Amended in Senate April 21, 2014

Senate BillNo. 993


Introduced by Senator Mitchell

(begin deleteCoauthor: Senator end deletebegin insertCoauthors: Senators Beall and end insertHernandez)

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 techniciansbegin insert, registered,end insert to possess prescribed qualifications, including academic requirements, andbegin delete provides that the use by any personend deletebegin insert makes it a misdemeanor for any personend insert not meeting those requirementsbegin insert to useend insert, in connection with his or her name or place of business,begin delete ofend delete the term “dieteticbegin delete technician” is a crime.end deletebegin insert technician, registered” or the letters “DTR.end insertbegin insertend insert

Existing lawbegin delete provides thatend deletebegin insert authorizesend insert a registered dietitianbegin delete mayend deletebegin insert, upon referral by a health care provider, toend insert provide medical nutrition therapy,begin delete upon referral by a health care provider,end delete 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 technicianbegin insert, registeredend insert to assist the registered dietitian in these circumstances in the implementation or monitoring of medical nutrition therapy. Existing lawbegin delete provides that practicingend deletebegin insert makes it a misdemeanor for a registered dietitian, or other specified nutritional professionals, to practiceend insert in a manner inconsistent with thesebegin delete provisions is a misdemeanor.end deletebegin insert provisions.end insert

This bill would revise the qualifications required for a person representing himself or herself as a dietetic technician,begin insert registeredend insert and would require the dietetic technicianbegin insert, registeredend insert to have completed his or her course of study before assisting the registered dietitian.begin delete Thisend deletebegin insert 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.”end insert

begin insert Thisend insert bill would also allow a registered dietitian, under the above-described circumstances,begin insert or other nutritional professional who meets specified qualifications,end insert to develop and recommend nutritional and dietary treatments, as provided, and would allow the registered dietitianbegin insert or other nutritional professionalend insert tobegin delete be authorized to provide medical nutrition therapyend deletebegin insert perform nutritional assessments and to initiate nutritional interventionsend insert pursuant to a licensed health care facility’s approvedbegin insert nutrition screeningend insert policy and procedure, as provided.begin insert 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.end insert 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:

P2    1

SECTION 1.  

Section 2585 of the Business and Professions
2Code
is amended to read:

3

2585.  

(a) Any person representing himself or herself as a
4registered dietitian shall meet one of the following qualifications:

5(1) Been granted, prior to January 1, 1981, the right to use the
6term “registered dietitian” by a public or private agency or
7institution recognized by the State Department of Public Health
8as qualified to grant the title, provided that person continues to
9meet all requirements and qualifications periodically prescribed
10by the agency or institution for the maintenance of that title.

P3    1(2) Possess all of the following qualifications:

2(A) Be 18 years of age or older.

3(B) Satisfactory completion of appropriate academic
4requirements for the field of dietetics and related disciplines and
5receipt of a baccalaureate or higher degree from a college or
6university accredited by the Western Association of Schools and
7Colleges or other regional accreditation agency.

8(C) Satisfactory completion of a program of supervised practice
9for a minimum of 900 hours that is designed to prepare entry level
10practitioners through instruction and assignments in a clinical
11setting. Supervisors of the program shall meet minimum
12qualifications established by public or private agencies or
13institutions recognized by the State Department of Public Health
14to establish those qualifications.

15(D) Satisfactory completion of an examination administered by
16a public or private agency or institution recognized by the State
17Department of Public Health as qualified to administer the
18examinations.

19(E) Satisfactory completion of continuing education
20requirements established by a public or private agency or institution
21recognized by the State Department of Public Health to establish
22the requirements.

23(b) Any person representing himself or herself as a dietetic
24technician, registered shall possess all of the following
25qualifications:

26(1) Be 18 years of age or older.

27(2) Satisfactory completion of either of the following:

28(A) Appropriate academic requirements for dietetic technicians,
29begin insert registered,end insert receipt of an associate’s degree or higher from a college
30or university accredited by the Western Association of Schools
31and Colleges or other regional accreditation agency, and at least
32450 hours of supervised practice experience. Supervisors of practice
33experiences shall meet the minimum qualifications established by
34public or private agencies or institutions recognized by the State
35Department of Public Health to establish the qualifications.

36(B) Appropriate academic requirements for the field of dietetics
37and related disciplines and receipt of a baccalaureate or higher
38degree from a college or university accredited by the Western
39Association of Schools and Colleges or other regional accreditation
40agency.

P4    1(3) Satisfactory completion of an examination administered by
2a public or private agency or institution recognized by the State
3Department of Public Health to administer the examination.

4(4) Satisfactory completion of continuing education requirements
5established by a public or private agency or institution recognized
6by the State Department of Public Health to establish the
7requirements.

