to state laws or the federal act or substances intended for use as fuels when stored in containers and used in the heating, cooking or refrigeration system of a house. This subdivision applies to any substance or article that is not itself an economic poison within the meaning of the federal insecticide, fungicide and rodenticide act or the state pesticide act, but that is a poison or hazardous substance within the meaning of this paragraph by reason of bearing or containing an economic poison or hazardous substance.
76. "Practice of pharmacy":
(a) Means furnishing the following health care services as a medical professional:
(i) Interpreting, evaluating and dispensing prescription orders in the patient's best interests.
(ii) Compounding drugs pursuant to or in anticipation of a prescription order.
(iii) Labeling drugs and devices in compliance with state and federal requirements.
(iv) Participating in drug selection and drug utilization reviews, drug administration, drug or drug-related research and drug therapy monitoring or management.
(v) Providing patient counseling necessary to provide pharmaceutical care.
(vi) Properly and safely storing drugs and devices in anticipation of dispensing.
(vii) Maintaining required records of drugs and devices.
(viii) Offering or performing acts, services, operations or transactions necessary in the to conduct, operation, management operate, manage and control of a pharmacy.
(ix) Initiating, monitoring and modifying drug therapy pursuant to a protocol-based drug therapy agreement with a provider as outlined in section 32-1970.
(x) Initiating and administering immunizations or vaccines pursuant to section 32-1974.
(b) Does not include initiating a prescription order for any medication, drug or other substance used to induce or cause a medication abortion as defined in section 36-2151.
77. "Practitioner" means any physician, dentist, veterinarian, scientific investigator or other person who is licensed, registered or otherwise permitted to distribute, dispense, conduct research with respect to or administer a controlled substance in the course of professional practice or research in this state, or any pharmacy, hospital or other institution that is licensed, registered or otherwise permitted to distribute, dispense, conduct research with respect to or administer a controlled substance in the course of professional practice or research in this state.
78. "Preceptor" means a pharmacist who is serving as the practical instructor of an intern and WHO complies with section 32-1923.
79. "Precursor chemical" means a substance that is:
(a) The principal compound that is commonly used or that is produced primarily for use and that is an immediate chemical intermediary used or likely to be used in the manufacture of a controlled substance, the control of which is necessary to prevent, curtail or limit manufacture.
(b) Listed in section 13-3401, paragraph 26 or 27.
80. "Prescription" means either a prescription order or a prescription medication.
81. "Prescription medication" means any drug, including label and container according to context, that is dispensed pursuant to a prescription order.
82. "Prescription-only device" includes:
(a) Any device that is limited by the federal act to use under the supervision of a medical practitioner.
(b) Any device required by the federal act to bear on its label essentially the legend "Rx only".
83. "Prescription-only drug" does not include a controlled substance but does include:
(a) Any drug that because of its toxicity or other potentiality for harmful effect, the method of its use, or the collateral measures necessary to its use is not generally recognized among experts, qualified by scientific training and experience to evaluate its safety and efficacy, as safe for use except by or under the supervision of a medical practitioner.
(b) Any drug that is limited by an approved new drug application under the federal act or section 32-1962 to use under the supervision of a medical practitioner.
(c) Every potentially harmful drug, the labeling of which does not bear or contain full and adequate directions for use by the consumer.
(d) Any drug, other than a controlled substance, THAT IS required by the federal act to bear on its label the legend "Rx only".
84. "Prescription order" means any of the following:
(a) An order to a pharmacist for drugs or devices THAT IS issued and signed by a duly licensed medical practitioner in the authorized course of the practitioner's professional practice.
(b) An order THAT IS transmitted to a pharmacist through word of mouth, telephone or other means of communication directed by that medical practitioner. Prescription orders received by word of mouth, telephone or other means of communication shall be maintained by the pharmacist pursuant to section 32-1964, and the record so made by the pharmacist constitutes the original prescription order to be dispensed by the pharmacist. This paragraph does not alter or affect laws of this state or any federal act requiring a written prescription order.
