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PA Bulletin, Doc. No. 05-280

PROPOSED RULEMAKING

STATE BOARD OF NURSING

[49 PA. CODE CH. 21]

Dietitian-Nutritionists

[35 Pa.B. 1213]

   The State Board of Nursing (Board) proposes to add Subchapter G (relating to dietitian-nutritionists) to read as set forth in Annex A.

Effective Date

   The proposed rulemaking will be effective upon final-form publication in the Pennsylvania Bulletin.

Statutory Authority

   The proposed rulemaking implements the act of June 29, 2002 (P. L. 651, No. 99) (Act 99), which grants the Board authority to regulate the practice of dietetics and nutrition and licensing of dietitian-nutritionists in this Commonwealth. The proposed rulemaking is authorized under section 2.1(k) of the Professional Nursing Law (act) (63 P. S. § 212.1(k)), which authorizes the Board to establish regulations for the practice of dietetics-nutrition.

Background and Need for the Proposed Rulemaking

   Act 99 became effective on September 29, 2002. Until September 27, 2003, persons registered by the American Dietetic Association (ADA) as registered dietitians (RD) were eligible for licensure under the grandfathering provision of section 5(e) of the act (63 P. S.§ 215(e)) without evidence of examination. In addition, until September 27, 2003, persons who met the requirements of section 6 of the act (63 P. S. § 216) who had been engaged in the practice for 5 of the preceding 7 years were eligible for licensure without examination. The Board proposes to add Subchapter G to establish procedures for issuance and biennial renewal of dietitian-nutritionist licenses and for the establishment of standards of professional conduct of licensed dietitian-nutritionists (LDNs).

Description of Proposed Amendments

   The following is a summary of the sections of Subchapter G and, when appropriate, an explanation of the Board's rationale for the regulations.

Proposed General Provisions

   Section 21.701 (relating to definitions) provides definitions for key terms used throughout the proposed rulemaking that are not defined in the act. Section 21.702 (relating to scope) provides a general statement of the scope of subchapter G. Subchapter G is limited to LDN licensees and applicants.

   Section 21.703 (relating to applicability of general rules) provides for the applicability of the general rules of administrative practice and procedure to the activities of and proceedings before the Board regarding Subchapter G. This section is included to direct applicants and licensees to the procedural provisions that govern the Board's actions.

   Section 21.704 (relating to matters related to allegations of sexual impropriety or violation) provides for specific procedural rules relevant in cases involving allegations of sexual impropriety or violation. These rules regarding defenses and presentation of opinion or reputation evidence protect alleged victims of sexual impropriety or violation and are consistent with the procedural rules applied in those cases involving a professional or practical nurse.

   Section 21.705(a) (relating to fees) provides for fees related to the Board's administration of licensing and disciplining LDNs. These fees are consistent with the fees charged to professional nurses, who have similar educational levels and levels of practice as LDNs. The fees for certification and verification of licensure are established by the Bureau of Professional and Occupational Affairs fees. Section 21.705(b) and (c) provides instructions to applicants regarding the two examinations approved by the Board under section 6(b)(4) of the act.

Proposed Sections Regarding Responsibilities of LDNs

   Section 21.711 (relating to professional conduct) provides rules of professional conduct for LDNs. Generally, the rules of professional conduct provide for the provision of information to clients, the objectivity of the LDN, the use of the title LDN and recordkeeping. The regulation prohibits: aiding the violation of law or Board regulation; discrimination in providing services; knowingly permitting another to use the licensee's license; misappropriating from an employer or patient; soliciting, borrowing or misappropriating from a patient or patient's family; leaving an assignment without proper notification; falsifying records; sexual improprieties or violations; misleading or false advertising; practicing while affected by a drug, emotional or mental disability that could affect practice; accepting or treating a client or patient unnecessarily; and accepting or receiving compensation for referrals. The rules of professional conduct are consistent with the professional conduct guidelines of the ADA and represent the acceptable and prevailing standards of conduct for LDNs Nationwide. Some representatives of the profession suggested that the Board adopt the guidelines of the ADA. Because the Board has no control over how the ADA might alter its guidelines, the Board has proposed setting forth standards of professional practice in its regulations.