8(c) It is a misdemeanor for any person not meeting the criteria
9of subdivision (a) or (b) to use, in connection with his or her name
10or place of business, the words “dietetic technician, registered,”
11“dietitian,” “dietician,” “registered dietitian,” “registered dietician,”
12begin insert “registered dietitian nutritionist,”end insert or the letters “RD,”begin insert “RDN,”end insert
13 “DTR,” or any other words, letters, abbreviations, or insignia
14indicating or implying that the person is a dietitian,begin delete orend delete dietetic
15technician,begin delete registered orend deletebegin insert registered,end insert registered dietitian,begin insert or
16registered dietitian nutritionistend insert
or to represent, in any way, orally,
17in writing, in print or by sign, directly or by implication, that he
18or she is a dietitianbegin delete orend deletebegin insert,end insert a dietetic technician, registeredbegin delete orend deletebegin insert,end insert a
19registered dietitianbegin insert, or a registered dietitian nutritionistend insert.

20(d) Any person employed by a licensed health care facility as
21a registered dietitian on the effective date of this chapter may
22continue to represent himself or herself as a registered dietitian
23while employed by a licensed health care facility, if he or she has
24satisfied the requirements of either paragraph (1) or paragraph (2)
25of subdivision (a), except that he or she shall not be required to
26satisfy the examination requirement of subparagraph (B) of
27paragraph (2) of subdivision (a).

28(e) Notwithstanding any otherbegin delete provision ofend delete law or regulation
29that limits reimbursement to state licensed health care providers
30and upon referral by a physician and surgeon, the following persons
31may be reimbursed for the nutritional advice or advice concerning
32proper nutrition as set forth in Section 2068, or for the nutritional
33assessments, counseling, and treatments as set forth in Section
34 2586:

35(1) Registered dietitians.

36(2) Other nutritional professionals with a master’s or higher
37degree in a field covering clinical nutrition sciences, from a college
38or university accredited by a regional accreditation agency, who
39are deemed qualified to provide these services by the referring
40physician and surgeon.

P5    1(f) Nothing in this section shall be construed to mandate direct
2reimbursement of registered dietitians, or other nutrition
3professionals described in subdivision (e), as a separate provider
4type under the Medi-Cal program, nor to mandate reimbursement
5where expressly prohibited by federal law or regulation.

6

SEC. 2.  

Section 2586 of the Business and Professions Code is
7amended to read:

8

2586.  

(a) (1) Notwithstanding any otherbegin delete provision ofend delete law, a
9registered dietitian, or other nutritional professional meeting the
10qualifications set forth in subdivision (e) of Section 2585 may,
11upon referral by a health care provider authorized to prescribe
12dietary treatments, provide nutritional and dietary counseling,
13conduct nutritional and dietary assessments, and develop and
14recommend nutritional and dietary treatments, including therapeutic
15diets, for individuals or groups of patients in licensed institutional
16facilities or in private office settings. The referral for medical
17nutrition therapy shall be accompanied by a written prescription
18signed by the health care provider detailing the patient’s diagnosis
19and including either a statement of the desired objective of dietary
20treatment or a diet order. The registered begin delete dietitian may be also
21authorized to provide medical nutrition therapy pursuant to a
22licensed health care facility’s approved policy and procedure to
23 identify patients that warrant medical nutrition therapy.end delete
begin insert dietitian,
24or other nutritional professional meeting the qualifications set
25forth in subdivision (e) of Section 2585, may perform nutritional
26assessments and initiate nutritional interventions within the
27parameters of the prescribed diet order pursuant to a licensed
28health care facility’s approved nutrition screening policy and
29procedure.end insert
The registered dietitianbegin insert, or other nutritional
30professional meeting the qualifications set forth in subdivision (e)
31of Section 2585,end insert
shall collaborate with a multidisciplinary team,
32which shall include the treating physician and the registered nurse,
33in developing the patient’s nutrition care plan.begin delete Theend deletebegin insert Unless
34otherwise stated in the prescribed diet order by a patient’s
35provider, theend insert
registered dietitianbegin insert, or other nutritional professional
36meeting the qualifications set forth in subdivision (e) of Section
372585,end insert
may individualize the patient’s nutritional or dietary
38treatment when necessary, by modifying the distributionbegin delete type,end deletebegin insert type
39orend insert
quantity ofbegin delete food,end deletebegin insert foodend insert and nutrients within the parameters of
40the prescribed diet order.begin insert Any modification, and the rationale for
P6    1the modification, shall be documented in the patient’s record for
2review by the prescribing provider. Nothing in this subdivision
3shall be construed to authorize a registered dietitian, or other
4nutritional professional meeting the qualifications set forth in
5subdivision (e) of Section 2585, to order or administer a central
6vein or peripheral vein nutrition.end insert

7(2) The services described in this subdivision may be termed
8“medical nutrition therapy.”

9(b) A registered dietitian, or other nutritional professional
10meeting the qualifications set forth in subdivision (e) of Section
112585, may accept or transmit verbal orders or electronically
12transmitted orders for medical nutrition therapy from the referring
13physicianbegin insert or the physicianend insert responsible for the care of the patient
14begin insert in a licensed health care facilityend insert.

