Bill Text: CA SB993 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Amended.html

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BILL NUMBER: SB 993	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 21, 2014

INTRODUCED BY   Senator Mitchell
   (  Coauthor:   Senator  
Hernandez   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, as amended, Mitchell. Healing arts: dietitians.
   Existing law requires dietetic technicians  , registered,
 to possess prescribed qualifications, including academic
requirements, and  provides that the use by any person
  makes it a misdemeanor for any person  not
meeting those requirements to use  , in connection with his
or her name or place of business,  of  the term
"dietetic  technician" is a crime.   technician,
registered" or the letters "DTR.   " 
   Existing law  provides that   authorize 
 s  a registered dietitian  may   ,
upon referral by a health care provider, to  provide medical
nutrition therapy,  upon referral by a health care provider,
 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  provides that
practicing   makes it a misdemeanor for a registered
dietitian, or other specified nutritional professionals, to practice
 in a manner inconsistent with these  provisions is a
misdemeanor.   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.  This   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  be authorized to provide medical
nutrition therapy   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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


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,  or  dietetic technician, 
registered or   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  or  
,  a dietetic technician, registered  or  
,  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  provision of  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  provision of
 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 may be also authorized to provide medical nutrition therapy
pursuant to a licensed health care facility's approved policy and
procedure to identify patients that warrant medical nutrition
therapy.   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.  The   Unless otherwise
stated in the prescribed 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,   type or  quantity of  food,
  food  and nutrients within the parameters of the
prescribed diet order.  Any modification, and the rationale for
the modification, shall be documented in the patient's record for
review by the prescribing provider. 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  provision of 
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  may 
 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  is  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 (d),
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 (4) 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.
      ____ CORRECTIONS  Text--Pages 4.
                               ____