This Act is a Substitute for House Bill No. 449. Like House Bill No. 449, this Substitute Act comprehensively amends Chapter 38 of Title 24 of the Delaware Code, the Dietitian/Nutritionist Licensure Act, to modernize the regulation of dietitians and nutritionists in this State by doing all of the following: (1) Replacing the single “licensed dietitian/nutritionist” license with 2 distinct licensure categories—“licensed dietitian” and “licensed nutritionist”—each with its own defined scope of practice, educational pathway, supervised practice requirements, examination standards, and protected professional titles. Licensed dietitians are authorized to provide medical nutrition therapy for complex and non-complex disease states and medical conditions, including in inpatient and high-acuity settings, while licensed nutritionists are authorized to provide medical nutrition therapy for non-complex conditions in low-acuity outpatient settings. (2) Updating the definitions in Chapter 38 of Title 24 to add defined terms, including “medical nutrition therapy”, “complex”, “non-complex”, “practice of dietetics”, “practice of nutrition”, “nutrition care process”, “therapeutic diet”, “qualified supervisor”, “telehealth”, and “registered dietitian”. (3) Raising the minimum educational requirement for licensed dietitian applicants from a baccalaureate degree to a master’s degree with a program accredited by the Accreditation Council for Education in Nutrition and Dietetics, increases the required supervised practice experience from 900 to 1,000 hours, and modernizes examination requirements by tying them to the Commission on Dietetic Registration. This Substitute Act establishes a parallel licensure pathway for licensed nutritionists based on a master’s or doctoral degree in nutrition with a supervised practice experience of at least 1,000 hours and passage of the certified nutrition specialist examination administered by the Board for Certification of Nutrition Specialists. (4) Amending the composition of the State Board of Dietetics/Nutrition to include 2 licensed dietitian members, 1 licensed dietitian or licensed nutritionist member, 1 Delaware-licensed physician, and 1 public member. It updates the licensure renewal section to require that continuing education hours for licensed dietitians meet the standards of the Commission on Dietetic Registration, and that continuing education hours for licensed nutritionists meet the standards of the Board for Certification of Nutrition Specialists. (5) Revising the licensure required section (§ 3810 of Title 24) to establish protected titles for both licensed dietitians and licensed nutritionists, to clarify who may engage in the practice of medical nutrition therapy, and to update the exemptions from licensure requirements. Exemptions are updated or added for students and trainees in supervised practice programs; persons providing general non-medical nutrition information; out-of-state practitioners providing services via telehealth; persons providing wellness, health coaching, and non-medical weight control services; WIC program employees; and others providing non-discretionary support activities under direct supervision. (6) Adding a new § 3814 of Title 24 authorizing the Board to issue provisional licenses to applicants who have completed education and supervised practice requirements but have not yet passed their licensure examination. (7) Providing that existing Delaware licensed dietitian nutritionists who hold the registered dietitian credential will be grandfathered as licensed dietitians and those who do not hold that credential will be grandfathered as licensed nutritionists, without additional requirements. (8) Making conforming amendments throughout Chapter 38 of Title 24 to replace outdated titles, organizational references, and scope of practice language consistent with the dual licensure structure created by this Act. (9) Making technical corrections to conform Chapter 38 of Title 24 to the standards of the Delaware Legislative Drafting Manual. This Substitute Act differs from House Bill No. 449 by making all of the following changes recommended by the Division of Professional Regulation: (1) Removing antiquated language prohibiting an individual appointed to fill a vacancy from serving on the Board for only 1 additional full term. (2) Providing that the actions that require the affirmative vote of 3 members of the Board are related to disciplinary actions under § 3811(b) of Title 24. (3) Removing a requirement that an applicant for licensure as a nutritionist must complete the required supervised practice experience within 5 years of completing the required educational requirements. (4) Clarifying the documentation required related to the supervised practice experience required for an applicant for licensure as a nutritionist. (5) Removing the requirement that an applicant for licensure as a dietitian or nutritionist complete 75 hours of continuing education for each 5-year period post-examination when the applicant passed the required examination more than 5 years before applying for licensure and has not maintained registration or certification and replacing that requirement with a requirement that the applicant complete continuing education as required by the Board, have actively practiced in dietetics, nutrition, or a substantially related healthcare profession within the last 5 years, completed coursework, supervised practice, or training related to dietetics or nutrition in the last 5 years, or provided other evidence demonstrating current competency. (6) Providing, as part of the grandfather provisions, for a pathway for nutritionists who are practicing at the level of a dietitian to continue practicing at that level. (7) Removing the telehealth provision that was in House Bill No. 449 because Chapter 60 of Title 24 applies to the Board. (8) Reverting to the "reasonably equivalent" standard for reciprocity and ensuring reciprocity is available for certified or licensed dietitians or certified or licensed nutritionists from another state whose standards are not reasonably equivalent if the applicant has held the certification or license in good standing for at least 5 years and the Board determines the applicant qualifies for licensure under Chapter 38 of Title 24. (9) Deferring standards related to qualified supervisors to the Board by regulation. (10) Providing for delayed implementation of this Substitute Act for 18 months or the adoption by the Board of regulations to implement this Substitute Act, whichever comes first. This Substitute Act requires a greater than majority vote for passage because § 11 of Article VIII of the Delaware Constitution requires the affirmative vote of three-fifths of the members elected to each house of the General Assembly to impose or levy a tax or license fee.
