BILL NUMBER: AB 1444 CHAPTERED
BILL TEXT
CHAPTER 628
FILED WITH SECRETARY OF STATE OCTOBER 9, 2001
APPROVED BY GOVERNOR OCTOBER 8, 2001
PASSED THE ASSEMBLY SEPTEMBER 10, 2001
PASSED THE SENATE SEPTEMBER 4, 2001
AMENDED IN SENATE AUGUST 30, 2001
AMENDED IN SENATE JULY 19, 2001
AMENDED IN SENATE JULY 3, 2001
AMENDED IN ASSEMBLY MAY 31, 2001
AMENDED IN ASSEMBLY MAY 2, 2001
AMENDED IN ASSEMBLY APRIL 4, 2001
INTRODUCED BY Assembly Member Maddox
FEBRUARY 23, 2001
An act to amend Sections 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, Maddox. Nutritional advice.
Existing law does not prohibit a person from providing nutritional
advice. Existing law contains provisions governing the practice of
registered dietitians and allows a registered dietitian with a
referral by an appropriate health care provider to provide
nutritional and dietary counseling, assessments, and treatment.
Existing law requires that the referral be accompanied by a written
prescription containing specified information and signed by the
health care provider.
This bill would subject other nutritional professionals to certain
provisions governing registered dietitians. The bill would create
an exception to the written prescription requirement where a
referring physician and surgeon has established or approved a written
protocol governing the patient's treatment. The bill would also
authorize registered dietitians and other nutritional professionals
who are not specified licensed health care providers to order, when
authorized to do so by a written protocol prepared or approved by the
referring physician and surgeon, medical laboratory tests related to
nutritional therapeutic treatments and to accept or transmit verbal
orders consistent with the established protocol or electronically
transmitted orders from a health care provider in order to implement
medical nutrition therapy. The bill would designate the services
described above that registered dietitians and other nutritional
professionals are authorized to perform as "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.
Existing law requires a person representing himself or herself as
a dietitian to meet certain requirements, including satisfactory
completion of a program of supervised clinical experience of not less
than 6 months.
This bill would instead require that the person satisfactorily
complete a program of supervised practice for a minimum of 900 hours.
Existing law requires any person representing himself or herself
as a dietetic technician, registered to complete a program meeting
specified requirements, including not less than 450 hours of
supervised clinical experience.
This bill would change the requirement to 450 hours of supervised
practice.
Existing law provides that it is a misdemeanor for a registered
dietitian to practice in violation of certain provisions.
Because this bill would extend this provision to other nutritional
professionals, 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 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 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) 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 Health Services 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 Health Services 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 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 practice.
(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 "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 (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) 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 when authorized
to do so by a written protocol prepared or approved by the referring
physician and surgeon, and accept or transmit verbal orders
consistent with an established protocol as required by this section
or electronically transmitted orders from the health care provider to
implement medical nutrition therapy 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, unless a referring physician and surgeon has
established or approved a written protocol governing the patient's
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, order medical laboratory tests, 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.
(c) 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.
(d) Nothing in this section shall preclude a person specified in
subdivision (e) of Section 2585 from providing information as
permitted by Section 2068.
(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.
(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.
(g) 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 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 registered dietitian or other nutrition professional
meeting the qualifications prescribed by subdivision (a) or (e) of
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 registered dietitian or
other nutrition professional.
SEC. 4. 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.