Telehealth and Licensing

Telehealth is becoming a more and more common area of practice for health care professionals, including dietitians/nutritionists. If one chooses to practice in the area of telehealth, it is important to ensure that one is aware of the various laws that may impact one’s practice, including licensure.

Under N.C. General Statute § 90-352(6) telepractice is defined as the delivery of services under this Article by means other than in-person, including by telephone, e-mail, Internet, or other means of electronic communication.  Per N.C. General Statute § 90-365.5 telepractice is not prohibited under the Dietetics/Nutrition Practice Act so long as (i) it is appropriate for the individual receiving the services and (ii) the level of care provided meets the required level of care for that individual. An individual providing services regulated by this Article via telepractice shall comply with, and shall be subject to, all licensing and disciplinary provisions of the Article.

Prior to providing telehealth services, one should determine whether one will only be providing health coaching/nutrition coaching services, for which one may not need to be licensed (see Guideline A for unlicensed persons who are not otherwise exempt), or, if one will be providing medical nutrition therapy for which a license is required in North Carolina. Per N.C. General Statute § 90-352(3a) medical nutrition therapy is defined as the provision of nutrition care services for the purpose of managing or treating a medical condition.  Per N.C. General Statute § 90-352(4), nutrition care services are defined as any, part, or all of the following:

  • Assessing and evaluating the nutritional needs of individuals and groups, and determining resources and constraints in the practice setting, including ordering laboratory tests related to the practice of nutrition and dietetics.
  • Establishing priorities, goals, and objectives that meet nutritional needs and are consistent with available resources and constraints.
  • Providing nutrition counseling in health and disease.
  • Developing, implementing, and managing nutrition care systems.
  • Evaluating, making changes in, and maintaining appropriate standards of quality in food and nutrition services.
  • Ordering therapeutic diets.

If one is providing the above detailed nutrition care services for the purpose of managing or treating a medical condition, and is not otherwise exempt, a license is required in North Carolina.

Per regulation 21 NCAC 17.0403, which addresses the electronic practice of dietitians/nutritionists: [a]ny person, whether residing in this state or not, who by use of electronic or other medium performs any of the acts described as the practice of dietetics/nutrition, but is not licensed pursuant to Article 25 of G.S. 90 shall be deemed by the Board as being engaged in the practice of dietetics/nutrition and subject to the enforcement provisions available to the Board. Among other remedies, the Board shall report violations of this Rule to any occupational licensing board having issued an occupational license to a person who violates this Rule. This Rule does not apply to persons licensed pursuant to, or exempt from licensure pursuant to, Article 25 of G.S. 90.

Unless one is otherwise exempt (see exemptions in N.C. General Statute § 90-368), if one is providing nutrition care services for the purpose of managing or treating a disease state, as a practitioner in North Carolina, or as a practitioner residing outside of the state but providing such services via the use of technology to the citizens of North Carolina, one must be licensed to provide such services. In addition, if a practitioner resides in North Carolina, but one’s clients include persons outside of North Carolina, one will need to investigate whether or not he/she is required to be licensed or certified in each state where one’s clients are located.

Finally, licensure is just one of many factors that one must consider when choosing to provide telehealth services. Such other factors include but are not limited to, consideration of reimbursement, ensuring one is utilizing HIPPA compliant technology, and whether one’s professional liability insurance covers telehealth.

It is clear that this emerging form of healthcare will continue to grow and will provide access to nutrition services to many who might not otherwise be able to access such services. As a licensee, it is important that you maintain awareness of this form of practice, and if you choose to provide it, ensure that you are in compliance with all laws and regulations of each state in which you choose to provide nutrition services.

Additional resources from the Academy of Nutrition and Dietetics are available at:

https://www.cdrnet.org/state-licensure?set_ga_opt_in_cookie=1&set_ga_opt_in=Save+Settings