BILL NUMBER: SB 993	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Mitchell
   (Coauthor: Senator 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 introduced, Mitchell. Healing arts: dietitians.
   Existing law requires dietetic technicians to possess prescribed
qualifications, including academic requirements, and provides that
the use by any person not meeting those requirements, in connection
with his or her name or place of business, of the term "dietetic
technician" is a crime.
   Existing law provides that a registered dietitian may 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 to
assist the registered dietitian in these circumstances in the
implementation or monitoring of medical nutrition therapy. Existing
law provides that practicing in a manner inconsistent with these
provisions is a misdemeanor.
   This bill would revise the qualifications required for a person
representing himself or herself as a dietetic technician, and would
require the dietetic technician to have completed his or her course
of study before assisting the registered dietitian. This bill would
also allow a registered dietitian, under the above-described
circumstances, to develop and recommend nutritional and dietary
treatments, as provided, and would allow the registered dietitian to
be authorized to provide medical nutrition therapy pursuant to a
licensed health care facility's approved policy and procedure, as
provided. 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  Health
Services   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  Health Services  
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  Health Services   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  Health Services  
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 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.  
   (2) Satisfactory completion of either of the following:  

   (A) Appropriate academic requirements for dietetic technicians,
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.  
   (4) 
    (3)  Satisfactory completion of an examination
administered by a public or private agency or institution recognized
by the State Department of  Health Services  
Public Health  to administer the examination. 
   (5) 
    (4)  Satisfactory completion of continuing education
requirements established by a public or private agency or institution
recognized by the State Department of  Health Services
  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," 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)  (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, 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."   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. The registered dietitian 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 registered dietitian may
individualize the patient's nutritional or dietary treatment when
necessary, by modifying the distribution type, quantity of food, and
nutrients within the parameters of the prescribed diet order. 

   (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  consistent with an established protocol
to implement medical nutrition therapy   responsible for
the care of the patient  .
   (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 
nutritional therapeutic treatments   medical nutrition
therapy services  when  authorized to do so by a written
protocol prepared or  approved by the referring physician
and when, in the absence of the referring physician 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 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 pursuant to
 paragraph (3)   subparagraph (A) of paragraph
(2)  of subdivision (b) of Section 2585.
   (b) The person is  enrolled in or  has completed
a course of study to fulfill the educational requirements for a
dietetic technician 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  supervised practice program for dietetic
technicians,   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 completed the supervised practice program
requirements under subdivision (b) of Section 2585. 

   (c) 
    (b)  The person has written verification, including the
program director's original signature, that the person has completed
the  required supervised practice   educational
program and possesses an associate's degree or higher  .

   (d) 
    (c) The person has applied to take the dietetic
technician 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.