(c) An order THAT IS initiated by a pharmacist pursuant to a protocol-based drug therapy agreement with a provider as outlined in section 32-1970, or immunizations or vaccines administered by a pharmacist pursuant to section 32-1974.
(d) A diet order or An order for enteral feeding, nutritional supplementation or parenteral nutrition that is initiated by a registered licensed dietitian nutritionist or other qualified nutrition professional in a hospital pursuant to section 36-416.
85. "Professionally incompetent" means:
(a) Incompetence based on a variety of factors, including a lack of sufficient pharmaceutical knowledge or skills or experience to a degree likely to endanger the health of patients.
(b) When considered with other indications of professional incompetence, a pharmacist or pharmacy intern who fails to obtain a passing score on a board-approved pharmacist licensure examination or a pharmacy technician or pharmacy technician trainee who fails to obtain a passing score on a board-approved pharmacy technician licensure examination.
86. "Radioactive substance" means a substance that emits ionizing radiation.
87. "Remote dispensing site pharmacy" means a pharmacy where a pharmacy technician or pharmacy intern prepares, compounds or dispenses prescription medications under remote supervision by a pharmacist.
88. "Remote supervision by a pharmacist" means that a pharmacist directs and controls the actions of pharmacy technicians and pharmacy interns through the use of audio and visual technology.
89. "Revocation" or "revoke" means the official cancellation of a license, permit, registration or other approval authorized by the board for a period of two years unless otherwise specified by the board. A request or new application for reinstatement may be presented to the board for review before the conclusion of the specified revocation period upon review of the executive director.
90. "Safely engage in employment duties" means that a permittee or the permittee's employee is able to safely engage in employment duties related to the manufacture, sale, distribution or dispensing of drugs, devices, poisons, hazardous substances, controlled substances or precursor chemicals.
91. "Satellite pharmacy" means a work area located within a hospital or on a hospital campus that is not separated by other commercial property or residential property, that is under the direction of a pharmacist, that is a remote extension of a centrally licensed hospital pharmacy, and that is owned by and dependent on the centrally licensed hospital pharmacy for administrative control, staffing and drug procurement and that is not required to be separately permitted.
92. "Symbol" means the characteristic symbols that have historically identified pharmacy, including show globes and mortar and pestle, and the sign "Rx".
93. "Third-party logistics provider" means an entity that provides or coordinates warehousing or other logistics services for a prescription or over-the-counter dangerous drug or dangerous device in intrastate or interstate commerce on behalf of a manufacturer, wholesaler or dispenser of the prescription or over-the-counter dangerous drug or dangerous device but that does not take ownership of the prescription or over-the-counter dangerous drug or dangerous device or have responsibility to direct its sale or disposition.
94. "Toxic substance" means a substance, other than a radioactive substance, that has the capacity to produce injury or illness in humans through ingestion, inhalation or absorption through any body surface.
95. "Ultimate user" means a person who lawfully possesses a drug or controlled substance for that person's own use, for the use of a member of that person's household or for administering to an animal owned by that person or by a member of that person's household.
Sec. 2. Section 36-414, Arizona Revised Statutes, is amended to read:
36-414. Health services licensing fund; exemption
A. The health services licensing fund is established consisting of monies deposited pursuant to sections 30-654, 32-2805, 36-405, 36-851.01, 36-882, 36-897.01, and 36-1903 and 36-4003. The department of health services shall administer the fund.
B. Monies in the fund are subject to legislative appropriation.
C. Monies in the fund are exempt from the provisions of section 35-190 relating to lapsing of appropriations.
Sec. 3. Section 36-416, Arizona Revised Statutes, is amended to read:
36-416. Licensed dietitian nutritionists; qualified nutrition professionals; hospital orders; definitions
A. A hospital that is licensed pursuant to section 36-422 and that has policies and procedures that meet the requirements of subsection B of this section may allow a registered licensed dietitian nutritionist or other qualified nutrition professional to order diets, enteral feeding, nutritional supplementation or parenteral nutrition the following if initially authorized OR GRANTED STANDING ORDERING PRIVILEGES by medical staff pursuant to 42 Code of Federal Regulations section 482.28(b) and if both:
1. The hospital's written policies and procedures allow registered dietitians or other qualified nutrition professionals to issue such orders.
