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Italicized text includes proposed additions to law or the previous version of the bill.
Struck text includes proposed deletions to law or the previous version of the bill.

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AMENDED IN ASSEMBLY APRIL 12, 2011

INTRODUCED BY Assembly Member Hayashi
( Coauthor: Assembly Member
Perea
)
( Coauthor: Senator Leno
)

FEBRUARY 16, 2011

An act to amend Section 205 of, and to repeal and add Chapter 5.65
(commencing with Section 2585) of Division 2 of, the Business and
Professions Code, relating to dietetics, and making an appropriation
therefor.



LEGISLATIVE COUNSEL'S DIGEST


AB 575, as amended, Hayashi. Dietetics.
Existing law provides that any person representing himself or
herself as a registered dietitian or dietetic technician shall meet
specified requirements and qualifications.
This bill would repeal these provisions and enact new provisions
providing for the licensing and regulation of registered
dietitians by the Dietitians Bureau in the Department of Consumer
Affairs, which the bill would create. The bill would specify the
qualifications required for licensed
registered
dietitians and their scope of practice. The bill
would specify the qualifications and required supervision for
dietetic technicians , registered . The bill
would create an advisory committee within the bureau, with 5 members
appointed by the Director of Consumer Affairs and the Legislature.
The bill would authorize the bureau to impose licensing fees, which
would be deposited in the Dietitian Licensing Fund, which the bill
would create, and would continuously appropriate those revenues to
the bureau. The bill would authorize the bureau to enforce these
provisions and would enact other related provisions. The bill would
provide that a violation of these provisions is a misdemeanor. By
creating a new crime, 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: yes. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1. The Legislature finds and declares all of the
following:
(a) Dietetics is a dynamic health profession that applies a
scientific body of knowledge to improve, promote, and optimize
millions of Californians' health by means of appropriate nutrition
care services.
(b) Registered dietitians are highly trained allied health
professionals who obtain and maintain national registration status.
Registered dietitians are uniquely qualified by virtue of academic
and supervised practice training and certification to provide a
comprehensive array of evidence-based, nutrition-related professional
services.
(c) Registered dietitians practice in a variety of work settings.
The majority of registered dietitians practice as part of a
coordinated multidisciplinary medical care team in the treatment and
prevention of disease in clinical, patient care settings. These
include acute care, ambulatory care, long-term care, other health
care facilities, as well as private practice and managed care
settings. A large number of registered dietitians work in community
and public health programs, food and nutrition management,
consultation and business, and education and research.
(d) In recognition of the continually evolving practice of
dietetics, California's current dietitian practice statutes require
updating to better reflect the breadth of nutrition-related services
provided by registered dietitians.
(e) In recognition of the continually evolving health care
practices in California and the requirement for licensed health care
providers to perform preventive and chronic disease management within
the health care arena, an enhanced regulatory framework for the
practice of dietetics is appropriate.
(f) For these reasons, the Legislature finds and declares that,
because the practice of dietetics in California affects the public's
health, safety, and welfare, there is a necessity for that practice
to be subject to licensing, regulation, and control.
SEC. 2. Section 205 of the Business and Professions Code is
amended to read:
205. (a) There is in the State Treasury the Professions and
Vocations Fund. The fund shall consist of the following special
funds:
(1) Accountancy Fund.
(2) California Architects Board Fund.
(3) Athletic Commission Fund.
(4) Barbering and Cosmetology Contingent Fund.
(5) Cemetery Fund.
(6) Contractors' License Fund.
(7) State Dentistry Fund.
(8) State Funeral Directors and Embalmers Fund.
(9) Guide Dogs for the Blind Fund.
(10) Home Furnishings and Thermal Insulation Fund.
(11) California Architects Board-Landscape Architects Fund.
(12) Contingent Fund of the Medical Board of California.
(13) Optometry Fund.
(14) Pharmacy Board Contingent Fund.
(15) Physical Therapy Fund.
(16) Private Investigator Fund.
(17) Professional Engineers' and Land Surveyors' Fund.
(18) Consumer Affairs Fund.
(19) Behavioral Sciences Fund.
(20) Licensed Midwifery Fund.
(21) Court Reporters' Fund.
(22) Veterinary Medical Board Contingent Fund.
(23) Vocational Nurses Account of the Vocational Nursing and
Psychiatric Technicians Fund.
(24) Electronic and Appliance Repair Fund.
(25) Geology and Geophysics Fund.
(26) Dispensing Opticians Fund.
(27) Acupuncture Fund.
(28) Physician Assistant Fund.
(29) Board of Podiatric Medicine Fund.
(30) Psychology Fund.
(31) Respiratory Care Fund.
(32) Speech-Language Pathology and Audiology Fund.
(33) Board of Registered Nursing Fund.
(34) Psychiatric Technician Examiners Account of the Vocational
Nursing and Psychiatric Technicians Fund.
(35) Animal Health Technician Examining Committee Fund.
(36) State Dental Hygiene Fund.
(37) State Dental Assistant Fund.
(38) Hearing Aid Dispensers Account of the Speech-Language
Pathology and Audiology Fund.
(39) Dietitian Licensing Fund.
(b) For accounting and recordkeeping purposes, the Professions and
Vocations Fund shall be deemed to be a single special fund, and each
of the several special funds therein shall constitute and be deemed
to be a separate account in the Professions and Vocations Fund. Each
account or fund shall be available for expenditure only for the
purposes as are now or may hereafter be provided by law.
SEC. 3. Chapter 5.65 (commencing with Section 2585) of Division 2
of the Business and Professions Code is repealed.
SEC. 4. Chapter 5.65 (commencing with Section 2585) is added to
Division 2 of the Business and Professions Code, to read:
CHAPTER 5.65. DIETETICS


