BILL NUMBER: AB 1444 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 4, 2001
INTRODUCED BY Assembly Member Maddox
FEBRUARY 23, 2001
An act to amend Sections 2068 , 2585, and 2586 of the
Business and Professions Code, and to amend Section 10176.25 of
the Insurance Code, relating to nutritional advice.
LEGISLATIVE COUNSEL'S DIGEST
AB 1444, as amended, Maddox. Nutritional advice.
Existing law does not prohibit a person from providing
nutritional advise. Existing law allows a registered dietician with a
referral by an appropriate health care provider to provide
nutritional and dietary counseling, assessments, and treatment.
This bill would provide that developing nutritional and dietary
treatments, therapeutic diets, or developing or providing medical
nutrition therapy without an express grant of statutory authority is
a violation of law punishable by imprisonment. The bill would
authorize a registered dietician to order medical laboratory
tests related to nutritional therapeutic treatments and accept
or transmit verbal or electronically transmitted orders or protocols
from a health care provider in order to implement therapeutic
treatments. The bill would term the services described above that a
registered dietician is authorized to perform "medical nutrition
therapy." The bill would authorize a dietetic technician,
registered, meeting certain qualifications, to assist a registered
dietitian with certain services. The bill would make conforming
changes to the Insurance Code.
Because developing nutritional and dietary treatments, therapeutic
diets, or developing or providing medical nutrition therapy without
a grant of statutory authority would be a crime, the bill would
impose a state-mandated local program by creating a new crime.
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 bill would become operative July 1, 2003.
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 2068 of the Business and Professions Code is
amended to read:
2068. This chapter shall not be construed to prohibit any person
from providing nutritional advice or giving advice concerning proper
nutrition. However, this section confers no authority to practice
medicine or surgery or to undertake the prevention, treatment, or
cure of disease, pain, injury, deformity, or physical or mental
conditions or to state that any product might cure any disease,
disorder, or condition in violation of any provision of law. Absent
an express grant of authority in this division, developing
nutritional and dietary treatments, therapeutic diets, or developing
or providing medical nutrition therapy, constitutes a violation of
Section 2053.
For purposes of this section, the terms "providing nutritional
advice or giving advice concerning proper nutrition" mean the giving
of information as to the use and role of food and food ingredients,
including dietary supplements.
Any person in commercial practice providing nutritional advice or
giving advice concerning proper nutrition shall post in an easily
visible and prominent place in his or her place of business the
following statement:
"NOTICE"
"State law allows any person to provide nutritional advice or give
advice concerning proper nutrition--which is the giving of advice as
to the role of food and food ingredients, including dietary
supplements. This state law does NOT confer authority to practice
medicine or to undertake the diagnosis, prevention, treatment, or
cure of any disease, pain, deformity, injury, or physical or mental
condition and specifically does not authorize any person other than
one who is a licensed health practitioner to state that any product
might cure any disease, disorder, or condition."
The notice required by this section shall not be smaller than 81/2
inches by 11 inches and shall be legibly printed with lettering no
smaller than 1/2 inch in length, except the lettering of the word
"NOTICE" shall not be smaller than 1 inch in length.
SEC. 2. Section 2585 of the Business and Professions Code is
amended to read:
2585. (a) Any person representing himself or herself as
a dietitian shall meet either of the qualifications in paragraph (1)
or (2), or both:
(1) Been granted, prior to January 1, 1981, the right to use the
term "dietitian" by a public or private agency or institution
recognized by the State Department of Health Services as qualified to
grant that 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 clinical
experience of not less than six months in length 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 Health Services to
establish such qualifications.
(b) 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 Health Services 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) Satisfactory completion of the requirements set forth
in subdivision (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 clinical
experience of not less than six months in length 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 Health Services to
establish those qualifications .
(B)
(D) Satisfactory completion of an examination administered
by a public or private agency or institution recognized by the State
Department of Health Services as qualified to administer the
examinations.
(C)
(E) Satisfactory completion of continuing education
requirements established by a public or private agency or institution
recognized by the State Department of Health Services 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 appropriate academic requirements
and 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.
(3) Satisfactory completion of the dietetic technician program
requirements by an accredited public or private agency or institution
recognized by the State Department of Health Services including not
less than 450 hours of supervised clinical experience.
(4) Satisfactory completion of an examination administered by a
public or private agency or institution recognized by the State
Department of Health Services to administer the examination.
(5) Satisfactory completion of continuing education requirements
established by a public or private agency or institution recognized
by the State Department of Health Services 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," or the letters "D," "RD," "DTR,"
or any other words, letters, abbreviations, or insignia
indicating or implying that the person is a dietitian, or
dietetic technician, registered or registered dietitian, 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.
(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 (b) (a) , except that he
or she shall not be required to satisfy the examination requirement
of subparagraph (B) of paragraph (2) of subdivision (b)
(a) .
(e) Upon 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, dietitians, registered dietitians
, or 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, 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 , notwithstanding
any other provision of law or regulation that limits reimbursement to
state licensed health care providers . Nothing in this
section shall be construed to mandate direct reimbursement of
dietitians, registered dietitians, or other
nutrition professionals described in this subdivision, as a separate
provider type under the Medi-Cal program, nor to mandate
reimbursement where expressly prohibited by federal law or
regulation.
SEC. 3. Section 2586 of the Business and Professions Code is
amended to read:
2586. (a) 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, develop
nutritional and dietary treatments, including therapeutic diets,
order medical laboratory tests related to nutritional therapeutic
treatments, and accept or transmit verbal or electronically
transmitted orders or standards of protocol from the health care
provider to implement therapeutic treatments, for individuals or
groups of patients in licensed institutional facilities or in private
office settings. The referral shall be accompanied by a written
prescription signed by the health care provider detailing the patient'
s diagnosis and including a statement of the desired objective of
dietary treatment. The services described in this subdivision may be
termed "medical nutrition therapy."
(b) (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 not develop nutritional or
dietary therapy or treatments.
(2) For purposes of this subdivision, "direct supervision" means
the supervising registered dietitian shall be physically available to
the dietetic technician, registered for consultation whenever is
required.
(3) For purposes of this subdivision, a registered dietitian shall
not supervise more than two dietetic technicians, registered at one
time.
(c) It is a misdemeanor for a registered dietitian to
practice in a manner inconsistent with the requirements set forth in
this section.
(c)
(d) Nothing in this section shall preclude a registered
dietitian from providing information as permitted by Section 2068.
(d)
(e) 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.
(e)
(f) 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.
SEC. 3.
SEC. 4. Section 10176.25 of the Insurance Code is amended to read:
10176.25. (a) As an alternative to an exclusion permitted by
Section 10176, a disability insurance policy may provide that
services of a dietitian or a registered dietitian
or other nutrition professional meeting the qualifications
prescribed by Section 2585 of the Business and Professions Code will
be paid only if rendered pursuant to a method of treatment
prescribed by a person holding a physician's and surgeon's
certificate issued by the Medical Board of California.
(b) Nothing in this section requires disability insurers to
automatically pay for services provided by a dietitian or
a registered dietitian or other nutrition professional
.
SEC. 5. This act shall become operative on July 1, 2003.
SEC. 6. No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB 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 XIIIB of the California Constitution.