1. Diets.
2. A change in diet orders.
3. Enteral feeding.
4. Durable medical equipment related to nutrition.
5. Nutritional supplementation.
6. Parenteral nutrition.
7. Medical nutrition therapy.
8. lABORATORY TESTS TO CHECK AND TRACK NUTRITION STATUS.
B. FOr the purposes of subsection A of this section, the hospital's written policies and procedures must do all of the following:
1. Allow licensed dietitian nutritionists to issue orders described in subsection A of this section or perform medical nutrition therapy.
2. Define the qualifications necessary for qualified nutrition professionals to issue orders described in subsection A of this SECTION AND list any additional restrictions on qualified nutrition professionals' ability to issue the orders.
2. 3. The hospital has written policies and procedures that Address the hospital's response to adverse events, if any, that arise as a result of orders issued by a registered licensed dietitian nutritionist or other qualified nutrition professional.
B. C. For the purposes of this section:
1. "medical nutrition therapy" has the same meaning prescribed in section 36-4001.
2. "Qualified nutrition professional" means a an unlicensed nutrition professional who is deemed qualified by a the hospital for which the person works.
2. "Registered dietitian" means a person who meets the qualifications of the credentialing agency for the American academy of nutrition and dietetics.
3. "sTANDING ORDERING PRIVILEGES" MEANS PERMISSION GRANTED TO AN INDIVIDUAL who is authorized TO ISSUE ORDERS LISTED IN SUBSECTION a OF THIS SECTION FOR ALL OR A SUBSET OF ALL PATIENTS OF THE HOSPITAL.
Sec. 4. Title 36, chapter 4, article 1, Arizona Revised Statutes, is amended by adding section 36-416.01, to read:
36-416.01. Licensed dietitian nutritionists; qualified nutrition professionals; nonhospital orders; definitions
A. A Licensed dietitian nutritionist or other qualified nutrition professional who practiceS in A nonhospital health care institution that IS licensed pursuant to SECTION 36-422 and who IS either an employee of the nonhospital health care institution or an independent contractor may order the following:
1. Diets.
2. A change in diet orders.
3. Enteral feeding.
4. Durable medical equipment related to nutrition.
5. Nutritional supplementation.
6. Parenteral nutrition.
7. Medical nutrition therapy.
8. lABORATORY TESTS TO CHECK AND TRACK NUTRITION STATUS.
B. For THE purposes of subsection A of this section, the nonhospital health care institution's written policIES and procedures must do all of the following:
1. Allow licensed dietitian nutritionists to issue orders described in subsection A of this section or perform medical nutrition therapy.
2. Define the qualifications necessary for qualified nutrition professionals to issue orders described in subsection A of this section and list any additional restrictions on qualified nutrition professionals' ability to issue the orders.
3. Address the nonhospital health care institution's response to adverse events, if any, that arise as a result of orders issued by a licensed dietitian nutritionist or qualified nutritional professional.
C. For the purposes of this section:
1. "medical nutrition therapy" has the same meaning prescribed in section 36-4001.
2. "Qualified nutrition professional" means an unlicensed NUTRITION professional who is deemed qualified by the nonhospital health care institution for which the person works.
Sec. 5. Title 36, Arizona Revised Statutes, is amended by adding chapter 40, to read:
CHAPTER 40
DIETITIAN NUTRITIONISTS
ARTICLE 1. GENERAL PROVISIONS
36-4001. Definitions
In this chapter, unless the context otherwise requires:
1. "Accreditation council for education in nutrition and dietetics" means the autonomous accrediting agency for education programs that prepares students to begin careers as registered dietitians or registered dietitian nutritionists.