2585. The purpose of this chapter is to protect the health,
safety, and welfare of the public by providing for the licensing and
regulation of persons engaged in the practice of dietetics.
2585.1. As used in this chapter, the following terms have the
following meanings:
(a) "Association" or "ADA" means the American Dietetic
Association.
(b) "Bureau" means the Dietitians Bureau created pursuant to
Section 2585.4.
(c) "Commission on Accreditation for Dietetics Education" or "CADE"
means ADA's accrediting agency for education programs preparing
students for careers as registered dietitians or dietetic
technicians, registered.
(d) "Commission" means the Commission on Dietetic Registration
that is accredited by the National Commission for Certifying
Agencies, and is the certifying agency for voluntary professional
credentialing.
(e) "Degree" means a degree received from a United States
regionally accredited college or university recognized by the Council
for Higher Education Accreditation and the United States Department
of Education at the time the degree was received.
(f) "Dietetics" means the integration and application of
principles derived from the sciences of food, nutrition, management,
and communication, and from the biological, physiological,
behavioral, and social sciences to achieve and maintain optimal human
health.
(g) "Dietetic technician" technician,
registered" is a person who is a graduate of at
least an associate degree program in dietetic technology or dietetics
that is accredited by CADE, and who is working
who passed a national exam administered by the commission, and
who maintains continuing education required by the commission. The
dietetic technician, registered, shall work
under the direct
supervision of a dietitian licensed under this chapter or a
registered dietitian and uses the title dietetic technician, or
dietetic technician, registered.
.
(h) "Direct supervision" means the supervising dietitian shall be
available to the dietetic technician , registered , for
consultation whenever consultation is required. The dietitian may be
available for consultation by telephone or other electronic means,
provided that the 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
.
(i) "General nonmedical nutrition information" means information
on any of the following:
(1) Principles of good nutrition and food preparation.
(2) Food to be included in the normal daily diet.
(3) The essential nutrients needed by the body.
(4) Recommended amounts of the essential nutrients, based on
established standards.
(5) The actions of nutrients on the body.
(6) The effects of deficiencies or excesses of nutrients.
(7) Food and supplements that are good sources of essential
nutrients.
(j) "Licensed dietitian" means a person licensed under this
chapter to practice dietetics, including medical nutrition therapy.
Activities of a licensed dietitian do not include the medical
differential diagnosis of the health status of an individual.
(k) "Medical nutrition therapy" means the use of specific
nutrition services for the purpose of disease management to treat or
rehabilitate an illness, injury, or condition and includes all of the
following:
(1) Performing nutritional assessments and reassessments.
(2) Interpreting dietary data and recommending nutrient needs
relative to medically prescribed diets, including, but not limited
to, tube feedings, specialized intravenous solutions, and specialized
oral feedings.
(3) Developing and implementing medically prescribed diets,
including, but not limited to, obesity, diabetes, cardiovascular
disease, and renal failure.
(4) Evaluating and advising about food and drug interactions.
(5) Developing and managing food service operations in facilities
whose functions include the provision of safe and effective nutrition
care and the provision of general or medically prescribed diets for
an individual, target group, or community as set out, and in
compliance with, recognized nutrition standards.
(6) Nutrition monitoring and evaluation.
(l) "Medically prescribed diet" means a diet prescribed when
specific food or nutrient levels need to be monitored or altered, or
both, as a component of a treatment program for an individual whose
health status is impaired or at risk due to disease, injury, or
surgery and that may only be performed as initiated by or in
consultation with a licensed physician and surgeon, or by an
individual authorized under the terms of his or her license to
prescribe medical care in this state.
(m) "Nutrition assessment" means the systematic process of
obtaining, verifying, and interpreting biochemical, anthropometric,
physical, and dietary data in order to make decisions about the
nature and cause of nutrition-related problems. It is an ongoing,
dynamic process that involves not only initial data collection, but
also reassessment and analysis of client or community needs and
provides the foundation for nutrition diagnosis and nutritional
recommendations, including enteral and parenteral nutrition.