Proposed Licensure Requirements

   Sections 21.721--21.723 and 21.725 concern education and the examination for licensure, inactive status, renewal of licensure and continuing education. Sections 5(b) and (c) and 6(b)(2) of the act require the Board to approve educational programs in dietetics-nutrition. Section 6(b)(4) of the act requires the Board to approve an examination for licensure. In § 21.721 (relating to education and examination of applicants), the Board adopts as approved educational programs those educational programs approved by the Commission on Accreditation for Dietetics Education or the American College of Nutrition.

   Section 6(b)(4) of the act requires the Board to approve an examination for licensure as an LDN. Section 21.721 adopts the Registration Examination for Registered Dietitians (RD examination) and the Examination of the Certification Board for Nutrition Specialists (CBNS examination) as the examinations approved by the Board for licensure. These examinations are widely accepted. The RD examination is taken by persons with an undergraduate degree in nutrition, whereas the CBNS examination is taken by persons with a graduate degree in nutrition.

   Section 21.722 (relating to license renewal) sets forth the requirements for biennial license renewal. LDN licenses will expire September 30 of even numbered years. This date was chosen based on the renewal cycles of the Board's approximately 250,000 nurse licensees to enable LDNs to have their license renewal applications processed in a timely and efficient manner and to give LDNs a maximum period of initial licensure prior to biennial renewal. The requirements for license renewal are consistent with the act and the regulations governing nurses. See §§ 21.29 and 21.156 (relating to expiration and renewal of license; and renewal of license).

   Section 21.723 (relating to continuing education) sets forth the Board's requirements for continuing education. Section 21.723(a) provides that one credit will be given for each 50-minute clock hour of continuing education activity because a 50-minute clock hour is the standard time period for 1 hour of academic instruction in American universities. Thirty hours of continuing education biennially is the licensure renewal requirement set forth in section 11(c) of the act (63 P. S. § 221(c)). Section 11(c) of the act provides for Board approval of continuing education for LDNs. Section 21.723(b) sets forth the requirements that continuing education courses must meet to be accepted by the Board for licensure renewal.

   During the development of the proposed rulemaking, several representatives of the dietetic profession expressed concern about the continuing education requirements in the act and this proposed rulemaking. First, concerns were raised because the requirement of 30 hours of continuing education for biennial renewal is not identical to the continuing education requirement for current registration by the Commission on Dietetic Registration (CDR) for RDs. Both RDs and certified nutrition specialists shall complete 75 hours of continuing education every 5 years. The Board explained to these commentators that it does not have the authority to alter the statutory requirement.

   Second, a question was raised as to why all continuing education courses that would meet the requirement for maintaining current RD registration were not Board-approved. The Board approved only the continuing education courses which are substantive learning experiences relating to the field of nutrition and dietetics including case presentations, patient case studies, certain certificate programs or individual study programs, interactive workshops, lectures and seminars, and postbaccalaureate residency and fellowship programs. The Board specifically did not approve certain types and subjects of continuing education that are approved for maintenance of the RD including courses on office management or computer skills, experiential skill development, journal clubs, poster presentations, professional leadership positions or courses and professional reading. The Board's determination was based on its evaluation of the types and subject matter of continuing education that offer substantive learning experiences related directly to the practice of dietetics-nutrition.

   Section 21.723(c) requires licensees to retain documentation evidencing their completion of Board-approved continuing education for at least 5 years and to submit this documentation to the Board upon request. The dietitian commentators informed the Board that all continuing education courses for RDs issue certificates of completion, as these certificates are required for RD renewal. In addition, all CNSs shall submit documentation of their attendance certificates to the CBNS when applying for recertification. Therefore, the Board anticipates no difficulties in licensees being able to comply with this provision.

