Licensure for Michigan
The Michigan Academy of Nutrition and Dietetics and the American Nutrition Association have been working with the support of our lobbyist and the Academy of Nutrition and Dietetics to create a bill in Michigan that would license the practice of Medical Nutrition Therapy for Registered Dietitian Nutritionists, and Certified Nutrition Specialists.
Michigan is one of only two states in the nation that does not have some form of licensure or title protection. After many years of collaborative work, we are proud to announce that the bill has been introduced by Senator Michael MacDonald with several senator co-sponsors. Read and follow Senate Bill 0614.
It will take all of us to make our voices heard for #MiMNTLicensure to be implemented and give Michigan residents safe and effective medical nutrition therapy.
Licensure is a topic of national importance. In a recent webinar, the Academy of Nutrition and Dietetics hosted licensure experts for a discussion on the importance of licensure for consumer protection, and they reviewed important Academy-led licensure initiatives. For more information on these topics, we highly encourage checking out the recording.
MiAND Licensure Town Hall Meetings
Wednesday, September 29
If you would like to view the recorded meeting, please contact our executive director, Susanne Consiglio.
Michigan Dietitian and Nutritionist Licensure Legislation (Senate Bill 614)
This information is not intended to be a “leave behind” or a
handout to give to your legislator.
What is in the bill?
- The legislation licenses the practice of dietetics and nutrition by licensed dietitian nutritionists (LDNs) and licensed nutritionists (LNs), recognizing licensees as Michigan’s qualified providers of the full scope of nutrition care services that includes both Medical Nutrition Therapy in addition to other nutrition care services focused on prevention and wellness. The law also places Medical Nutrition Therapy within the exclusive legal and statutory scope of practice of LDNs and LNs, meaning a license will be required to provide MNT.
- RDNs would be licensed as LDNs
- Certified Nutrition Specialists (CNS) and other advanced degree nutrition professionals without ACEND-accredited education or experience could qualify as an LN if they meet specific education and experience requirements. The bill does not license anyone as an LN simply because they hold some privately issued credential.
- The Michigan Academy of Nutrition and Dietetics and the American Nutrition Association have worked collaboratively on this licensure bill with ongoing consultation and participation from the national Academy of Nutrition and Dietetics.
- Medical Nutrition Therapy means the use of nutrition care services, including any of the following, for the treatment or management of diseases or medical conditions:
- Interpreting anthropometric, biochemical, clinical, and dietary data in acute and chronic disease states and recommending or ordering nutrient needs based on dietary data, including tube feedings and parenteral nutrition.
- Food and nutrient counseling, including counseling on food and prescription drug interactions.
- Developing and managing food service operations for the management or treatment of diseases or medical conditions, including operations with the primary function of nutrition care or recommending, ordering, or providing therapeutic diets.
- Medical Nutrition Therapy is a complex, potentially harmful service, and should be provided only by qualified nutrition professionals meeting high objective educational standards and have exhibited the necessary specialized training and competencies outlined in detail in the bill.
- This legislation will not affect the ability of anyone to provide general nutrition services that do not constitute Medical Nutrition Therapy, such as:
- healthy eating
- nutrient requirements and food sources
- individualized guidance or nutrition counseling for healthy individuals
- non-medical weight control
- wellness counseling
- sports nutrition or cooking classes by personal trainers, fitness coaches or health food stores.
- This legislation will also not affect the practice of any licensed health professionals who is practicing within his or her scope of practice. The legislation also specifically exempts health care professionals who already have the authority to provide nutrition care services for the treatment or management of diseases or medical conditions nutrition in their Scope of Practice.
Why do we need licensure of RDNs and other advanced-degree nutritionists?
- In order to protect public health and safety, Medical Nutrition Therapy and other complex nutrition care services should only be provided by qualified individuals with the education, training and experience necessary to ensure safe and effective care.
- With numerous and often-changing sources of nutrition advice and opinions purporting to be able to treat a wide variety of ailments, it can be very challenging for individuals with particular diseases or conditions to determine who they can turn to or who they cannot rely on for competent, safe, and appropriate advice and will not result in worsening health, diminished quality of life or increased health care costs.
- Licensure enables Michigan consumers to easily identify those individuals Michigan recognizes as qualified providers of nutrition care services and whether an individual iseligible to provide Medical Nutrition Therapy.
- Allows for collaboration with other licensed health professionals (SLPs, exercise physiologists, etc.) to further strengthen and protect public health.
Will this licensure law monopolize the industry or hamper the ability for non-licensed nutrition practitioners? Will licensure stifle freedom of choice for consumers seeking nutrition advice?
- No. This licensure legislation continues to allow the public to seek nutrition advice from whomever they want.
- Any individual or group/business can continue to provide individual guidance, wellness services, counseling on general healthy eating, or nutrition information obtained from research, educational, corporate or government sources without needing to be licensed.
- The bill creates multiple pathways for a variety of differently trained and qualified nutrition professionals to become licensed to provide Medical Nutrition Therapy. Multiple professional associations collaborated throughout the bill drafting process.