2. "Commission on dietetic registration" means the credentialing agency for the academy of nutrition and dietetics.
3. "dEPARTMENT" MEANS THE DEPARTMENT OF HEALTH SERVICES.
4. "Dietetics" means INTEGRATING, APPLYING and communicatING practice principles derived from the food, nutrition, social, business and basic sciences to achieve and maintain the optimal nutrition status of an individual.
5. "dIRECTOR" MEANS THE DIRECTOR OF THE DEPARTMENT.
6. "Medical nutrition therapy" means nutrition care services THAT ARE provided TO treat or manage a disease or medical condition AND THAT INCLUDE any part or all of the following services:
(a) Interpreting anthropometric, biochemical, clinical and dietary data in acute and chronic disease states and recommending or ordering nutrient needs based on the dietary data, including enteral FEEDING and parenteral nutrition.
(b) Food and nutrition counseling, including prescription drug nutrient interactions.
(c) Developing and managing food service operations TO manage or treat diseaseS or medical conditions, INCLUDING functionS IN nutrition care SUCH AS ordering, PREPARING OR SERVING therapeutic diets.
(d) Medical weight control.
7. "Medical weight control" means medical nutrition therapy for the purpose of reducing, maintaining or gaining weight.
8. "Nutrition" means the science of food and nutrients, including the action, interaction and balance of food and nutrients in relation to health and disease and the process by which humans ingest, absorb, transport, use and excrete food substances.
9. "Nutrition assessment":
(a) Means the systematic process of obtaining, verifying and interpreting biochemical, anthropometric, physical, nutrigenomic and dietary data to make decisions about the nature and cause of nutrition-related problems.
(b) Includes an ongoing, dynamic process that both:
(i) Involves an initial data collection and a reassessment and analysis of client or community needs.
(ii) Provides the foundation for A nutrition diagnosis and nutritional recommendations, including enteral FEEDING and parenteral nutrition.
(c) Does not include The mere collection of data itself.
10. "Nutrition care services" means PROVIDING any part or all of the following services within a systematic process:
(a) Assessing and evaluating the nutritional needs of individuals and groups and determining resources and constraints in the practice setting, including ordering laboratory tests to check and track nutrition status, creating dietary plans and orders and monitoring the effectiveness of the dietary plans and orders.
(b) Establishing priorities, goals and objectives that meet nutritional needs and THAT are consistent with available resources and constraints.
(c) Providing nutrition counseling in health and disease.
(d) Developing, implementing and managing nutrition care systems.
(e) Evaluating, making changes in and maintaining appropriate standards of quality in food and nutrition services.
(f) Ordering therapeutic diets.
11. "Nutrition counseling" means a supportive process, characterized by a collaborative counselor-patient or counselor-client relationship with individuals or groups, to establish food, nutrition and physical activity priorities, goals and individualized action plans that acknowledge and foster responsibility for self-care to treat an existing DISEASE OR MEDICAL condition or promote health.
12. "Nutrition diagnosis":
(a) Means identifying and labeling nutritional problems THAT ARE managed and treated by a REGISTERED dietitian nutritionist or nutritionist.
(b) Does not include the medical differential diagnosis of the health status of an individual.
13. "Nutrition intervention" means purposefully planned actions and nutrition counseling THAT ARE intended to positively change a nutrition-related behavior, risk factor, environmental condition or aspect of the health status for an individual.
14. "Practice of dietetics and nutrition" MEANS:
(a) iNTEGRATING and APPLYING scientific principles derived from the study of food, nutrition, biochemistry, metabolism, nutrigenomics, physiology AND food management and from behavioral and social sciences TO achievE and maintain health throughout the life span and TO providE nutrition care services in person and by telehealth.
(b) pROVIDING medical nutrition therapy for the purpose of disease management or to treat or rehabilitate an illness, injury or condition AND PROVIDING OTHER NUTRITION CARE SERVICES FOR HEALTH AND WELLNESS AND TO PREVENT CHRONIC DISEASE.