   Subsection 21.723(d) permits an LDN to request a waiver of all or part of the continuing education requirement in cases of verified hardship. The Board acknowledges that there is no specific statutory section that provides that the Board may grant a waiver of the continuing education requirement. The CDR and the CBNS do not grant waivers of the continuing education requirement for renewal of the RD or CNS; however, the continuing education requirements for these bodies must be fulfilled over a period of 5 years. The Board is generally granted discretion in matters involving licensure. When a continuing education requirement must be completed in 2 years, and given individual circumstances such as illness, pregnancy or military service, the Board believes it should exercise discretion in granting a waiver of the continuing education requirement. Only in rare cases of extreme hardship would a waiver encompass elimination of the continuing education requirement; it is more likely the Board would grant an extension of time in which to complete the requirement. Continuing education provides an important safeguard to the citizens of this Commonwealth. The Board believes that it should exercise its statutory discretion in licensure matters in considering requests for waivers when balanced against protection of the citizens of this Commonwealth accorded in the continuing education requirement.

   Section 21.724 is left open for future use by the Board.

   Section 21.725 (relating to inactive status) sets forth the rules related to a licensee placing his license on inactive status and later returning the license to active status. A license that has been on inactive status cannot be renewed unless the licensee submits proof of completing the continuing education requirement during the biennial period preceding reactivation. Consistent with the requirements for nurses, licensees who have had their licenses on inactive status for 5 consecutive years are required to retake the licensure examination or demonstrate they have held an active license in another state for at least 2 out of the last 5 years. These provisions ensure licensees will possess current knowledge, thereby protecting the citizens of this Commonwealth.

   The Board sent these proposed regulations to numerous nursing and dietetics associations and individuals and hospital systems. These organizations were: Pennsylvania Dietetic Association, American Association of Neuroscience Nurses, Emergency Nurses Association, GPC-Oncology Nursing Society, The Hospital and Healthsystem Association of Pennsylvania, Intravenous Nurse Society, Licensed Practical Nurses Association of Pennsylvania, Pennsylvania Association of Home Health Agencies, Pennsylvania Association of Private School Administrators, Pennsylvania Association of Non-Profit Homes for the Aging, Pennsylvania Association of Nurse Anesthetists, Pennsylvania Association of Practical Nursing Program Administrators, Pennsylvania Coalition of Nurse Practitioners, Pennsylvania College of Associate Degree Nursing, Pennsylvania Council of Operating Room Nurses, Pennsylvania Department of Health--Bureau of CH Systems, Pennsylvania Health Care Association, Pennsylvania Higher Education Nursing Schools Association, Pennsylvania League for Nursing, Inc., Pennsylvania Organization of Nurse Leaders, Pennsylvania Society of Gastroenterology Nurses and Associates, Pennsylvania State Nurses Association, School Nurse Section, Southwestern Pennsylvania Organization for Nurse Leaders, Pennsylvania Medical Society, Nurses of Pennsylvania, Pennsylvania Association of School Nurses and Practitioners, Pennsylvania Nurses Association and Professional Nursing Resources, Inc. The draft regulations were also sent to individuals who expressed an interest in commenting on the regulations. In addition, the Board considered the impact the regulations would have on the regulated community and on public safety and welfare. The Board finds that the proposed regulations address a compelling public interest as described in this Preamble.

Fiscal Impact and Paperwork Requirements

   The proposed rulemaking will have no adverse fiscal impact on the Commonwealth or its political subdivisions. The Board is self-supporting. The Board will experience an increase in paperwork due to processing applications and renewals and pursuing disciplinary actions. However, the cost of providing these services will be borne by the licensees and applicants.

Sunset Date

   The Board continuously monitors the cost effectiveness of its regulations. Therefore, no sunset date has been assigned.

Regulatory Review

   Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on February 2, 2005, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.

   Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections must specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor of comments, recommendations or objections raised.

Public Comment

   Interested persons are invited to submit written comments, suggestions or objections regarding this proposed rulemaking to Ann Steffanic, Board Administrator, State Board of Nursing, P. O. Box 2649, Harrisburg, PA 17105-2649, www.dos.state.pa.us within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin.

