SCR23

WHEREAS, Hawaii has repeatedly and consistently been recognized by the federal government as a health professional shortage area; and

WHEREAS, registered dietitian nutritionists (RDNs) enhance patient care by providing key nutrition services, and is recognized widely by physicians as the most qualified health care professionals to help patients with diet-related conditions; and

WHEREAS, in 2014, the federal Centers for Medicare and Medicaid Services (CMS) announced a final rule allowing RDNs in hospital settings to be privileged to independently write diet orders without the supervision or approval of the physician, on the basis that it would:

(1) Reduce unnecessary and burdensome procedures by physicians to write the diet orders;

(2) Increase flexibility for health care providers to improve care;

(3) Reduce costs to each health care facility; and

(4) Allow primary care physicians to focus on their respective areas of expertise to care for patients; and

WHEREAS, the CMS rules deferred to each individual hospital system the determination of whether to grant RDNs specific nutrition order-writing privileges to suit each hospital system's needs, within the confines of state regulations; and

WHEREAS, the existing Hawaii Administrative Rules do not allow licensed dietitians to issue diet orders; and

WHEREAS, allowing licensed dietitians to prescribe and plan diets within the State's health care system will reduce issues associated with the current shortage of physicians in the State, while ensuring that patients have sufficient nutrition; now, therefore,

BE IT RESOLVED by the Senate of the Thirty-second Legislature of the State of Hawaii, Regular Session of 2024, the House of Representatives concurring, that the Department of Health is urged to amend the Hawaii Revised Statutes to authorize licensed dietitians to prescribe modified diets and plan therapeutic diets; specifically, by amending section 11‑93‑8, subsections (c) and (d), Hawaii Administrative Rules, to read as follows:

"(c) All modified diets shall be:

(1) Prescribed by the patient's physician or qualified dietitian privileged by the hospital to do so with a record of the diet as ordered kept on file.

(2) Planned, prepared, and served by qualified personnel using the current Hawaii Dietetic Association manual or the American Dietetic Association manual, or both.

(3) Reviewed and adjusted as needed.

(d) Therapeutic diets shall be planned by a [~~qualified~~] licensed dietitian, as prescribed by the patient's physician[.] or licensed dietitian privileged by the hospital to do so. Nutrition assessment and dietary counseling shall be provided by a dietitian when indicated for a patient. Nutrition plans and follow-ups shall be documented in the individual medical record."; and

BE IT FURTHER RESOLVED that a certified copy of this Concurrent Resolution be transmitted to the Director of Health.

	OFFERED BY:	_____________________________

Report Title:

Department of Health; Rules; Licensed Dieticians; Prescribing Authority; Modified Diets; Therapeutic Diets

THE SENATE	S.C.R. NO.	23
THIRTY-SECOND LEGISLATURE, 2024
STATE OF HAWAII