While the exact number of nurse vacancies in Delaware fluctuates, healthcare providers agree that the current shortage is unsustainable. Nursing shortages lead to missed nursing care, higher morbidity, and mortality rates. The American Association of Colleges of Nursing (AACN) outlines a number of contributing factors impacting the current national nursing shortage. One is a lack of nursing school faculty - including the preceptors that provide supervision and instruction for clinical practice. Since Delaware’s nursing education programs must require clinical learning experiences provided by these preceptors, nursing students have difficulty completing the required coursework necessary for degree and licensure. Section 1 of this Act provides for an annual appropriation in an amount determined by the General Assembly to the Delaware Nursing Workforce Initiative or similar nonprofit to administer a program to provide funding to hospitals and clinical facilities to implement or continue offering preceptorship programs. Section 2 provides that this Act is effective 6 months after enactment.
The Health Care Professional Access Act requires carriers to participate in uniform processes with specific timetables to create speed-to-market for health care professionals. Currently, health care professionals may be employed for 6 months or more with no ability to collect insurer reimbursement due to lengthy carrier credentialing process. Ensuring uniformity across carriers, as well as relevant procedural standards, will help attract and retain health care professionals in our state, enable movement between practices and the creation of new ones, and ensure nondiscrimination in credentialing decisions. Under this Act, credentialing processes are limited to 45 days. This Act additionally provides for provisional credentialing, whereby reimbursement ability is provided even more quickly for certain health care professionals, including FQHCs, and in designated shortage areas which currently include mental health professionals statewide and primary and dental care in Kent and Sussex Counties, or is offered if timelines are not met. Oversight of compliance with this Act falls to the applicable regulatory agency. The Act also ensures specific processes and health care professional rights during a carrier’s intent to terminate a credential. More than 30 states have credentialing standards in law, with additional jurisdictions considering relevant legislation. Components of this legislation are derived from the National Association of Insurance Commissioners’ Health Care Professional Credentialing Verification Model Act. This substitute differs from the original in that it does the following: - Clarifies that it applies to those carriers that require credentialing and does not require carriers to create a credentialing process if they do not already do so; - Clarifies the process for credentialing of health care professionals whose primary or home state is not Delaware and prefer to use the credentialing process in their primary or home state; - Allows a carrier to require earlier recredentialing to address activity that could disqualify a health care professional from credentialing; - Allows for certain electronic delivery of recredentialing notices; - Simplifies the language for the basis to deny, suspend, nonrenew, or terminate a health care professional’s to align with NCQA standards; - Clarifies that the penalties and remedies in this Act are in addition to those already otherwise available; and - Makes technical changes to information about CAQH.
This Act updates Delaware laws relating to Sexually Transmitted Disease (STD) prevention and control, much of which are outdated and do not reflect current research and medical practice. To that end, this Act does the following: (1) Clarifies that Sexually Transmitted Infections (STIs) are to be treated in the same manner as STDs. (2) Removes the requirement that reportable STDs be reported to DPH within 1 working day. (3) Repeals the provision permitting the Director of DPH to examine a person suspected of being infected with an STD and to order that person to isolate or quarantine. (4) Repeals the provision relating to apprehending, committing, mandating treatment, and quarantine of an infected person. (5) Repeals the provision permitting the Director to bring an action in the Justice of the Peace Court when a person suspected of having an STD presents an imminent danger to public health. (6) Removes the provisions concerning the DOC and DPH isolating or quarantining persons with suspected or known STDs. (7) Provides that health care providers must provide STD and STI testing, but that a pregnant person may refuse testing. Documentation of refusal must be retained in the patient’s medical record along with documentation of test counseling. (8) Repeals the provision permitting a DPH investigator without a medical license to withdraw blood for test purposes. (9) Makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.