JANET HUNTER SHIELDS, MSN, CRNP, CS,   
Chairperson

   Fiscal Note: 16A-5120. No fiscal impact; (8) recommends adoption.

Annex A

TITLE 49.  PROFESSIONAL AND
VOCATIONAL STANDARDS

PART I.  DEPARTMENT OF STATE

Subpart A.  PROFESSIONAL AND
OCCUPATIONAL AFFAIRS

CHAPTER 21.  STATE BOARD OF NURSING

Subchapter G.  DIETITIAN-NUTRITIONISTS

GENERAL PROVISIONS

Sec.

21.701.Definitions.
21.702.Scope.
21.703.Applicability of general rules.
21.704.Matters related to allegations of sexual impropriety or violation.
21.705.Fees.

RESPONSIBILITIES OF THE LICENSED DIETITIAN-NUTRITIONIST

21.711.Professional conduct.

LICENSURE REQUIREMENTS

21.721.Education and examination of applicants.
21.722.License renewal.
21.723.Continuing education.
21.725.Inactive status.

GENERAL PROVISIONS

§ 21.701.  Definitions.

   The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

   ADA--American Dietetic Association.

   ACN--American College of Nutrition.

   Act--The Professional Nursing Law (63 P. S. §§ 211--225), which provides for the licensing of Licensed Dietitian-Nutritionists.

   Approved--Approved by the Board.

   Approved program--Those educational programs accredited by the Commission on Accreditation for Dietetics Education or the American Council on Education for dietetics-nutrition education.

   Board--The State Board of Nursing of the Commonwealth.

   CADE--Commission on Accreditation for Dietetics Education--The organization recognized by the Council on Higher Education Accreditation and the United States Department of Education as the accrediting agency for education programs that prepare individuals for the practice of dietetics-nutrition.

   CBNS--Certification Board for Nutrition Specialists--The certification body of the American College of Nutrition (ACN).

   CDR--Commission on Dietetic Registration--The credentialing agency for the American Dietetic Association.

   CNS--Certified Nutrition Specialist--The title given to individuals who meet the requirements of the CBNS.

   CPE--Continuing professional education, required by the act for biennial license renewal.

   LDN--Licensed dietitian-nutritionist--A person holding a current license under this subchapter to practice dietetics-nutrition in this Commonwealth.

   Patient--A person upon whom or with whom an LDN is practicing dietetics-nutrition.

   RD--Registered Dietitian--The title given to an individual who meets the requirements set forth by CDR.

   Registration Examination for Registered Dietitians--A written academic examination developed, prepared, administered and scored by CDR.

   Sexual impropriety--The term includes the following offenses:

   (i)  Making sexually demeaning or sexually suggestive comments about or to a patient, including comments about a patient's body or undergarments.

   (ii)  Exposing unnecessarily a patient's body or watching a patient dress or undress, unless the patient specifically requests assistance.

   (iii)  Examining or touching genitals or breasts of a patient.

   (iv)  Discussing or commenting on a patient's potential sexual history or preferences during consultation, except when the consultation is pertinent to the issue of sexual function or dysfunction or reproductive healthcare. Discussion of a patient's sexual practices and preferences shall be fully documented in the patient's chart.

   (v)  Soliciting a date from a patient.

   (vi)  Volunteering information to a patient about one's sexual problems, preferences or fantasies.

   Sexual violation--The term includes the following offenses:

   (i)  Engaging in sexual intercourse with a patient during the professional relationship.

   (ii)  Engaging in genital to genital contact with a patient during the professional relationship.

   (iii)  Engaging in oral to genital contact with a patient during the professional relationship.

   (iv)  Encouraging the patient to masturbate in the presence of the dietitian-nutritionist or masturbating while a patient is present.

   (v)  Providing or offering to provide drugs, herbs, nutritional supplements or treatment in exchange for sexual favors.

