BILL ANALYSIS �
AB 575
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Date of Hearing: April 26, 2011
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
AB 575 (Hayashi) - As Amended: April 12, 2011
SUBJECT : Dietetics
SUMMARY : Establishes the Dietitians Bureau (Bureau) within the
Department of Consumer Affairs (DCA) to license and regulate
dietitians. Specifically, this bill :
1)Establishes the Bureau within the DCA, authorizes the Bureau
to establish rules and regulations necessary for the
administration and enforcement of these provisions, as
specified.
2)Establishes the Dietitian Licensing Fund (Fund) within the
Professions and Vocations Fund in the State Treasury and
requires all fee revenues collected pursuant to these
provisions be deposited in the Fund.
3)Establishes a five-member advisory committee (Committee)
within the Bureau to advise the Bureau with respect to matters
relating to dietetics, including annually reviewing the fee
schedule, licensing, and enforcement of these provisions,
consisting of the following:
a) Three members, who have been actively practicing in the
field of dietetics for not less than five years, to be
appointed by the Director of DCA on or before July 1, 2012;
b) One public member to be appointed by the Senate
Committee on Rules on or before July 1, 2012; and,
c) One public member to be appointed by the Speaker of the
Assembly on or before July 1, 2012.
4)Requires the Bureau to do all of the following:
a) Actively seek input from, and consult with, the
Committee regarding the development of regulations to
implement these provisions and prohibits the Bureau from
proceeding with any proposed regulations without first
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receiving written comments from the Committee;
b) Adopt as continuing education requirements the
requirements utilized by the Commission on Dietetic
Registration (Commission), which is accredited by the
National Commission for Certifying Agencies and is the
certifying agency for voluntary professional credentialing;
c) Provide the Committee with information regarding the
number of complaints received by the bureau regarding the
practice of dietetics, a summary of the nature of the
complaints, and the number of enforcement actions
undertaken by the Bureau or referred to other agencies, on
an annual basis; and,
d) Notify in writing any person determined by the Bureau to
be in violation of these provisions, which shall state that
the person may request a hearing by the Bureau within the
amount of time, as specified. If the person fails to
request a hearing, or if the Bureau determines from the
hearing that the person is in violation of these
provisions, the Bureau may apply for an injunction or other
appropriate remedy to prohibit the continued violation of
these provisions, as specified.
5)Requires the Bureau to issue a license as a dietitian to a
person who has met all of the following requirements:
a) Is 18 years of age or older;
b) Satisfactorily completed an application;
c) Paid all required fees; and,
d) Certified and furnished evidence to the Bureau that the
applicant has completed all of the following:
i) Received a baccalaureate or post-baccalaureate
degree from a United Stated regionally accredited
college or university, or its validated equivalent, and
completed a major course of study in human nutrition,
nutrition education, public health nutrition, food and
nutrition, dietetics, or food systems management, or an
equivalent major course of study as approved by the
Bureau;
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ii) Completed a documented supervised
preprofessional practice experience component in
dietetics of not less than 900 hours under the
supervision of a registered dietitian or licensed
dietitian, as specified; and,
iii) Successfully completed the registration
examination for dietitians administered by the
Commission.
6)Requires the Bureau waive the licensure requirement for one
year, beginning on January 1, 2012, and authorizes the Bureau
to grant a license to any applicant who satisfactorily
completed an application and is registered with the
Commission.
7)Requires the Bureau waive any additional educational
requirements the Bureau considers necessary if the applicant
presents satisfactory evidence of current registration as a
registered dietitian with the Commission.
8)Authorizes a license to be renewed upon satisfactory
completion of the renewal application, payment of the renewal
fee, and proof of compliance with the Commission's continuing
education requirements.
9)Requires the Bureau waive the licensure requirements if the
application for renewal is made within two years after the
date of licensure expiration.
10)Requires the Bureau establish reasonable, necessary, and
non-refundable fees relating to the administration of these
provisions, to be set at a level to produce revenue which
shall not exceed the cost and expense of administering these
provisions.
11)Defines the following terms:
a) "Licensed dietitian" means an individual licensed by the
Bureau, as specified, to practice dietetics;
b) "Registered dietitian" means an individual registered
with the Commission and licensed by the Bureau; and,
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c) "Dietetic technician, registered" means a person who is
a graduate of at least an associate degree program in
dietetic technology or dietetics that is accredited by the
Commission on Accreditation for Dietetics Education (CADE),
has passed a national exam administered by the Commission,
and maintains continuing education required by the
Commission.
12)Specifies that a registered dietitian engages in the
provision of medical nutrition therapy and the nutrition care
process and defines those terms.
13)Authorizes a registered dietitian to:
a) Conduct nutritional and dietary assessments and develop
nutritional and dietary treatments, including therapeutic
diets, for individuals or groups of patients in licensed
institutional facilities or in private office setting, upon
referral by a health care provider authorized to prescribe
dietary treatments. 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;
b) Accept or transmit verbal orders, telephone orders, or
electronically transmitted orders from a referring
physician and surgeon; and,
c) Order medical laboratory tests approved by a referring
physician and surgeon and related to nutritional
therapeutic treatments by facility or agency policy and
when otherwise permitted by applicable law and regulations.