- The proposed legislation merely establishes the minimum education and experience requirements for those nutrition professionals qualified to treat or manage diseases or medical conditions.
- Only Michigan and Arizona fail to regulate the provision of Medical Nutrition Therapy or the qualifications and/or titles of those providing it. Moreover, most states require providers of Medical Nutrition to be licensed because legislatures found “the practice of dietetics and nutrition or nutrition counseling by unskilled and incompetent practitioners presents a danger to the public health and safety.” Dietetics and Nutrition Practice Act – Section 468.502 (Florida).
Why choose a licensed nutrition professional instead of another individual providing nutrition services?
- All complex and potentially harmful nutrition care services, including any services provided to individuals with medical conditions or diseases, such as diabetes, heart disease, cancer, gastrointestinal diseases, and kidney diseases.
- Incompetent or unskilled practitioners have been shown to cause significant harm, delay effective and safe intervention, decrease quality of life and increase health care costs.
- An advanced degree alone provides no assurance that the academic degree-holder has demonstrated an ability to translate knowledge into practice or meets necessary competencies. To meet established standards of practice, an academic must undertake specialized training, complete supervised practice experiences and obtain an accredited evaluation of their competency.
- Michigan’s proposed law to license dietitian nutritionists and nutritionists adopts this national standard for education, training and experience.
Will licensure impact gym employees, health coaches, holistic nutrition practitioners, and others and their ability to practice?
- No. These individuals can continue to provide information related to athletic training, coaching and holistic nutrition for a healthy diet. For individuals in these occupations to be impacted by this licensure bill, they would have to be treating or managing diseases or medical conditions, which would violate their practice acts.
- Knowledge about fitness and exercise do not equate with knowledge about nutrition and dietetics, let alone confer an ability to counsel patients with malnutrition or end-stage renal disease about their nutrient disease (i.e., provide. Medical Nutrition Therapy). Similarly, a state license recognizing one’s ability to provide complex nutrition care services such as Medical Nutrition Therapy confer neither authority nor ability to provide advice regarding exercise and fitness.
- Professionals and lay practitioners who work with the public should recognize their areas of expertise and, when an individual’s needs exceed their expertise, refer them to other professionals with competency in the areas needed.
- Qualified health professionals in Michigan, including, MDs, PA, NPs, RNs, OTs, PTs, SLPs, chiropractic, naturopathic and other professionals operate competently in their fields and know when to refer someone to a more specialized practitioner.
What does MNT involve that cannot be provided by someone who does not meet criteria for licensure but has a lot of experience?
- Medical Nutrition Therapy is evidenced-based and includes a comprehensive nutrition assessment, nutrition diagnosis, individualized interventions and ongoing evaluation and monitoring to improve health outcomes including delaying the advancement or preventing the worsening of a disease.
- LDNs and LNs meet rigorous scientific standards in their education, training and experience in disease management.
- An individual who has obtained a few days or months of generalized health training is not qualified to apply complex Medical Nutrition Therapy. The depth and scope are key indicators of who is and is not qualified.
- The Center for Medicare and Medicaid Services (CMS) has ruled that: “RD[N]s are the professionals who are best qualified to assess a patient’s nutritional status and to design and implement a nutritional treatment plan in consultation with the patient’s interdisciplinary care team. In order for patients to receive timely nutritional care, the RD[N] must be viewed as an integral member of the hospital inter-disciplinary care team, one who, as the team’s clinical nutrition expert, is responsible for a patient’s nutritional diagnosis and treatment in light of the patient’s medical diagnosis.”
- The National Academies of Science, Engineering and Medicine (formerly the Institute of Medicine) recognizes that “the registered dietitian [nutritionist] is currently the single identifiable group of health-care professionals with standardized education, clinical training, continuing education and national credentialing requirements necessary to be directly reimbursed as a provider of nutrition therapy.”
What is the difference between a Registered Dietitian Nutritionist and Nutritionist?
- Based on their professional education and training standards, every RDN is a Nutritionist but not every Nutritionist is an RDN.
- RDNs work in a variety of settings. In health care their title may be Clinical Dietitian. In school food service, corporate dining/wellness, the food industry or health and wellness centers it may be Nutritionist.
- The credential RDN is a trademark of the Academy of Nutrition and Dietetics and is awarded to those who meet academic and supervised practice requirements and pass a registration exam. The term Nutritionist is not trademarked and may be used by anyone who wishes to use it.
- Licensure of the Registered Dietitian Nutritionist (LDN) and Nutritionist (LN) will assure that both have met the highest standards of education, training and experience for Medical Nutrition Therapy as detailed in the bill so as to distinguish them from individuals who do not meet these licensure requirements.
How is this bill different from bills in the past?
- Previous licensure bills for dietitians:
- Created a license for holders of only one type of nutrition credential, the RDN,
- The current bill expands the educational professional pathways for those seeking a license to include a pathway for other, such as CNSs, to be licensed.
- Made licensure required to provide any type of nutrition care.
