Bill Text: CA SB993 | 2013-2014 | Regular Session | Chaptered
Bill Title: Healing arts: dietitians.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2014-09-26 - Chaptered by Secretary of State. Chapter 622, Statutes of 2014. [SB993 Detail]
Download: California-2013-SB993-Chaptered.html
BILL NUMBER: SB 993 CHAPTERED
BILL TEXT
CHAPTER 622
FILED WITH SECRETARY OF STATE SEPTEMBER 26, 2014
APPROVED BY GOVERNOR SEPTEMBER 26, 2014
PASSED THE SENATE AUGUST 20, 2014
PASSED THE ASSEMBLY AUGUST 19, 2014
AMENDED IN ASSEMBLY AUGUST 14, 2014
AMENDED IN ASSEMBLY JULY 2, 2014
AMENDED IN SENATE APRIL 21, 2014
INTRODUCED BY Senator Mitchell
(Coauthors: Senators Beall and Hernandez)
FEBRUARY 12, 2014
An act to amend Sections 2585, 2586, 2586.4, and 2586.8 of the
Business and Professions Code, relating to dietitians.
LEGISLATIVE COUNSEL'S DIGEST
SB 993, Mitchell. Healing arts: dietitians.
Existing law requires dietetic technicians, registered, to possess
prescribed qualifications, including academic requirements, and
makes it a misdemeanor for any person not meeting those requirements
to use, in connection with his or her name or place of business, the
term "dietetic technician, registered" or the letters "DTR."
Existing law authorizes a registered dietitian, upon referral by a
health care provider, to provide medical nutrition therapy, which
includes, among other things, the development of nutritional and
dietary treatments for individuals or groups of patients in specified
settings. Existing law allows a dietetic technician, registered to
assist the registered dietitian in these circumstances in the
implementation or monitoring of medical nutrition therapy. Existing
law makes it a misdemeanor for a registered dietitian, or other
specified nutritional professionals, to practice in a manner
inconsistent with these provisions.
This bill would revise the qualifications required for a person
representing himself or herself as a dietetic technician, registered
and would require the dietetic technician, registered to have
completed his or her course of study before assisting the registered
dietitian. The bill would also make it a misdemeanor for any person
not meeting those qualifications to use, in connection with his or
her name or place of business, the term "registered dietitian
nutritionist" or the letters "RDN."
This bill would also allow a registered dietitian, under the
above-described circumstances, or other nutritional professional who
meets specified qualifications, to develop and recommend nutritional
and dietary treatments, as provided, and would allow the registered
dietitian or other nutritional professional to perform nutritional
assessments and to initiate nutritional interventions pursuant to a
licensed health care facility's approved nutrition screening policy
and procedure, as provided. The bill would specify that these
provisions do not authorize a registered dietitian, or other
nutritional professional, to administer central vein or peripheral
vein nutrition. This bill would also make technical, nonsubstantive
changes.
By both expanding and changing the definition of existing crimes,
the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 2585 of the Business and Professions Code is
amended to read:
2585. (a) Any person representing himself or herself as a
registered dietitian shall meet one of the following qualifications:
(1) Been granted, prior to January 1, 1981, the right to use the
term "registered dietitian" by a public or private agency or
institution recognized by the State Department of Public Health as
qualified to grant the title, provided that person continues to meet
all requirements and qualifications periodically prescribed by the
agency or institution for the maintenance of that title.
(2) Possess all of the following qualifications:
(A) Be 18 years of age or older.
(B) Satisfactory completion of appropriate academic requirements
for the field of dietetics and related disciplines and receipt of a
baccalaureate or higher degree from a college or university
accredited by the Western Association of Schools and Colleges or
other regional accreditation agency.
(C) Satisfactory completion of a program of supervised practice
for a minimum of 900 hours that is designed to prepare entry level
practitioners through instruction and assignments in a clinical
setting. Supervisors of the program shall meet minimum qualifications
established by public or private agencies or institutions recognized
by the State Department of Public Health to establish those
qualifications.
(D) Satisfactory completion of an examination administered by a
public or private agency or institution recognized by the State
Department of Public Health as qualified to administer the
examinations.
(E) Satisfactory completion of continuing education requirements
established by a public or private agency or institution recognized
by the State Department of Public Health to establish the
requirements.
(b) Any person representing himself or herself as a dietetic
technician, registered shall possess all of the following
qualifications:
(1) Be 18 years of age or older.
