101101

LegislationLegislation

Federal and State Government Federal and State Government and Role of ADA/CDAand Role of ADA/CDA

Federal/State GovernmentFederal/State GovernmentStructureStructure

Legislative ProcessLegislative Process ADA/CDA Public Policy CouncilADA/CDA Public Policy Council

Division of Government Affairs (ADA)Division of Government Affairs (ADA) VP Public Policy (CDA)VP Public Policy (CDA)

LNCs, GRLs, LCs LNCs, GRLs, LCs Current Nutrition BillsCurrent Nutrition Bills LobbyingLobbying

FEDERAL/STATE (CA) FEDERAL/STATE (CA) GOVERNMENT – The 3 BranchesGOVERNMENT – The 3 Branches

EXECUTIVE – The President/VP

The Governor/Lt. Governor

George BushGeorge Bush

Dick CheneyDick Cheney

The GovernatorThe Governator

Cruz BustamanteCruz Bustamante

JUDICIAL -- Supreme Court/ State Supreme Court

LEGISLATIVE BRANCH Federal:

2 housesSenate (100 members – 6 year term)

House of Representatives (435 - 2 year term) State:

2 houses (term limits) Senate (40 members) – 4 year term (2 terms)Assembly (80 members) – 2 year term (3 terms)

Senators Diane Feinstein/Barbara Senators Diane Feinstein/Barbara BoxerBoxer

Congressman Wally HergerCongressman Wally Herger

State Senator Stan AanestadState Senator Stan Aanestad

Assemblyman Rick KeeneAssemblyman Rick Keene

HOW A BILL BECOMES A LAW HOW A BILL BECOMES A LAW IN CALIFORNIAIN CALIFORNIA

Bill introduced by a member of Assembly or Bill introduced by a member of Assembly or SenateSenate

Bill goes to Bill goes to rulesrules committee and assigned to a committee and assigned to a policypolicy committee & then goes to a committee & then goes to a fiscalfiscal committeecommittee

Bill goes back to Bill goes back to house of originhouse of origin for a vote for a vote

Bill goes to Bill goes to second housesecond house & referred to a & referred to a policypolicy committee and possibly a committee and possibly a fiscalfiscal committeecommittee

HOW A BILL BECOMES A LAW HOW A BILL BECOMES A LAW IN CALIFORNIAIN CALIFORNIA

Bill goes to Bill goes to floorfloor of of second housesecond house and is and is approved (approved (may be amendedmay be amended); if amended must go ); if amended must go back to back to house of originhouse of origin for a vote for a vote

After passage by both houses, bill goes to After passage by both houses, bill goes to Governor who has 12 days to sign it into lawGovernor who has 12 days to sign it into law

Law takes effect following January 1stLaw takes effect following January 1st

CDA’S FEDERAL LEGISLATIVE CDA’S FEDERAL LEGISLATIVE PROGRAMPROGRAM

ADA Division of Government AffairsADA Division of Government Affairs

Legislative Network Coordinators (LNCs)Legislative Network Coordinators (LNCs)North:North: Kim VagtKim Vagt South:South: Angela MetropulosAngela Metropulos

Grass Roots Liaisons (GRL)Grass Roots Liaisons (GRL)Me for Wally HergerMe for Wally Herger

CDA’S STATE LEGISLATIVE CDA’S STATE LEGISLATIVE PROGRAMPROGRAM

CDACDAExecutive BoardExecutive Board

President – Lisa GibsonPresident – Lisa GibsonLevel 1Level 1

CDA Public Policy Council– – VP Public PolicyVP Public Policy

Elaine KeeganElaine Keegan State Legislative Chairperson – VacantState Legislative Chairperson – Vacant

Level 2Level 2

CDA’S STATE LEGISLATIVE CDA’S STATE LEGISLATIVE PROGRAMPROGRAM

District & Practice Group District & Practice Group CoordinatorsCoordinatorsLevel 3Level 3