14)Prohibits anyone from using the title registered dietitian,
licensed dietitian, or the letters RD or LD, or any other
similar titles or initials, and from practicing dietetics or
medical nutrition therapy unless he or she is licensed
pursuant to these provisions.
15)Requires a dietetic technician, registered, to work under the
direct supervision of a dietitian licensed pursuant to these
provisions.
16)Makes a violation of any of these provisions a misdemeanor
punishable by imprisonment in a county jail not exceeding six
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months, or a fine not exceeding one thousand dollars, or both.
The Board may assess and collect all costs incurred in
connection with disciplinary actions, which shall by deposited
in the Fund.
17)Exempts all of the following:
a) Any person licensed in this state, as specified, may
engage in the practice of dietetics when it is within his
or her licensed scope of practice and is incidental to the
practice for which he or she is licensed;
b) A student enrolled in a CADE-accredited program in
dietetics or nutrition may engage in the practice of
dietetics under the supervision of a licensed dietitian as
part of that program;
c) A dietitian or nutritionist who is serving in the Armed
Forces or the public health service of the United States or
is employed by the United States Department of Veterans
Affairs may engage in the practice of dietetics provided
that practice is related to the service or employment;
d) A person that furnishes oral or written general
nonmedical nutrition information related to food, food
materials, or dietary supplements or the marketing of food,
food materials, or dietary supplements, provided the person
is not engaged in the practice of dietetics;
e) Any commercial weight management program;
f) A person who has completed the educational and
preprofessional practice requirements to sit for the
registration examination for dietitians administered by the
Commission, but has not yet passed the examination, may
practice under the supervision of a registered dietitian
for a period of six months after completing the educational
requirements of the Commission; and,
g) A dietetic technician, registered, may, under the
supervision of a registered dietitian, assist with the
nutrition care process.
18)Makes legislative findings and declarations.
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EXISTING LAW
1)Requires any person representing himself or herself as a
registered dietician or dietetic technician meet and possess
qualifications, as specified.
2)Prohibits anyone from using the title dietitian, or any other
similar term, unless he or she meets the criteria, as
specified, and makes such violation a misdemeanor.
3)Defines the scope of practice of registered dietitians and
dietetic technicians, but provides that any person may provide
nutritional advice or give advice concerning proper nutrition.
4)Authorizes a registered dietician or any other nutritional
professional, as specified, to be reimbursed for the
nutritional advice or advice concerning proper nutrition, as
specified, or for the nutritional assessments, counseling, and
treatments, as specified.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of the bill . According to the author's office, "AB 575
establishes licensing standards for dieticians to ensure proper
reimbursement for preventive and treatment services designated
by the Affordable Care Act and Medicare to be performed by
Registered Dieticians, by clarifying the dietitian's scope of
practice, making California law consistent with federal
regulations and the American Dietetic Association's national
practice framework, and establishing the basis for licensing
registered dietitians.
"Healthy dietary habits can provide energy, promote necessary
metabolic activities in the body, prevent micronutrient
deficiencies, and ward off chronic disease. With the explosion
of interest in healthy eating and nutrition, consumers are faced
with a dizzying array of products and information. As such, the
need to protect the public by establishing minimum educational
and experience criteria for those individuals who hold
themselves out to be experts in food and nutrition is
increasingly important."
Background . Registered Dieticians (RD) are highly trained
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health care professionals who provide dietetic and nutrition
services. The majority of RDs work in the treatment and
prevention of disease through the practice of evidence-based
medical nutrition therapy, often in hospitals, HMOs, private
practice, and other healthcare facilities. There are more than
8,000 RDs in California. Currently, 33 states license
dieticians.
RDs are the only health professional qualified to provide and be
reimbursed by Medicare for medical nutrition therapy for
diabetes and renal disease. Additionally, health care reform
language in the federal Affordable Care Act specifies
reimbursement for licensed health care professionals for certain
preventive and treatment services that should be performed by
RDs. Without licensure, RDs may be left out of activities where
their expertise is needed due to confusion about reimbursement.
State law provides title-protection and a non-exclusionary scope
of practice. This bill recasts many of the existing provisions,
but provides oversight that is currently lacking. While the
Department of Health Services is charged with recognizing which
public or private agencies or institutions are qualified to
administer exams and offer programs, there appears to be no
involvement or oversight by the Department or any other state
agency.
The Commission on Dietetic Registration (Commission) is the
credentialing agency for the American Dietetic Association. The
Commission currently awards RD, Dietetic Technician, Registered
(DTR), and five other separate and distinct credentials. The RD
requirements are nearly identical to the licensure requirements
in this bill.
REGISTERED SUPPORT / OPPOSITION :
Support
California Dietetic Association (sponsor)
California Hospital Association
California WIC Association
Finely Fit Nutrition Services
Madera Community Hospital
UCSF Medical Center
Hundreds of individuals
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Opposition
An individual
Analysis Prepared by : Marina Wiant / B.,P. & C.P. / (916)
319-3301