   (vi)  Using or causing the use of any herb, nutritional supplement or drug affecting consciousness for the purpose of engaging in conduct that would constitute a sexual impropriety or sexual violation.

§ 21.702.  Scope.

   In this subchapter the Board:

   (1)  Provides for licensure of dietitian-nutritionists who meet the qualifications set forth in the act.

   (2)  Administers the act by providing rules and regulations for the practice of dietetics-nutrition.

   (3)  Provides rules and regulations for the conduct of licensees.

   (4)  Regulates the practice of LDNs.

§ 21.703.  Applicability of general rules.

   The provisions of 1 Pa. Code § 31.1 (relating to scope of part) and 1 Pa. Code Part II (relating to the general rules of administrative practice and procedure) apply to the activities of and proceedings before the Board.

§ 21.704.  Matters related to allegations of sexual impropriety or violation.

   (a)  The consent of the patient to any sexual impropriety or violation is not a defense to any disciplinary charge for violation of the act or this subchapter.

   (b)  Evidence of specific instances, opinion evidence or reputation evidence of a patient's past sexual conduct is not admissible in proceedings brought under § 21.711 (relating to standards of professional conduct). The Board may consider sexual relationships between the dietitian-nutritionist and the patient occurring prior to the professional relationship.

   (c)  A dietitian-nutritionist who attempts to raise as a defense an argument that conduct prohibited as a sexual violation or sexual impropriety was necessary or appropriate to the treatment of any patient shall be required to demonstrate competency in practice which relates directly to the treatment of sexual function or dysfunction. This competence may be demonstrated through educational training and supervised clinical experience. Appropriate discussions of sexual matters between a dietitian-nutritionist and a patient shall be fully documented in the patient records.

§ 21.705.  Fees.

   (a)  The following fees are charged by the Board:

Application for licensure$45
Renewal fee$45
Reactivation of inactive or lapsed license$50
License verification fee$15
License certification fee$25
Restoration after suspension or revocation$50

   (b)  In addition to the application fee prescribed in subsection (a), which is payable directly to the Board, a candidate for the Registration Examination for Registered Dietitians will also pay an additional examination fee. A candidate may contact the Commission on Dietetic Registration, 216 West Jackson Blvd., Chicago, Illinois 60606-6995, www.cdrnet.org, for more information regarding the examination and examination fee.

   (c)  In addition to the application fee prescribed in subsection (a), which is payable directly to the Board, a candidate for the Certification Board for Nutrition Specialists examination for Certified Nutrition Specialists will also pay an additional examination fee. A candidate may contact the Certification Board for Nutrition Specialists, 300 S. Duncan Avenue, Suite 225, Clearwater, Florida 33755, www.cert-nutrition.org, for more information regarding the examination and examination fee.

RESPONSIBILITIES OF THE LICENSED DIETITIAN-NUTRITIONIST

§ 21.711.  Professional conduct.

   (a)  Licensed dietitian-nutritionists shall:

   (1)  Conduct themselves with honesty, integrity and fairness.

   (2)  Practice dietetics based on scientific principles and current information.

   (3)  Present substantiated information and interpret controversial information without personal bias, recognizing that legitimate differences of opinion exist.

   (4)  Provide information that will enable clients to make their own informed decisions regarding nutrition and dietetic therapy, including:

   (i)  The purpose and nature of any evaluation, treatment, educational or training procedure.

   (ii)  The estimated cost of each stage of a procedure or of the entire treatment.

   (iii)  The reasonable expectations of the professional relationship.

   (iv)  The right to withdraw from treatment at any time.

   (5)  Safeguard the patient's dignity, the right to privacy and the confidentiality of patient information and make full disclosure about any limitations on the LDN's abilities to guarantee full confidentiality. This standard does not prohibit or affect reporting responsibilities under 23 Pa.C.S. Chapter 63 (relating to Child Protective Services law), the Older Adults Protective Services Act (35 P. S. §§ 10211--10224) and other statutes which may mandate reporting of this information.