(2) Satisfactory completion of either of the following:
(A) Appropriate academic requirements for dietetic technicians,
registered, receipt of an associate's degree or higher from a college
or university accredited by the Western Association of Schools and
Colleges or other regional accreditation agency, and at least 450
hours of supervised practice experience. Supervisors of practice
experiences shall meet the minimum qualifications established by
public or private agencies or institutions recognized by the State
Department of Public Health to establish the qualifications.
(B) Appropriate academic requirements for the field of dietetics
and related disciplines and receipt of a baccalaureate or higher
degree from a college or university accredited by the Western
Association of Schools and Colleges or other regional accreditation
agency.
(3) Satisfactory completion of an examination administered by a
public or private agency or institution recognized by the State
Department of Public Health to administer the examination.
(4) Satisfactory completion of continuing education requirements
established by a public or private agency or institution recognized
by the State Department of Public Health to establish the
requirements.
(c) It is a misdemeanor for any person not meeting the criteria of
subdivision (a) or (b) to use, in connection with his or her name or
place of business, the words "dietetic technician, registered,"
"dietitian," "dietician," "registered dietitian," "registered
dietician," "registered dietitian nutritionist," or the letters "RD,"
"RDN," "DTR," or any other words, letters, abbreviations, or
insignia indicating or implying that the person is a dietitian,
dietetic technician, registered, registered dietitian, or registered
dietitian nutritionist or to represent, in any way, orally, in
writing, in print or by sign, directly or by implication, that he or
she is a dietitian, a dietetic technician, registered, a registered
dietitian, or a registered dietitian nutritionist.
(d) Any person employed by a licensed health care facility as a
registered dietitian on the effective date of this chapter may
continue to represent himself or herself as a registered dietitian
while employed by a licensed health care facility, if he or she has
satisfied the requirements of either paragraph (1) or paragraph (2)
of subdivision (a), except that he or she shall not be required to
satisfy the examination requirement of subparagraph (B) of paragraph
(2) of subdivision (a).
(e) Notwithstanding any other law or regulation that limits
reimbursement to state licensed health care providers and upon
referral by a physician and surgeon, the following persons may be
reimbursed for the nutritional advice or advice concerning proper
nutrition as set forth in Section 2068, or for the nutritional
assessments, counseling, and treatments as set forth in Section 2586:
(1) Registered dietitians.
(2) Other nutritional professionals with a master's or higher
degree in a field covering clinical nutrition sciences, from a
college or university accredited by a regional accreditation agency,
who are deemed qualified to provide these services by the referring
physician and surgeon.
(f) Nothing in this section shall be construed to mandate direct
reimbursement of registered dietitians, or other nutrition
professionals described in subdivision (e), as a separate provider
type under the Medi-Cal program, nor to mandate reimbursement where
expressly prohibited by federal law or regulation.
SEC. 2. Section 2586 of the Business and Professions Code is
amended to read:
2586. (a) (1) Notwithstanding any other law, a registered
dietitian, or other nutritional professional meeting the
qualifications set forth in subdivision (e) of Section 2585 may, upon
referral by a health care provider authorized to prescribe dietary
treatments, provide nutritional and dietary counseling, conduct
nutritional and dietary assessments, and develop and recommend
nutritional and dietary treatments, including therapeutic diets, for
individuals or groups of patients in licensed institutional
facilities or in private office settings. The referral for medical
nutrition therapy shall be accompanied by a written prescription
signed by the health care provider detailing the patient's diagnosis
and including either a statement of the desired objective of dietary
treatment or a diet order. The registered dietitian, or other
nutritional professional meeting the qualifications set forth in
subdivision (e) of Section 2585, may perform nutritional assessments
and initiate nutritional interventions within the parameters of the
prescribed diet order pursuant to a licensed health care facility's
approved nutrition screening policy and procedure. The registered
dietitian, or other nutritional professional meeting the
qualifications set forth in subdivision (e) of Section 2585, shall
collaborate with a multidisciplinary team, which shall include the
treating physician and the registered nurse, in developing the
patient's nutrition care plan. Unless otherwise stated in the diet
order by a patient's provider, the registered dietitian, or other
nutritional professional meeting the qualifications set forth in
subdivision (e) of Section 2585, may individualize the patient's
nutritional or dietary treatment when necessary, by modifying the
distribution, type, or quantity of food and nutrients within the
parameters of the diet order. Any modification, and the rationale for
the modification, shall be documented in the patient's record for
review by the practitioner, or other licensed health care
professional, who is legally authorized to prescribe and is
responsible for the care of the patient. Nothing in this subdivision
shall be construed to authorize a registered dietitian, or other
nutritional professional meeting the qualifications set forth in
subdivision (e) of Section 2585, to order or administer a central
vein or peripheral vein nutrition.