(n)

(m) "Nutrition care process" means the systematic
problem solving method that dietitians use to critically think and
make decisions when providing medical nutrition therapy or to address
nutrition-related problems and provide safe, effective, high-quality
care. The nutrition care process consists of four distinct, but
interrelated steps, including nutrition assessment, nutrition
diagnosis, nutrition intervention, and nutrition monitoring and
evaluation . , as follows:
(1) "Nutrition assessment" means the systematic process of
obtaining, verifying, and interpreting biochemical, anthropometric,
physical, and dietary data in order to make decisions about the
nature and cause of nutrition-related problems. It is an ongoing,
dynamic process that involves not only the initial data collection,
but also reassessment and analysis of client or community needs and
provides the foundation for nutrition diagnosis and nutritional
recommendations, including enteral and parental nutrition.


(2) "Nutrition diagnosis" means the identification and description
of a specific nutrition problem that can be resolved or improved
through nutrition intervention by a registered dietitian. A nutrition
diagnosis is not a medical diagnosis.

(o) "Nutrition care services" means any of the following:

(1) Assessing the nutrition needs of individuals and groups and
determining resources and constraints.

(2) Establishing priorities, goals, and objectives that meet
nutrition needs and are consistent with available resources and
constraints.

(3) Providing nutrition counseling in health and disease.

(4) Developing, implementing, and managing nutrition care systems.

(5) Evaluating making changes in and maintaining appropriate
standards of quality in food and nutrition care services.


(p) "Nutrition diagnosis" means identifying and labeling
nutritional problems that a licensed dietitian is responsible for
treating independently.

(q)

(3) "Nutrition intervention" means purposefully planned
actions intended to positively change a nutrition-related behavior,
risk factor, environmental condition, or aspect of health status for
an individual and his or her family or caregiver, target groups, or
community at large.
(r)

(4) "Nutrition monitoring and evaluation" means
identifying patient-client outcomes relevant to the nutrition
diagnosis and intervention plans and goals, and comparing those
outcomes with previous status, intervention goals, or a reference
standard to determine the progress made in achieving desired outcomes
of nutrition care and whether planned interventions should be
continued or revised.
(s)

(n) "Registered dietitian" means an individual
registered with the commission and licensed by the bureau
.
2585.2. (a) A licensed registered
dietitian engages in (1) the provision of medical nutrition therapy
and (2) the nutrition care process.
(b) A licensed registered dietitian
may, upon referral by a health care provider authorized to prescribe
dietary treatments, 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 settings. 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. The
requirement of a referral shall be deemed to be satisfied by
an entry
a diet order in the patient
records of a patient person
who is undergoing treatment at a licensed health care facility if the
contents of the patient records reflect the information required by
this section. The services described may be termed medical nutrition
therapy.
(c) A licensed registered dietitian
may accept or transmit verbal orders , telephone orders, or
electronically transmitted orders from a referring physician and
surgeon.
(d) A licensed registered dietitian
may 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. In the absence of the referring physician
and surgeon at a patient visit, in a clinic where there is a
registered nurse on duty, the medical laboratory test may be ordered
if a registered nurse is notified that the test is being ordered and
is afforded an opportunity to assess the patient.