This Act expands the scope of practice for dental hygienists in this State. Allowing dental hygienists to use the full range of their education and expertise when providing oral health services will help alleviate provider shortages that make it challenging for Delawareans to obtain dental care. In particular, this Act will help fill gaps in access to preventative oral health care. Oral health is inseparable from overall health, and patients are best served when care is delivered through an integrated, team-based model. Dental hygienists play a vital and respected role in prevention, education, and early identification of disease. A collaborative dental team where each provider practices at the top of their education within a structured system of referral, communication, and accountability ensures patients receive timely preventative services along with accurate diagnosis and appropriate treatment. This approach strengthens access while preserving the standard of care and protecting the public. This Act grants dental hygienists the authority to do all of the following, in addition to the services they currently provide: 1. Administer and dispense topical agents under the standing order of a dentist providing general supervision. 2. Prescribe, administer, and dispense fluoride under the standing order of a dentist providing general supervision 3. Apply sealants without the need for a dentist to examine a patient beforehand, provided a dentist will see the patient within 12 months of receiving treatment. 4. Engage in dental hygiene assessment and treatment planning within the scope of the authority of a dental hygienist as defined by the Board of Dentistry and Denal Hygiene based on education and experience. 5. Provide direct access to prophylaxis without the need for a dentist to examine a patient beforehand, provided a dentist will see the patient within 12 months of receiving treatment. 6. Directly supervise dental assistants in a manner to be prescribed by the Board of Dentistry and Dental Hygiene. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.
Senate Substitute No. 1 for Senate Bill 208 differs from Senate Bill No. 208 in the following 9 ways: 1. Makes technical corrections, including changing § 3508A and § 3509A to § 3508B and § 3509B to avoid confusion with existing code sections in Chapter 35A of Title 24 of the Code, correcting the title for § 3509 and § 3509B, and making changes to use consistent language and structure. 2. Adds cognitive rehabilitation to the list of evidence-based therapeutic interventions under the practice of psychology. 3. Adds cognitive therapy to the list of therapies that are included as examples of evidence-based interventions. 4. Replaces "organic brain syndromes" with the modern term " brain-based disorders". 5. Adds programs accredited by the Canadian Psychological Association to the list of degree programs that are accepted by the Board of Examiners of Psychologists (Board) for licensure or registration under Chapter 35 of Title 24 of the Code. This makes it easier for individuals from Canada to be licensed or registered under Chapter 35 of Title 24 of the Code. 6. Removes from the qualifications of applicants for licensure as a licensed psychology associate the requirement that a master’s degree must be from a program with a minimum of 60 graduate semester hours, because the qualifications of applicants for licensure as a psychologist do not include a required number of semester hours for doctoral degree programs. The Board determines the qualifications of applicants, including whether the applicant’s degree is from a program that meets the requirements listed in § 3508 and § 3508B of Title 24. 7. In the scope of practice of a licensed psychology associate, replaces "general measures of cognitive abilities and achievement" with "measures of intellectual ability". This clarifies that a licensed psychology associate may not administer neuropsychological tests. 8. Updates registration as a doctoral-level psychological assistant under § 3509 and registration as a master's-level psychological assistant under § 3509B to reflect modern practice. The applicant for registration, not the supervising psychologist or supervising licensed psychology associate, is responsible for providing to the Board evidence of the applicant's qualifications for registration. Similar updates are made throughout Chapter 35 of Title 24 to reflect that the individual applying for registration is applying rather than the supervising psychologist or licensed psychology associate. 9. Removes the requirement for applicants for licensure or registrations under Chapter 35 of Title 24 to submit the applicant’s criminal history reports from the State Bureau of Identification (SBI) and the Federal Bureau of Investigation (FBI) to the Board. The Board directly receives electronic copies of each applicant’s criminal history reports from the SBI and the FBI, as provided in § 3508(b)(1), § 3508B(b)(1), §3509(b)(1), and §3509B(b)(1). Like SB 208, this Act adds 2 additional psychology professionals regulated under Chapter 35 of Title 24: (1) a licensed psychology associate and (2) a master’s-level psychological assistant. This Act also renames the psychological assistant registered under § 3509 of Title 24 to “doctoral-level psychological assistant” to mark the difference in education between the existing psychological assistant and the master’s-level psychological assistant added by this Act. This Act also changes § 3511 to clarify that licensing through reciprocity does not apply to individuals registered under § 3509 and § 3509B. A licensed psychology associate may independently practice at a master’s-level of education and training, subject to the limitations listed under § 3508B(e) added by this Act. The Board of Examiners of Psychologists (Board) may grant a license to practice as a licensed psychology associate if an applicant meets certain qualifications, including holding a master’s degree in psychology from an accredited school, completing an internship, obtaining at least 2 years of supervised