(2) The services described in this subdivision may be termed
"medical nutrition therapy."
(b) A registered dietitian, or other nutritional professional
meeting the qualifications set forth in subdivision (e) of Section
2585, may accept or transmit verbal orders or electronically
transmitted orders for medical nutrition therapy from the referring
physician or the physician responsible for the care of the patient in
a licensed health care facility.
(c) A registered dietitian, or other nutritional professional
meeting the qualifications set forth in subdivision (e) of Section
2585, may order medical laboratory tests related to medical nutrition
therapy services when approved by the referring physician or the
physician responsible for the care of the patient and when, in the
absence of the referring physician or physician responsible for the
care of the patient at a patient visit, in a clinic where there is a
registered nurse on duty, a registered nurse is notified that a
medical laboratory test is being ordered and is afforded an
opportunity to assess the patient.
(d) (1) Notwithstanding any other law, a dietetic technician,
registered meeting the qualifications set forth in Section 2585 may,
under the direct supervision of a registered dietitian, assist in the
implementation or monitoring of services specified in subdivision
(a), but shall not develop nutritional or dietary therapy or
treatments or accept or transmit verbal orders.
(2) (A) For purposes of this subdivision, "direct supervision"
means the supervising registered dietitian shall be physically
available to the dietetic technician, registered for consultation
whenever consultation is required. However, in the case of a small or
rural hospital, as defined in Section 124840 of the Health and
Safety Code, the registered dietitian may be available for
consultation by telephone or other electronic means, provided that
the registered dietitian is physically on the facility site a
sufficient amount of time to provide adequate supervision over and
review of the work of the dietetic technician, registered.
(B) For purposes of this subdivision, "physically available" means
physical onsite presence during regular business hours, and includes
telephonic or electronic availability at all times and the ability
to respond to the facility within a reasonable period of time when
required. The registered dietitian shall review any activities
performed by the dietetic technician, registered during any period
when the registered dietitian was not physically onsite.
(3) For purposes of this subdivision, a registered dietitian shall
not supervise more than two dietetic technicians, registered at one
time.
(e) It is a misdemeanor for a person specified in subdivision (e)
of Section 2585 to practice in a manner inconsistent with the
requirements set forth in this section.
(f) Nothing in this section shall preclude a person specified in
subdivision (b) or (e) of Section 2585 from providing information as
permitted by Section 2068.
(g) For purposes of this section, "health care provider" means any
person licensed or certified pursuant to this division, or licensed
pursuant to the Osteopathic Initiative Act or the Chiropractic
Initiative Act.
(h) The requirement of a written prescription shall be deemed to
be satisfied by an entry in the patient records of a patient who is
undergoing treatment at a licensed health care facility if the
contents of the patient records reflect the information required by
this section.
(i) Nothing in this section or Section 2585 shall be interpreted
to establish educational criteria or practice restrictions or
limitations for other health care providers licensed under Division 2
(commencing with Section 500) or the Osteopathic Initiative Act or
the Chiropractic Initiative Act.
SEC. 3. Section 2586.4 of the Business and Professions Code is
amended to read:
2586.4. A person may engage in the activities set forth in
subdivision (d) of Section 2586 if the person meets both of the
following requirements:
(a) The person is engaged in the activities as part of a
supervised practice program for a dietetic technician, registered
pursuant to subparagraph (A) of paragraph (2) of subdivision (b) of
Section 2585.
(b) The person has completed a course of study to fulfill the
educational requirements for a dietetic technician, registered in
subparagraph (A) or (B) of paragraph (2) of subdivision (b) of
Section 2585.
SEC. 4. Section 2586.8 of the Business and Professions Code is
amended to read:
2586.8. A person may engage in the activities set forth in
subdivision (d) of Section 2586 for six months from the date he or
she completed the academic requirements for dietetic technicians
specified in subparagraph (A) or (B) of paragraph (2) of subdivision
(b) of Section 2585, or until the person receives notice that he or
she has failed the examination specified in subdivision (c),
whichever occurs first, if all of the following conditions apply:
(a) The person performs under the direct and immediate supervision
of a registered dietitian.
(b) The person has written verification, including the program
director's original signature, that the person has completed the
educational program and possesses an associate's degree or higher.
(c) The person has applied to take the dietetic technician,
registered examination specified in paragraph (3) of subdivision (b)
of Section 2585 and is waiting for an examination date.
SEC. 5. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