   (6)  Provide professional services with objectivity and with respect for the unique needs and values of individuals.

   (7)  Be alert to situations that might cause a conflict of interest or have the appearance of a conflict. The LDN shall provide full disclosure when a real or potential conflict of interest arises.

   (8)  Permit the use of their names for the purpose of certifying that dietetic services have been rendered only if they provided or supervised the provision of those services.

   (9)  Accurately present professional qualifications and credentials.

   (i)  Dietitian-nutritionists may use the title ''Licensed Dietitian-Nutritionist'' or abbreviation LDN only when they hold a current license issued by the Board.

   (ii)  LDNs are subject to disciplinary action for aiding another person in violating any Board requirement or aiding another person in representing himself as a Licensed Dietitian Nutritionist or LDN when that person is not currently licensed.

   (10)  Document and maintain accurate records in accordance with the acceptable and prevailing standard of recordkeeping.

   (b)  The licensed dietitian-nutritionist may not:

   (1)  Knowingly aid, abet or assist another person to violate or circumvent a law or Board regulation.

   (2)  Discriminate, while providing dietitian-nutritionist services, on the basis of age, marital status, gender, sexual preference, race, ethnicity, religion, diagnosis, socioeconomic status or disability.

   (3)  Knowingly permit another individual to use his license for any purpose.

   (4)  Misappropriate equipment, materials, property, drugs or money from an employer or patient.

   (5)  Solicit, borrow or misappropriate money, materials or property from a client or the client's family.

   (6)  Leave an assignment prior to the proper reporting and notification to the appropriate department head or personnel.

   (7)  Falsify or knowingly make incorrect entries into the patient's record or other related documents.

   (8)  Engage in conduct defined as a sexual violation or sexual impropriety in the course of a professional relationship.

   (9)  Advertise in a false or misleading manner. Statements which qualify as false or misleading include the following:

   (i)  Statements containing a misrepresentation of facts.

   (ii)  Statements likely to mislead or deceive because in context the statement makes only a partial disclosure of the relevant facts.

   (iii)  Statements intended to, or likely to, create false or unjustified expectations of favorable results.

   (iv)  Statements relating to fees without reasonable disclosure of all relevant variables so that the statement would be misunderstood or would be deceptive to a layperson.

   (v)  Statements conveying the impression that the LDN could influence improperly any public body, official, corporation or any person on behalf of the patient.

   (vi)  Statements containing a representation or implication that is likely to cause a reasonable person to misunderstand or to be deceived, or fails to contain reasonable warnings or disclaimers necessary to make a representation or implication not deceptive.

   (vii)  Statements containing representations that the LDN is willing to perform any procedure that is illegal under the laws or regulations of the Commonwealth or the United States.

   (10)  Practice when:

   (i)  The LDN has engaged in any substance abuse that could affect his practice.

   (ii)  The LDN has been adjudged by a court to be mentally incompetent.

   (iii)  The LDN has an emotional or mental disability that affects his practice in a manner that could harm the client or others.

   (11)  Accept a client or patient for treatment or continue treatment unnecessarily, if benefit cannot reasonably be expected to accrue.

   (12)  Accept or receive, or both, remuneration for making or accepting referrals.

LICENSURE REQUIREMENTS

§ 21.721.  Education and examination of applicants.

   The Board approves educational programs that meet the requirements of section 6(b)(2) of the act (63 P. S. § 216(b)(2)) that are approved by CADE or the ACN. The Board approves the Registration Examination for Registered Dietitians and Examination of the Certification Board for Nutrition Specialists as the examinations which an applicant may complete to satisfy section 6(b)(4) of the act.

§ 21.722.  License renewal.

   (a)  A license issued under section 5(e) of the act (63 P. S. § 215(e)) or under this subchapter will be valid from the date of issuance through September 30, 2006, following the issuance of the license. Each subsequent license renewal will be valid for 2 years from October 1 through September 30.