professional experience, and achieving a passing score on a Board-approved examination. A licensed psychology associate is subject to the same standards as a psychologist licensed under Chapter 35 of Title 24, including handling of patient records, mandatory reporting, character and fitness requirements, and professional discipline. A licensed psychology associate also may be granted a license by reciprocity. An individual who is seeking further licensure under Chapter 35 of Title 24 may register as a master’s-level psychological assistant. A master’s-level psychological assistant may perform specific functions, appropriate for the assistant’s level of education and training, under the supervision of a licensed psychologist or licensed psychology associate. The supervising licensed psychologist or supervising licensed psychology associate may apply to the Board for registration of a master’s-level psychological assistant and shall provide to the Board evidence that the individual presented for registration has the required master’s-level of education and training, that the individual will receive appropriate training and supervision, that the individual meets character and fitness requirements. The supervising psychologist or licensed psychology associate must also give the Board a statement outlining the specific functions the master’s-level psychological assistant will perform under supervision. The individual seeking registration must provide a statement, under oath, that the individual will not practice independently, will perform only the specific functions outlined in the statement submitted by the supervising psychologist or supervising licensed psychology associate, and will not represent that the individual is a licensed psychologist or licensed psychology associate. A master’s-level psychological assistant is subject to the same professional standards and professional discipline as a doctoral-level psychological assistant. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual. Technical changes include removing deadlines that have passed and are no longer relevant, changing language to increase clarity and consistency, and changing the structure of certain paragraphs to increase readability and organization. Additionally, to clarify that all applicants for licensure or registration under Chapter 35 of Title 24 must provide criminal background checks, this Act moves the provision requiring applicants to provide fingerprints to obtain a criminal background report from § 3514 of Title 24 to the qualification requirements for each individual licensee or registrant under § 3508, § 3508B, § 3509, and § 3509B of Title 24. This Act requires a greater than majority vote for passage because § 11 of Article VIII of the Delaware Constitution requires the affirmative vote of three-fifths of the members elected to each house of the General Assembly to impose or levy a tax or license fee. This Act is effective on its enactment and is to be implemented the earlier of the following: 1. Twelve months from the date of enactment. 2. Notice by the Board of Examiners of Psychology published in the Register of Regulations that final regulations to implement this Act have been adopted.
This Act is a substitute for Senate Bill No. 101. It makes no substantive changes to Senate Bill No. 101 other than substituting the synopsis language from the prior bill for the new synopsis, as follows: This Act resolves a conflict between the Uniform Controlled Substances Act which requires an in-person examination to prescribe controlled substances for treatment of Opioid Use Disorder (OUD) and Delaware's telehealth regulations, the Telehealth Access Act which does not require an in-person examination. This bill connects and clarifies the two regulations by modifying the "patient-practitioner relationship" definition in Chapter 47, Title 16, the Uniform Controlled Substances Act, to include a practitioner treating OUD via telemedicine with Schedule III through V medication. The guardrails included in this short addition include: limiting the medication to only Schedule III through V, which has been approved by the FDA for the treatment of OUD and citing to the thorough requirements for establishing a provider-patient relationship under Section 6003 of Title 24, the 2021 Telehealth Access Act, which addresses requirements such as standard of care, medical record keeping, consent, and medical board oversight.
SB 70 amends Delaware law to allow licensed genetic counselors to directly order genetic tests, which previously required physician authorization. This change directly affects licensed genetic counselors and their patients in Delaware, streamlining access to genetic testing. The key provision removes the prior requirement that counselors obtain orders from physicians for genetic tests, enabling counselors to make these clinical decisions independently within their scope of practice.
This Act updates the Respiratory Care Advisory Council to the Board of Medical Licensure and Discipline’s enabling act to allow qualified licensed respiratory therapists to perform all duties associated with extracorporeal life support. Under the current law, respiratory therapists are authorized to assist with such support but may not administer medication during the process. As a result, a therapist is required to wait for another licensed professional to do so, resulting in delays to patient care. This bill eliminates this delay in patient care and allows qualified respiratory therapists to work within the full scope of their training. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.
This Act expands the “practice of occupational therapy” to include dry needling, and sets forth requirements and limitations for licensed occupational therapists and occupational therapy assistants pertaining to the practice of dry needling. Dry needling may not be performed without a physician referral, and occupational therapists and occupational therapy assistants may not hold themselves out as acupuncturists unless they are licensed acupuncturists.
