Senate Bill No. 993

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 begin delete Health Services end delete
begin insert Public Health end insert 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 begin delete Health Services end delete
begin insert Public Health end insert 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 begin delete Health Services end delete begin insert Public Health end insert 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 begin delete Health Services end delete begin insert Public
Health end insert 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.

begin delete

(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.

end delete begin delete

(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.

end delete begin insert

(2) Satisfactory completion of either of the following:

end insert begin insert

(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.

end insert begin insert

(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.

end insert begin delete

(4)

end delete

begin insert (3) end insert  Satisfactory completion of an examination administered by
a public or private agency or institution recognized by the State
Department of begin delete Health Services end delete begin insert Public Health end insert to administer the
examination.

begin delete

(5)

end delete

begin insert (4) end insert  Satisfactory completion of continuing education requirements
established by a public or private agency or institution recognized
by the State Department of begin delete Health Services end delete begin insert Public Health end insert 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 begin insert , end insert 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)  begin insert (1) end insert begin insert   end insert 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 begin insert and
recommend end insert nutritional and dietary treatments, including therapeutic
diets, for individuals or groups of patients in licensed institutional
facilities or in private office settings. The referral begin insert for medical
nutrition therapy end insert shall be accompanied by a written prescription
signed by the health care provider detailing the patient’s diagnosis
and including begin insert either end insert a statement of the desired objective of dietary
begin delete 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.” end delete begin insert 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. end insert

begin insert

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

end insert

(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 begin insert for medical nutrition therapy end insert from the referring
physician begin delete consistent with an established protocol to implement
medical nutrition therapy end delete begin insert responsible for the care of the patient end insert .

(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 begin delete nutritional
therapeutic treatments end delete begin insert medical nutrition therapy services end insert when
begin delete authorized to do so by a written protocol prepared or end delete 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 begin insert (b) or end insert (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 begin delete paragraph
(3) end delete begin insert subparagraph (A) of paragraph (2) end insert of subdivision (b) of Section
2585.

(b) The person is begin delete enrolled in or end delete has completed a course of study
to fulfill the educational requirements for a dietetic technician in
begin insert subparagraph (A) or (B) of end insert 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 begin delete supervised practice program for dietetic
technicians, end delete begin insert academic requirements for dietetic technicians
specified in subparagraph (A) or (B) of paragraph (2) of
subdivision (b) of Section 2585, end insert 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.

begin delete

(b) The person has completed the supervised practice program
requirements under subdivision (b) of Section 2585.

end delete begin delete

(c)

end delete

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

begin delete

(d)

end delete

begin insert (c) end insert  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.