   (b)  A dietitian-nutritionist license issued under the act will be renewed if the licensee applying for the renewal:

   (1)  Completes the renewal application, including disclosing a license to practice dietetics-nutrition in any other state, territory, possession or country.

   (2)  Pays the required fee as set forth in § 21.705 (relating to fees).

   (3)  Submits proof to the Board that he has satisfactorily completed a minimum of 30 hours of CPE approved by the Board in accordance with § 21.723 (relating to continuing education) during the 2 calendar years immediately preceding the application for renewal.

   (4)  Discloses any discipline imposed by any state licensing board in the previous biennial period or any criminal charges pending or criminal conviction, plea of guilty or nolo contendere, or admission into a probation without verdict or accelerated rehabilitative disposition program during the previous biennial period.

§ 21.723.  Continuing education.

   (a)  Prior to renewal. One hour of CPE credit will be given for each 50-minute clock hour of CPE activity. Each LDN shall complete 30 CPE credits during the 2 calendar years immediately preceding the application for license renewal. If an activity overlaps two renewal periods, the date of completion of the activity determines the date in which the activity can be reported.

   (b)  Board-approved continuing professional education. The Board will accept for completion of the CPE requirement substantive learning experiences, subject to the limitations in paragraph (2), relating to the field of nutrition and dietetics which are not designed for the public and which are sponsored by the ADA, the ACN, by individual state dietetic associations, if the association is a member of the ADA or ACN, by approved college or dietetic programs where a certificate of attendance is issued, and courses related to the practice of dietetics-nutrition offered by the Accreditation Council for Continuing Medical Education, the Accreditation Council on Pharmaceutical Education, the American Osteopathic Association and the American Medical Association.

   (1)  In addition to lecture-based CPE courses, the Board will accept documentation of the following:

   (i)  Case presentations, such as grand rounds or patient case studies.

   (ii)  Academic coursework and research studies approved by an institutional review board.

   (iii)  Interactive workshops.

   (iv)  Lectures and seminars.

   (v)  Residency and Fellowship programs which are at the postbaccalaureate level, and are sponsored by a United States regionally accredited college or university, or an institution accredited/approved by the Joint Committee on Accreditation of Healthcare Organizations (JCAHO) or the National Committee for Quality Assurance (NCQA).

   (2)  The Board will not accept for completion of the CPE requirement the following:

   (i)  Academic coursework or programs on office management skills, or entrepreneurship, strategic business planning, computer skills, except courses directly related to the practice of dietetics-nutrition such as accessing nutrient analysis databases.

   (ii)  Attendance at exhibits manned by detail personnel.

   (iii)  Journal clubs.

   (iv)  Professional leadership, such as holding an elective office in a dietetics or dietetics-related organization.

   (v)  Professional reading for which there is no evaluative test submitted and no certificate of completion or CPE unit awarded.

   (c)  Documentation. The licensee shall retain documentation of completion of Board-approved continuing education (as set forth in subsection (b)) for at least 5 years and shall submit this documentation upon request of the Board.

   (d)  Waiver. An LDN who can demonstrate to the Board a verified hardship may request a waiver of CPE requirements for a single biennial period. It shall be the duty of each licensee seeking waiver to notify the Board in writing and request the waiver, at least 60 days prior to the end of the biennial renewal period, which will be granted, denied or granted in part.

§ 21.725.  Inactive status.

   An LDN may request that his license be placed on inactive status. The licensee will not be required to remit the biennial renewal fee during the period when the license is on inactive status. To return to active status, the licensee shall submit proof of completion of a minimum of 30 hours of approved CPE in the biennial period preceding the request for reactivation and pay any applicable fees. A person who requests an active status license who has been on inactive status for 5 consecutive years shall satisfy the requirements of section 6(b)(4) of the act (63 P. S. § 216(b)(4)), unless the person demonstrates that he has held an active license to practice in another state, an RD registration, or a CNS certification for at least 2 out of the last 5 years.

[Pa.B. Doc. No. 05-280. Filed for public inspection February 11, 2005, 9:00 a.m.]



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