Licensure

History of Licensure for Registered Dietitian Nutritionist  in California


Lorri Holzberg, MA, RDN
Vice President Public Policy


1926, 1942, 1946 and 1960: In the state of California, the California Dietetic Association
(CDA) was formed in 1924-1925. CDA discussed licensure for dietitians at the named
dates and sent recommendations to ADA for study and recommendation. No action was
taken.

1978-1980:  CDA evaluated options to gain legal recognition for Registered Dietitians
(RDs), and in 1980, CDA chose to pursue Title Act legislation as a first step towards
licensure of dietitians.

1982:  CDA sponsored successful legislation to create the Dietitian Title Act, which went
into effect January 1, 1983 as California Business & Professions Code Sections 2585-
2586. This was signed into law by then Governor, Jerry Brown. It established a required
identity for the RD of education, internship, examination and continuing education, as
well as a scope of practice to provide nutrition assessment, nutrition counseling, and
nutrition treatments for those with illnesses and diseases when referred by a health care
professional who can refer for nutrition services. (physicians and surgeons, physician’s
assistants, dentists, and osteopathic physicians.)

1987: CDA sponsored the unsuccessful Assembly Bill 2369 which called for the licensing
and regulation of dietitians and dietetic technicians with a definition for "nutritionist."
The bill was dropped due to extensive organized opposition.

1988: CDA sponsored the unsuccessful Senate Bill 2078, which was a rewritten licensing
law for dietitians. An Interim Hearing was held November 30, 1988 on this topic. CDA filed an
extensive justification document with the Department of Consumer Affairs (DCA) on
November 9, 1988, but did not convince DCA of the need for licensing dietitians.

1999:  CDA Task Force explored ways to update and improve the RD scope of practice.

2000 and 2001: CDA gathered member input and evaluated how CDA could best
improve the RD scope of practice; help identify, legally, the DTR; and how best to focus
future CDA legislation. Member input from all districts indicated that members opposed
licensure based on the anticipated costs for maintaining licensure status.

2001: CDA sponsored the successful Assembly Bill 1444 to modernize the RD scope of
practice within Business & Professions Codes 2585 & 2586. The bill also clarified the scope
of practice for the "other nutrition professional" (defined in 1995 as those with Masters
or higher degrees in clinical nutrition from US Dept. Education regionally accredited
colleges/universities, whose individual qualifications must be validated by the referring
MD. (Please note they can only accept referrals with validation from an MD). AB 1444
also added a DTR definition of education, training, duties, and supervision by the RD. AB
1444 was passed and signed into law by then Governor Gray Davis and went into effect
January 1, 2002 and was added to CA Business & Professions Code Sections 2585---2586.

2002: The California Nurses’ Association put forth legislation (SB 1642) to delete the
modernization of the RD scope of practice passed into law in 2001. CDA put up active
opposition to this bill; consulted with CNA and testified before the Senate, which resulted
in a compromise amendment developed jointly by CNA and CDA. The Senate Business &
Professions Committee passed SB 1642 with a compromise amendment developed jointly
by the California Nurses’ Association and the California Dietetic Association.

2003: More legislation (AB769 - Maddox) was sponsored by CDA to address a gap in state
law concerning allowable practice by dietetics students in supervised practice programs.
AB769 was signed into state law on July 15, 2003 and went into effect on January 1, 2004.
Students and new graduates of Dietetic Internships, Coordinated Programs and Dietetic
Technician, Registered programs are covered by the new language in the law.

2004-2014: Hospitals continued to be cited by California Department of Public Health
(CDPH), Licensing and Certification, for violations of CMS conditions of participation
because of RDs practicing “outside their scope of practice.”

2007-2009: CDA developed a Professional Practice Task Force to examine the reasons for
the hospital citations. Members of the Task Force met with CDPH officials over the course
of two years to determine what RDs could do to improve and clarify their scope of
practice. It was recommended that CDA hire a health policy attorney who could legally
analyze our Business & Professions Codes (2585 & 2586). Also, the CMS (Centers for
Medicare & Medicaid) Conditions of Participation and recent memos were thoroughly
discussed with the conclusion that for RDs to be able to go beyond nutrition assessments
and recommendations in their practices, there would need to be a regulatory, oversight
body governing them as protection for the public i.e. a licensing board.

2009: Approval of a Licensure Committee by the CDA Board.

2009: A health policy attorney from San Francisco was hired by CDA.

2009-2010: The health policy attorney made a complete and thorough analysis of B&P
Codes 2585 & 2586 and presented this to CDA via a white paper. At this point, CDA
determined that CDA should pursue legislation for licensure in California.

February 2011: AB 575 (Mary Hayashi), licensure legislation, was not acted upon in the
2011 legislative session and died.

February 2012: CDA  staged licensure in small increments beginning with clarification of
the RD scope of practice in B&P Codes 2585 & 2586.

March 2013: No author could be found for scope clarification legislation.

2014: SB 993 was introduced into the legislature authored by Sen. Holly Mitchell. The bill
offered clarification of scope of practice for RDNs in California; inclusion of the term RDN;
as well as updating pathways for becoming a DTR based on national standards. The bill
successfully passed through the legislature and was signed into law.

2015: SB 993 incorporated into the CA Business & Professions Code 2586 on January 1, 2015. 

2016: Work with Academy’s Report of Harm Tool; investigate ways of oversight
protection to promote order-writing privileges for RDNs in acute care settings in
California. Order-writing is currently not permitted under CA state law.