15. "Registered dietitian" or "registered dietitian nutritionist" means an individual who is CREDENTIALED as a REGISTERED dietitian or a REGISTERED dietitian nutritionist with the commission on dietetic registration that authorizes the individual to use the title "registered dietitian nutritionist" AND "registered dietitian" and the abbreviation "rdn" AND "rd".
16. "Telehealth" MEANS USING electronic information and telecommunications technologies to provide services under this chapter to support clinical health care, patient and professional health-related education, public health and health administration between a licensee in one location and an individual in another location.
17. "Therapeutic diet" means a diet intervention prescribed by a physician or other authorized nonphysician practitioner that provides food or nutrients via oral, enteral and parenteral routes as part of treatING diseaseS or clinical conditions to modify, eliminate, decrease or increase identified micronutrients and macronutrients in the diet.
36-4002. Powers and duties of the director; advisory committee
A. The director shall:
1. License persons who apply for and possess all qualifications required for the practice of DIETETICS and nutrition.
2. Authorize all disbursements necessary to carry out this chapter.
3. Ensure the public's health and safety by adopting and enforcing qualification standards and a scope of practice for licensees and applicants for licensure under this chapter.
4. Adopt a scope of practice for licensed dietitian nutritionists consistent with thAT adopted by the academy of nutrition and dietetics.
B. The director may:
1. Appoint an advisory committee to collaborate with and assist the director and to perform duties as prescribed by this chapter. The director may inform the advisory committee regarding disciplinary actions.
2. Issue and renew a license.
3. Deny, suspend, revoke or refuse TO renew a license or file a letter of concern, issue a decree of censure, prescribe probation, impose a civil penalty or restrict or limit the practice of a licensee pursuant to this chapter.
4. Make and publish rules that are consistent with the laws of this state and that are necessary to carry out this chapter.
5. Require a licensee to produce records of patients involved in complaints on file with the department.
C. The advisory committee appointed pursuant to this section consists of the director, one physician licensed under title 32, chapter 13 or 17, THREE licensed dietitian nutritionists and ONE public member. Committee members who are licensed under this chapter shall have at least five years of experience in their field of practice in this state immediately preceding the appointment.
D. The advisory committee may provide recommendations to the director in the following areas, on which the director shall act within a reasonable period of time:
1. License issuance and renewal.
2. Disciplinary procedures.
3. Rules that are consistent with the laws of this state and that are necessary to carry out this chapter.
4. Licensee production of records of patients who are involved in complaints on file with the department.
36-4003. Deposit of monies
The director shall deposit, pursuant to sections 35-146 and 35-147, ten percent of all monies collected pursuant to this chapter in the state general fund and shall deposit the remaining ninety percent in the health services licensing fund established by section 36-414, except that monies collected from civil penalties imposed pursuant to this chapter shall be deposited in the state general fund.
36-4004. Issuance of license; renewal of license; continuing education
A. The director shall issue a license to each applicant who meets the requirements of this chapter. A license is valid for two years.
B. A licensee shall renew THE license every two years on payment of the renewal fee prescribed BY section 36-4008. There is a thirty-day grace period after a license EXPIRES WHEN the licensee may renew THE license on payment of a late fee in addition to the renewal fee.
C. When renewing a license, the licensee shall attest to having completed continuing professional education as required by this section during the licensing period and shall make DOCUMENTATION of completion available on the department's request. The director by rule shall provide standards for continuing professional education units required by this SUBsection. Educational courses that are accepted by the commission on dietetic registration are deemed to comply with department standards.
d. The director may refuse to renew a license for any cause provided in section 36-4011.
e. A person who does not renew a license as prescribed by this section shall reapply for a new license pursuant to the requirements of this chapter. The person must provide proof of HAVING COMPLETED the continuing professional education units prescribed by subsection C of this section within the previous twenty-four months before the date of reapplication.