15(c) A registered dietitian, or other nutritional professional
16meeting the qualifications set forth in subdivision (e) of Section
172585, may order medical laboratory tests related to medical
18nutrition therapy services when approved by the referring physician
19begin insert or the physician responsible for the care of the patientend insert and when,
20in the absence of the referring physicianbegin insert or physician responsible
21for the care of the patientend insert
at a patient visit, in a clinic where there
22is a registered nurse on duty, a registered nurse is notified that a
23medical laboratory test is being ordered and is afforded an
24opportunity to assess the patient.

25(d) (1) Notwithstanding any otherbegin delete provision ofend delete law, a dietetic
26technician, registered meeting the qualifications set forth in Section
272585 may, under the direct supervision of a registered dietitian,
28assist in the implementation or monitoring of services specified
29in subdivision (a), butbegin delete mayend deletebegin insert shallend insert not develop nutritional or dietary
30therapy or treatments or accept or transmit verbal orders.

31(2) (A) For purposes of this subdivision, “direct supervision”
32means the supervising registered dietitian shall be physically
33available to the dietetic technician, registered for consultation
34whenever consultation is required. However, in the case of a small
35or rural hospital, as defined in Section 124840 of the Health and
36Safety Code, the registered dietitian may be available for
37consultation by telephone or other electronic means, provided that
38the registered dietitian is physically on the facility site a sufficient
39amount of time to provide adequate supervision over and review
40of the work of the dietetic technician, registered.

P7    1(B) For purposes of this subdivision, “physically available”
2means physical onsite presence during regular business hours, and
3includes telephonic or electronic availability at all times and the
4ability to respond to the facility within a reasonable period of time
5when required. The registered dietitian shall review any activities
6performed by the dietetic technician, registered during any period
7when the registered dietitian was not physically onsite.

8(3) For purposes of this subdivision, a registered dietitian shall
9not supervise more than two dietetic technicians, registered at one
10time.

11(e) It is a misdemeanor for a person specified in subdivision (e)
12of Section 2585 to practice in a manner inconsistent with the
13requirements set forth in this section.

14(f) Nothing in this section shall preclude a person specified in
15subdivision (b) or (e) of Section 2585 from providing information
16as permitted by Section 2068.

17(g) For purposes of this section, “health care provider” means
18any person licensed or certified pursuant to this division, or
19licensed pursuant to the Osteopathic Initiative Act or the
20Chiropractic Initiative Act.

21(h) The requirement of a written prescription shall be deemed
22to be satisfied by an entry in the patient records of a patient who
23is undergoing treatment at a licensed health care facility if the
24contents of the patient records reflect the information required by
25this section.

26(i) Nothing in this section or Section 2585 shall be interpreted
27to establish educational criteria or practice restrictions or limitations
28for other health care providers licensed under Division 2
29(commencing with Section 500) or the Osteopathic Initiative Act
30or the Chiropractic Initiative Act.

31

SEC. 3.  

Section 2586.4 of the Business and Professions Code
32 is amended to read:

33

2586.4.  

A person may engage in the activities set forth in
34subdivision (d) of Section 2586 if the person meets both of the
35following requirements:

36(a) The person is engaged in the activities as part of a supervised
37practice program for a dietetic technicianbegin insert, registeredend insert pursuant to
38subparagraph (A) of paragraph (2) of subdivision (b) of Section
392585.

P8    1(b) The personbegin delete isend delete has completed a course of study to fulfill the
2educational requirements for a dietetic technicianbegin insert, registeredend insert in
3subparagraph (A) or (B) of paragraph (2) of subdivision (b) of
4Section 2585.

5

SEC. 4.  

Section 2586.8 of the Business and Professions Code
6 is amended to read:

7

2586.8.  

A person may engage in the activities set forth in
8subdivision (d) of Section 2586 for six months from the date he
9or she completed the academic requirements for dietetic technicians
10specified in subparagraph (A) or (B) of paragraph (2) of subdivision
11(b) of Section 2585, or until the person receives notice that he or
12she has failed the examination specified in subdivision (d),
13whichever occurs first, if all of the following conditions apply:

14(a) The person performs under the direct and immediate
15supervision of a registered dietitian.

16(b) The person has written verification, including the program
17director’s original signature, that the person has completed the
18educational program and possesses an associate’s degree or higher.

19(c) The person has applied to take the dietetic technicianbegin insert,
20registeredend insert
examination specified in paragraph (4) of subdivision
21(b) of Section 2585 and is waiting for an examination date.

22

SEC. 5.  

No reimbursement is required by this act pursuant to
23Section 6 of Article XIII B of the California Constitution because
24the only costs that may be incurred by a local agency or school
25district will be incurred because this act creates a new crime or
26infraction, eliminates a crime or infraction, or changes the penalty
27for a crime or infraction, within the meaning of Section 17556 of
28the Government Code, or changes the definition of a crime within
29the meaning of Section 6 of Article XIII B of the California
30Constitution.


CORRECTIONS:

Text--Pages 4.




O

Corrected 8-7-14—See last page.     98