The Senate Appropriations Committee advanced House Bill 12 20 on a 6-1 vote after hours of testimony and debate over whether Colorado should license providers who deliver medical nutrition therapy. The measure would create a pathway for dietitians and qualified nutritionists to be licensed for medical nutrition therapy and, sponsors and supporters said, allow them to be credentialed for Medicaid reimbursement.

The bill’s proponents argued licensing would improve patient safety and expand access to medically tailored nutrition services. Zachary Hedden, a registered dietitian with Project Angel Heart, said, “By licensing dietitians, Colorado will be better positioned to meet the growing need for medical nutrition therapy,” and that licensure would help providers secure Medicaid contracts. Michael Ruddock of the Adams County Health Department told the committee local public health agencies rely on dietitians and that allowing licensure “would change that by creating the path to a license and increase access to nutrition services across Colorado.”

Opponents included officials from the Department of Regulatory Agencies (DORA), who argued regulation is unnecessary and could be hard to enforce. Sam Delp, division director for the Division of Professions and Occupations at DORA, said the bill “will create confusion for consumers” because it includes multiple exemptions and a new intent-based test for who must be licensed. Delp warned the intent standard would force the division “to prove whether or not an individual had the intent to deliver medical nutrition therapy when considering discipline,” a burden he said would make accountability “very expensive and very difficult.”

Ginny Brown, deputy executive director at DORA, told senators the department completed a sunrise review in December 2024 that recommended no regulation was required and said existing federal and state protections limit the need for a new licensing program. Brown cited Section 1861 of the Social Security Act as part of the existing federal framework the department reviewed.

Mac Lawrence, director of legislative affairs for DORA, addressed confusion over the agency’s public registration on the Secretary of State’s website, saying there is “actually no mechanism on the website for liaisons to register an official position. It shows up as NA,” and that the agency notifies committees directly when it forms a position.

Sponsors and supporters also offered examples they said showed harm from unregulated practice. Senator Christopher Pelton, a sponsor, recounted cases of patients with advanced cancer who he said were harmed after following nutrition guidance he described as medical nutrition therapy. Pelton said insurance reimbursement for some services already requires licensure in other states and that “46 other states have this; there’s only four other states that don’t.”

The committee also debated and then withdrew a technical amendment (L015) that would have clarified that the statute refers to “licensed nutritionist” without restricting the use of the title “nutritionist” for nonlicensed wellness practitioners. Senator Pelton said he would consider running the amendment on the floor.

After debate, the committee voted to send House Bill 12 20 to the Committee of the Whole with a favorable recommendation. Senators recorded voting “aye” included Senators Gonzales, Kirkmeyer, Volker, Lundin, the vice chair, and the chair; Senator Liston voted “no.”

If enacted, supporters said, the bill would enable registered dietitians and qualified nutritionists providing medical nutrition therapy to pursue licensure and seek Medicaid reimbursement through Health First Colorado; opponents said the state’s sunrise review and existing federal rules argue against a new regulatory program. The sponsors indicated they may continue to refine statutory language on the floor.

Committee discussion and testimony showed a clear split: public-health and provider groups urged licensing to expand access and oversight, while DORA officials warned a new program could be costly, confusing for consumers and difficult to enforce under the bill’s intent-based language.