- The current bill defines those professionals who are qualified to provide nutrition services where the risk of harm is the greatest – Medical Nutrition Therapy.
- Created a license for holders of only one type of nutrition credential, the RDN,
What impact will this bill have on our state economy, jobs and the way you currently practice in Michigan?
- No negative impact is anticipated. Unlicensed nutrition service providers continue to have the ability to offer general nutrition advice in a variety of settings and can offer nutrition counseling and individualized guidance to healthy clients.
- RDNs in Michigan will likely notice little change in the way they currently practice; however, licensure enables licensees to practice at the height of their scope of practice and opens professional opportunities resulting from health care stakeholders’ recognition of the value of highly qualified nutrition professionals.
- Michigan has 22 accredited academic and experiential programs providing the highest quality education and training for dietetic students and interns. Licensure will enable licensees to order therapeutic diets, practice telehealth with reciprocity in other states across the country, and open opportunities for third-party reimbursement conditioned on having a state license, all of which are expected to lead more graduates of these programs to choose Michigan to live, work, and build their families.
- Licensure will increase access to Medical Nutrition Therapy for Michigan citizens since most insurers require a licensed professional to provide those services.
- Hospitals, clinics and physician offices currently providing Medical Nutrition Therapy by RDNs would also be able to receive reimbursement for these services.
- Increased accessibility to Medical Nutrition Therapy will improve health and reduce health care costs.
- Currently heart disease is the leading cause of death in Michigan (MI Department of Health and Human Services).
- Twelve percent of Michigan residents are living with diabetes, while another 37% have prediabetes and may be unaware (American Diabetes Association). Diagnosed diabetes costs an estimated $9.7 billion in Michigan each year (American Diabetes Association).
- Michigan’s adult obesity rate is 32%, up from 22% in 2000 (Center for Disease Control; State of Obesity). The cost of obesity to Michigan is over $58 billion annually (Obesity Care Advocacy Network).
- Licensure will facilitate working across state lines whether through consulting, corporate positions, telehealth or with health systems with facilities in more than one state.
How many dietitians are in MI?
- Over 4,000 Registered Dietitian Nutritionists in Michigan would qualify to be LDNs under this legislation.
- Approximately 40 Certified Nutrition Specialists (CNS) would qualify to be LNs in the state.
How many states have licensure?
- Forty-eight (48) states plus the District of Columbia and Puerto Rico have some type of regulation – licensure, certification, or title protection.
- Michigan and Arizona are the only two states that have no regulation at all for practicing Medical Nutrition Therapy.
What is our “ask”?
- Before concluding your meeting be sure to make your ask:
“We hope that you will support Senate Bill 614 being sponsored by
Senator Mike MacDonald (R-Macomb Twp).”
- Thank the legislator for their time and offer to be a resource to answer any questions they may have in the future. Leave your contact information with them.
What are good examples of Medical Nutrition Therapy to share with legislators to demonstrate the complexity of the care being provided?
- COVID/RDN handout
- Stunt Man Needs MNT video
- Michigan Dietitian Tells Surprising MNT Story video
- Hero to a Military Mom video
- Michigan Dietitian Saves Kidneys video
- But feel free to share one of your stories!
Help us meet our goal of $10,000 to get our seat at the table. You can make a quick and easy donation via the form below. If you wish to donate via check, please contact the MiAND Executive Director.
Act Now! Please complete this ACTION ALERT right now!
Here’s what you do for the Action Alert:
- Click the Action Alert link above.
- Scroll down on the Action Alert and enter your name/address FIRST to connect to your Senator
- You can personalize the message if you’d like, or leave as is. Click “Send Message” and a letter thanking or asking for support will be sent to your senator.
Michigan is one of only two states without any legal recognition of the practice of dietetics and nutrition or protection of our scope of practice. Licensure will protect the public from unqualified providers, give us the power to fully serve our patients and community and compete with out-of-state providers.
Senate Bill 614, Licensure of Medical Nutrition Therapy, is currently in the Senate Health Policy and Human Services Committee. It is scheduled for a second hearing SOON. At the hearing, we are hoping that the committee members will vote favorably on our bill, vote it out of the committee and send it to the Senate floor for a full vote. We need YOUR help to make this happen as YOUR senator will be voting on SB 614!
Check out this brief video to learn how to complete an Action Alert:
- Senate Bill 614 Summary-Michigan MNT Practice
- What is an RDN?
- Consumer Protection Handout
- What is Medical Nutrition Therapy?
- Effectiveness of MNT: MI Policymaker Leave Behind (handout)
- COVID and the RDN (infographic)
- Stunt Man Needs MNT (video)
- Michigan Dietitian Tells Surprising Story (video)
- Hero to a Military Mom (video)
- Michigan Dietitian Saves Kidneys (video)
- Effectiveness of MNT in the Management of Adult Dyslipidemia: A systemic review and meta-analysis
- Academy of Nutrition and Dietetics Webinar “A License to Practice: Updates on the Academy’s National Approach to Consumer Protection,”
- Printable MiAND Licensure Business Card (share with your patients and clients so they can spread the news)