36-4005. Licensure; renewal; military members
a. A license issued pursuant to this chapter to any member of the national guard or the United States armed forces reserves does not expire while the member is serving on federal active duty and is extended one hundred eighty days after the member returns from federal active duty if the member, or the legal representative of the member, notifies the director of the member's federal active duty status. A license issued pursuant to this chapter to any member serving in the regular component of the United States armed forces is extended one hundred eighty days after the date of expiration if the member, or the legal representative of the member, notifies the director of the member's federal active duty status.
B. A license that is issued pursuant to this chapter to any member of the national guard, the United States armed forces reserves or the regular component of the United States armed forces does not expire and is extended one hundred eighty days after the date the military member is able to perform activities necessary under the license if the member both:
1. Is released from active duty service.
2. Suffers an injury as a result of active duty service that temporarily prevents the member from being able to perform activities necessary under the license.
C. If the license is renewed during the applicable extended time period after the member returns from federal active duty, the member is responsible only for normal fees and activities relating to renewal of the license and may not be charged any additional costs such as late fees or delinquency fees.
D. A military member, or the legal representative of the member, shall present to the director a copy of the member's official military orders, a redacted military identification card or a written verification from the member's commanding officer before the end of the applicable extended time period in order to qualify for the extension prescribed in this section.
36-4006. Place of business; change of address; notice to director
A. A person who holds a license under this article shall notify the director in writing of the address of the place or places where the person engages in the practice of dietetics and nutrition or provides the nutrition care services and of any change of address.
B. The director shall keep a record of the places of practice of persons who hold licenses under this article. Any notice the director is required to give to a person who holds a license may be given by mailing it to that person at the address last given by that person to the director.
36-4007. Title designation; violation
A. A person may use the title:
1. "Certified nutrition specialist" or any alternative spelling or abbreviation of the title in an advertisement or publication or orally or in writing to any member of the public only if the person holds a valid current certification with the board for certification of nutrition specialists that authorizes the person to use the title "certified nutrition specialist" or the abbreviation "CNS".
2. "Dietitian", "registered dietitian" or "registered dietitian nutritionist" or the abbreviation "RD" or "RDN" only if the person is currently credentialed as a registered dietitian or registered dietitian nutritionist by the commission on dietetic registration.
3. "licensed dietitian" or "licensed dietitian nutritionist" or any alternative spelling or abbreviation of those titles in any advertisement or publication or orally or in writing to any member of the public only if that person is licensed as a dietitian nutritionist under this chapter.
B. A violation of this section constitutes an unlawful practice under section 44-1522. The attorney general may investigate and take appropriate action as prescribed by title 44, chapter 10, article 7.
36-4008. Fees
The director shall prescribe and collect fees in an amount to be determined by the director from persons who are regulated under this chapter for the following:
1. An application for a license.
2. The issuance of a license.
3. The renewal of a license.
4. The issuance of a duplicate license.
5. A late fee.
36-4009. Dietitian nutritionists; licensure requirements
An initial applicant for a dietitian nutritionist license shall:
1. Submit a nonrefundable application fee as prescribed by section 36-4008.
2. Submit evidence satisfactory to the director that the applicant either:
(a) Holds a current and valid registration as a registered dietitian or registered dietitian nutritionist with the commission on dietetic registration.
(b) Meets all of the following requirements:
(i) Earned A baccalaureate degree, master's degree or doctoral degree from a regionally accredited college or university or an academic degree from a college or university in a foreign country validated as equivalent by the director that meets the competency requirements in dietetics as required by the director with a major course of study in human nutrition, foods and nutrition, dietetics, food systems management, nutrition education, nutrition, nutrition science, clinical nutrition, applied clinical nutrition, nutrition counseling, nutrition and functional medicine, nutritional biochemistry, and nutrition and integrative health, or an equivalent course of study as determined by the director, that meets the competency requirements of a program for dietitian nutritionists accredited by the accreditation council for education in nutrition and dietetics as approved by the director.