2585.3. Only a person licensed as a dietitian or otherwise
authorized to practice under this chapter shall practice dietetics or
medical nutrition therapy, or use the title registered
dietitian, or use the word dietitian or registered dietitian, alone
or in combination, or use the term licensed dietitian, or the letters
LD RD, LD, or similar titles or
initials.
2585.4. There is, in the Department of Consumer Affairs, the
Dietitians Bureau, under the supervision and control of the director.
The director may appoint a chief at a salary to be fixed and
determined by the director, with the approval of the Director of
Finance. The duty of enforcing and administering this chapter is
vested in the chief, and he or she is responsible to the director
therefor. The chief shall serve at the pleasure of the director.
2585.5. The bureau may establish rules and regulations necessary
for the administration and enforcement of this chapter and prescribe
the form of statements and reports provided for in this chapter. The
rules and regulations shall be adopted, amended, or repealed in
accordance with the provisions of the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 2
of Title 2 of the Government Code).
2585.6. In the enforcement of this chapter, the bureau has all
the powers and is subject to all the responsibilities vested in and
imposed upon the head of a department under Chapter 2 (commencing
with Section 11150) of Part 1 of Division 3 of Title 2 of the
Government Code, as follows:
(1) To license dietitians in a manner consistent with the
provisions of this chapter.
(2) To keep a record of its proceedings, a register of all
applicants for licensure, and a register of all licensed dietitians.
2585.7. (a) There is within the bureau a five-member advisory
committee. On or before July 1, 2012, the members of the committee
shall be appointed as follows:
(1) Three members, who shall have been actively practicing in the
field of dietetics for not less than five years, appointed by the
director.
(2) One public member appointed by the Senate Committee on Rules.
(3) One public member appointed by the Speaker of the Assembly.
(b) The advisory committee shall advise the bureau with respect to
matters relating to the administration of this chapter, including
annually reviewing the fee schedule, licensing, and enforcement
provisions of this chapter.
(c) The bureau shall actively seek input from, and consult with,
the advisory committee regarding the development of regulations to
implement this chapter.
(d) The bureau shall not proceed with any proposed regulations
without first receiving written comments from the advisory committee.

(e) The bureau shall adopt as continuing education requirements
the requirements utilized by the commission as they are periodically
modified, and shall require all applicants for licensure to provide
evidence of compliance with those requirements.
(f) The bureau shall have power to seek injunctive relief to
prohibit any person from providing professional dietetic or
nutritional care services as defined in this chapter without being
licensed or exempt from licensure as provided in this chapter.
(g) On an annual basis, the bureau shall provide the advisory
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.
2585.8. The bureau shall notify in writing any person determined
by the bureau to be in violation of this chapter. The notification
shall state that the person may request a hearing by the bureau
within the amount of time specified by the bureau pursuant to the
Administrative Procedure Act. If the person fails to request a
hearing, or if the bureau determines from the hearing that the person
is in violation of this chapter, the bureau may apply to the
superior court in the county in which the violation is occurring for
an injunction or other appropriate remedy to prohibit the continued
violation of this chapter.
2585.9. (a) The bureau shall issue a license as a dietitian to a
person who satisfactorily completes an application, pays all required
fees, and certifies and furnishes evidence satisfactory to the
board bureau that the applicant has
completed all of the following:
(1) (A) Has received a baccalaureate or post-baccalaureate degree
from a United States regionally accredited college or university
with 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.
(B) Applicants who have obtained their education outside the
United States and its territories must have their academic degree or
degrees validated as equivalent to the baccalaureate or master's
degree conferred by a regionally accredited college or university in
the United States.
(2) Has completed a documented supervised preprofessional practice
experience component in dietetics of not less than 900 hours under
the supervision of a registered dietitian, or a licensed
dietitian or nutritionist, or an individual with a doctoral
with a minimum of a master's degree conferred by
a United States regionally accredited college or university with a
major course of study in human nutrition, nutrition education, food
and nutrition, dietetics, or food systems management. Supervised
practice experience must be completed in the United States or its
territories. Supervisors who obtained their doctoral
degree outside the United States and its territories must
have their degree validated as equivalent to the doctoral
with a minimum of a master's degree conferred by
a United States regionally accredited college or university.
Supervisors must have completed 900 hours of
practice
experience.