District Public Policy District Public Policy ChairsChairs

GED district: Christie CrawfordGED district: Christie Crawford

Legislative ContactsLegislative Contacts(LC)(LC)MeMe

Level 4Level 4

Practice GroupPractice GroupPublic PolicyPublic Policy

ChairsChairs

CDEP Practice Group - MeCDEP Practice Group - Me

CDA DistrictsCDA Districts

11 Bay AreaBay Area 22 Golden EmpireGolden Empire 33 Coastal Tri-CountiesCoastal Tri-Counties 44 Los AngelesLos Angeles 55 San DiegoSan Diego 66 Central ValleyCentral Valley 77 San JoseSan Jose 88 OrangeOrange 99 Diablo ValleyDiablo Valley 1010 InlandInland

CDA Practice GroupsCDA Practice Groups

California Clinical Nutrition Management (CCNM)California Clinical Nutrition Management (CCNM) California Dietetic Educators of Practitioners (CDEP)California Dietetic Educators of Practitioners (CDEP) California Dietetic Technicians in Practice (CDTP)California Dietetic Technicians in Practice (CDTP) California Gerontological Nutrition (CGN)California Gerontological Nutrition (CGN) Caifornia Pediatric Nutrition (CPN)Caifornia Pediatric Nutrition (CPN) California School Food and Nutrition Services (CSFNS)California School Food and Nutrition Services (CSFNS) California Sports and Cardiovascular Nutrition California Sports and Cardiovascular Nutrition

(CSCAN)(CSCAN) Consultant Dietitians of California (CDC)Consultant Dietitians of California (CDC) Public Health Nutrition of California (PHNC)Public Health Nutrition of California (PHNC)

LEGISLATIVE CONTACTLEGISLATIVE CONTACTGRASS ROOTS LIAISONGRASS ROOTS LIAISON

Legislative Contact (LC): Legislative Contact (LC):

Contact to Contact to StateState Legislators Legislators

Assembly membersAssembly members

State SenatorsState Senators Grassroots Liaison (GRL):Grassroots Liaison (GRL):

Contact to Contact to FederalFederal Legislators Legislators

Congress membersCongress members

SenatorsSenators

ADA’s Key Issues at Federal LevelADA’s Key Issues at Federal Level

Medical Nutrition Therapy (MNT) –Medical Nutrition Therapy (MNT) – Ensuring coverage of MNT by RDs for Ensuring coverage of MNT by RDs for Medicare Part BMedicare Part B

National Nutrition Monitoring IssuesNational Nutrition Monitoring Issues Obesity ActivitiesObesity Activities Providing Nutrition Services for Older Providing Nutrition Services for Older

Americans and ChildrenAmericans and Children

MedicareMedicare

Part A: Covers expenses associated with Part A: Covers expenses associated with inpatient hospital/skilled nursing facility inpatient hospital/skilled nursing facility services. Nutrition services are included as services. Nutrition services are included as an administrative cost.an administrative cost.

Part B: Supplementary Medical Coverage Part B: Supplementary Medical Coverage for outpatient services. Seniors must pay for outpatient services. Seniors must pay for a carrier. Coverage of services provided for a carrier. Coverage of services provided by RDs is inconsistent. by RDs is inconsistent.

Medical Nutrition Therapy Act – a Medical Nutrition Therapy Act – a time linetime line

Would provide Part B coverage for MNT Would provide Part B coverage for MNT by RDsby RDs

Bill first introduced to H.R. in Bill first introduced to H.R. in 19951995 Goal was to have a a majority of members Goal was to have a a majority of members

sponsor the billsponsor the bill Quickly became clear that fiscal issues were Quickly became clear that fiscal issues were

of concernof concern

ADA commissioned the Lewin Group ADA commissioned the Lewin Group to conduct study – Results released in to conduct study – Results released in spring spring 19971997

Estimated that net 7-year costs for coverage Estimated that net 7-year costs for coverage of MNT for all Medicare beneficiaries of of MNT for all Medicare beneficiaries of $370 million. Savings from decreased $370 million. Savings from decreased hospitalizations and physicians visits would hospitalizations and physicians visits would be be $1.2 billion$1.2 billion from patients with diabetes from patients with diabetes and CVD alone. After year 3 and CVD alone. After year 3 savings>costs.savings>costs.

