Amended in Assembly July 2, 2014

Amended in Senate April 21, 2014

Senate Bill No. 993

Introduced by Senator Mitchell

(Coauthors: Senators Beall and 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 amended, Mitchell. Healing arts: dietitians.

Existing law requires dietetic technicians, registered, to possess prescribed qualifications, including academic requirements, and makes it a misdemeanor for any person not meeting those requirements to use, in connection with his or her name or place of business, the term “dietetic technician, registered” or the letters “DTR.”

Existing law authorizes a registered dietitian, upon referral by a health care provider, to provide medical nutrition therapy, 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, registered to assist the registered dietitian in these circumstances in the implementation or monitoring of medical nutrition therapy. Existing law makes it a misdemeanor for a registered dietitian, or other specified nutritional professionals, to practice in a manner inconsistent with these provisions.

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

This bill would also allow a registered dietitian, under the above-described circumstances, or other nutritional professional who meets specified qualifications, to develop and recommend nutritional and dietary treatments, as provided, and would allow the registered dietitian or other nutritional professional to perform nutritional assessments and to initiate nutritional interventions pursuant to a licensed health care facility’s approved nutrition screening policy and procedure, as provided. 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. 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 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 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 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 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 either of the following:

(A) Appropriate academic requirements for dietetic technicians,
registered, 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.

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

(4) Satisfactory completion of continuing education requirements
established by a public or private agency or institution recognized
by the State Department of 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,”
“registered dietitian nutritionist,” or the letters “RD,” “RDN,”
“DTR,” or any other words, letters, abbreviations, or insignia
indicating or implying that the person is a dietitian, dietetic
technician, registered, registered dietitian, or registered dietitian
nutritionist 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,
a dietetic technician, registered, a registered dietitian, or a
registered dietitian nutritionist.

(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 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 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 or a diet
order. The registered dietitian, or other nutritional professional
meeting the qualifications set forth in subdivision (e) of Section
2585, may perform nutritional assessments and initiate nutritional
interventions within the parameters of the prescribed diet order
pursuant to a licensed health care facility’s approved nutrition
screening policy and procedure. The registered dietitian, or other
nutritional professional meeting the qualifications set forth in
subdivision (e) of Section 2585, shall collaborate with a
multidisciplinary team, which shall include the treating physician
and the registered nurse, in developing the patient’s nutrition care
plan. Unless otherwise stated in the begin delete prescribed end delete diet order by a
patient’s provider, the registered dietitian, or other nutritional
professional meeting the qualifications set forth in subdivision (e)
of Section 2585, may individualize the patient’s nutritional or
dietary treatment when necessary, by modifying the begin delete distribution
type end delete begin insert distribution, type, end insert or quantity of food and nutrients within the
parameters of the begin delete prescribed end delete diet order. Any modification, and the
rationale for the modification, shall be documented in the patient’s
record for review by the begin delete prescribing provider. end delete begin insert physician responsible
for the care of the patient end insert begin insert . end insert Nothing in this subdivision shall be
construed to authorize a registered dietitian, or other nutritional
professional meeting the qualifications set forth in subdivision (e)
of Section 2585, to order or administer a central vein or peripheral
vein nutrition.

(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 or the physician responsible for the care of the patient
in a licensed health care facility.

(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 medical
nutrition therapy services when approved by the referring physician
or the physician responsible for the care of the patient and when,
in the absence of the referring physician or physician responsible
for the care of the patient 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 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 shall 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, registered pursuant to
subparagraph (A) of paragraph (2) of subdivision (b) of Section
2585.

(b) The person has completed a course of study to fulfill the
educational requirements for a dietetic technician, registered 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 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 begin delete (d), end delete begin insert (c), end insert
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 written verification, including the program
director’s original signature, that the person has completed the
educational program and possesses an associate’s degree or higher.

(c) The person has applied to take the dietetic technician,
registered examination specified in paragraph begin delete (4) end delete begin insert (3) end insert 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.

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CORRECTIONS:

Text--Page 4.

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