(3) Has successfully completed the registration examination for
dietitians administered by the commission.
(b) The applicant must be 21 years of age
18 years of age or older
.
(c) (1) For one year, beginning on January 1, 2012, the bureau
shall waive the licensure requirement and may grant a license to any
applicant who makes satisfactory application to the bureau and
complies with either of the following:
(A) Is registered with the commission.

(B) Received a
baccalaureate or post-baccalaureate degree from a United States
regionally accredited college or university with a program in
dietetics or nutrition or an equivalent major course of study as
approved by the board, has completed an experience approved by, and
met the educational requirements of, the commission, and has
successfully completed the registration examination for dietitians
administered by the commission.
is registered with the
commission.

(2) The bureau shall waive any additional educational requirements
the bureau considers necessary if the applicant presents
satisfactory evidence to the bureau of current registration as a
registered dietitian with the commission.
(3) The bureau shall waive the licensure requirements if the
application for renewal is made within two years after the date of
license expiration.
(4) A nonresident registered dietitian licensed in another state
may practice dietetics in the state without a license for 90 days or
up to 120 days if the requirements for licensure are substantially
equal to the requirements for licensure contained in this chapter.

2585.10. (a) All fee revenues collected under this chapter shall
be deposited in the Dietitian Licensing Fund, which is hereby
created, and are hereby continuously appropriated to the bureau for
the ordinary expenses of the bureau in administration of this
chapter.
(b) The bureau shall establish reasonable and necessary fees
relating to the administration of this chapter, none of which are
refundable. The fees shall be set at a level to produce revenue which
shall not exceed the cost and expense of administering this chapter.

2585.11. This chapter shall not be construed to affect or prevent
any of the following:
(a) Any person licensed in this state under this division from
engaging 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) Any person licensed in this state under this division from
engaging in the practice for which he or she is licensed.
(c) A student enrolled in a CADE-accredited program in dietetics
or nutrition from engaging in the practice of dietetics under the
supervision of a licensed dietitian as part of that program.
(d) 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 from engaging in the
practice of dietetics provided that practice is related to the
service or employment.
(e) 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.
(f) A person providing weight control services through a program
that has been reviewed and approved by a licensed dietitian, or where
consultation from a licensed dietitian is not available, from a
dietitian licensed in another state that has licensure requirements
at least as stringent as the requirements for licensure under this
chapter, from a registered dietitian, or from a licensed physician
and surgeon. Program changes may not be initiated without prior
approval by the program approver.

(f) Any commercial weight management program.

(g) A person who has completed the educational and
preprofessional practice requirements to sit for the
licensure examination
registration examination for
dietitians administered by the commission
, but has not yet
passed the examination, may practice under the supervision of a
licensed registered dietitian for a
period of six months after completing the licensure
education
educational requirements of the
commission
.
(h) A dietetic technician , registered, may, under the
direct supervision of a licensed registered
dietitian, assist in the implementation or monitoring
of services
with the nutrition care process .
2585.12. Licenses may 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.
2585.13. (a) Any person who violates any of the provisions of
this chapter shall be guilty of a misdemeanor punishable by
imprisonment in a county jail not exceeding six months, or a fine not
exceeding one thousand dollars ($1,000), or by both that fine and
imprisonment.
(b) In addition to any other fine or penalty that may be imposed
against any person found to have violated any provision of this
chapter, the board may assess and collect all costs incurred in
connection with disciplinary actions, including, but not limited to,
investigator fees, stenographer fees, attorney's fees, and hearing
costs. Any amounts collected under this subdivision shall be
deposited in the Dietitian Licensing Fund and shall be subject to
Section 207.
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.