(ii) successfully completed a planned clinical program in the practice of dietetics and nutrition that meets the competency requirements of a supervised practice for dietitian nutritionist accredited by the accreditation council for education in nutrition and dietetics as approved by the director. A planned clinical program shall include at least one thousand hours under the supervision of a dietitian nutritionist who is either registered with the commission on dietetic registration or who is licensed in this state or registered, certified or licensed in any other state with requirements that are equivalent to the licensure requirements under this chapter as approved by the director.
(iii) Passed the examination for registered dietitians administered by the commission on dietetic registration or another examination accredited by the national commission of certifying agencies if approved by the director for measuring competence in issuing orders DESCRIBED in section 36-416, subsection A and in performing medical nutrition therapy.
3. Be of good moral character.
4. Not have had a license, registration or certificate revoked or suspended by a state within the past two years and not be presently ineligible for licensure in any state because of a prior revocation or suspension.
36-4010. Waiver of educational requirements
The advisory committee appointed pursuant to section 36-4002 may recommend to the director a waiver of the educational requirements prescribed in section 36-4009 if an applicant submits proof satisfactory to the director that the applicant received professional education in another country equivalent to the education requirements of this article.
36-4011. Denial, revocation or suspension of license; hearings; alternative sanctions
A. The director may deny, revoke or suspend a license issued under this article if the applicant or licensee does any of the following:
1. Is convicted of a felony or misdemeanor involving moral turpitude. The record of the conviction or a certified copy from the clerk of the court where the conviction occurred or from the judge of that court is sufficient evidence of conviction.
2. Secures a license under this article through fraud or deceit.
3. Engages in unprofessional conduct or incompetence in the conduct of practice.
4. Uses a false name or alias in the practice of the applicant's or licensee's profession.
5. Violates any provision of this article.
B. The department may deny a license without holding a hearing. After receiving notification of the denial, the applicant may request a hearing to review the denial.
C. If the director determines pursuant to a hearing that grounds exist to revoke or suspend a license, the director may do so permanently or for a fixed period of time and may impose conditions as prescribed by rule.
D. The department shall conduct a hearing before revoking or suspending a license or imposing a civil penalty under section 36-4014. All proceedings pursuant to subsections B and C of this section and this subsection shall be conducted in accordance with title 41, chapter 6, article 10.
E. Instead of denying, revoking or suspending a license, the director may file a letter of concern, issue a decree of censure, prescribe a period of probation or restrict or limit the practice of a licensee.
F. The director shall promptly notify a licensee's employer if the director initiates a disciplinary action against the licensee.
36-4012. Injunctive relief
The director may enforce any provision of this chapter by injunction or by any other appropriate proceeding. An enforcement proceeding may not be barred by any prior completed proceeding or pending proceeding pursuant to any other provisions of this chapter, or by the imposition of any fine or term of imprisonment resulting from a prior completed proceeding or pending proceeding.
36-4013. Violation; classification
A violation of any provision of this chapter is a class 3 misdemeanor.
36-4014. Civil penalties; enforcement
A. The director may impose a civil penalty of not more than $500 for a violation of this chapter or a rule adopted pursuant to this chapter.
B. The director may impose penalties assessed pursuant to this section in addition to other penalties imposed pursuant to this chapter.
C. All monies collected from civil penalties collected for a violation of this chapter or a rule adopted pursuant to this chapter shall be deposited, pursuant to sections 35-146 and 35-147, in the state general fund.
D. The attorney general and the county attorney may bring an action in the name of this state to enforce civil penalties imposed pursuant to this section. Actions shall be brought in the superior court in the county where the violation occurs.
Sec. 6. Exemption from rulemaking; scope of practice
Notwithstanding any other law, for the purposes of this act, the department of health services is exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, for one year after the effective date of this act.
Sec. 7. Legislative intent
The legislature intends that the total fees for acquiring an initial license as a dietitian nutritionist not exceed $200.