July of 1997July of 1997 Clinton signed a Medicare Clinton signed a Medicare Reform bill as part of the Balanced Budget Reform bill as part of the Balanced Budget Act of 1997.Act of 1997.

Diabetes Self-Management Bill passed. Diabetes Self-Management Bill passed. Diabetes education (including nutrition Diabetes education (including nutrition services) will be covered.services) will be covered.

Money for study to be performed by NAS Money for study to be performed by NAS (IOM) – (IOM) – The Role of Nutrition in The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services Evaluating Coverage of Nutrition Services for the Medicare Population – for the Medicare Population – Results released in Dec. 1999

HighlightsHighlights

Nutrition assessment reduces hospital costsNutrition assessment reduces hospital costs Aggressive therapy benefits diabeticsAggressive therapy benefits diabetics RD intervention improves lipid values, RD intervention improves lipid values,

saves medication cost for hyperlipidemiasaves medication cost for hyperlipidemia Recommend that MNT (with MD referral) Recommend that MNT (with MD referral)

be a covered benefit under Medicare.be a covered benefit under Medicare.

Push to cover additional diseasesPush to cover additional diseases

Medicare Wellness Act of Medicare Wellness Act of 2000 – passed in Dec.2000 – passed in Dec. Added RD coverage for kidney disease.Added RD coverage for kidney disease.

HR 1HR 1 – passed 2003 – the Medicare Prescription – passed 2003 – the Medicare Prescription Drug, Improvement and Modernization Act. Drug, Improvement and Modernization Act. Effective Date Jan. Effective Date Jan. 2005.2005.– New beneficiary has 6 months to get complete physicalNew beneficiary has 6 months to get complete physical

– MD can make referral to RD for preventative servicesMD can make referral to RD for preventative services

– Will CMS (Centers for Medicare + Medicaid Services) Will CMS (Centers for Medicare + Medicaid Services) cover for diseases other than diabetes + kidney cover for diseases other than diabetes + kidney disease??disease??

Continue to push for CVD Continue to push for CVD HR 1225HR 1225 and and S 632S 632, which establish a new , which establish a new

cardiovascular benefit in traditional cardiovascular benefit in traditional Medicare. Medicare. 

State IssuesState Issues

Modernizing Laws Regulating Nutrition Modernizing Laws Regulating Nutrition PracticePractice

19991999--Passage of SB 148 – Health Care coverage Passage of SB 148 – Health Care coverage of PKU – mandates that every health care of PKU – mandates that every health care service plan contract in CA provide service plan contract in CA provide coverage for testing and treatment of PKU coverage for testing and treatment of PKU (monitoring blood levels, providing for (monitoring blood levels, providing for formulas and food)formulas and food)

19991999

-passage of SB 64 – Diabetes Management -passage of SB 64 – Diabetes Management and Treatment Law – requires that all and Treatment Law – requires that all insurance policies and plans that cover insurance policies and plans that cover hospital, medical or surgical expenses in hospital, medical or surgical expenses in CA to provide coverage for equipment, CA to provide coverage for equipment, supplies and educational services for the supplies and educational services for the management of diabetesmanagement of diabetes

CALIFORNIA LAWSCALIFORNIA LAWSREGULATING NUTRITION REGULATING NUTRITION

PRACTICEPRACTICE

Business & Professions Code 2068:Business & Professions Code 2068:

1/1/811/1/81

Permits anyone to give advice about proper nutritionPermits anyone to give advice about proper nutrition

Prohibits giving information that claims a food or Prohibits giving information that claims a food or food supplement can cure or treat a disease conditionfood supplement can cure or treat a disease condition

CALIFORNIA LAWSCALIFORNIA LAWSREGULATING NUTRITION REGULATING NUTRITION

PRACTICEPRACTICE

Business & Professions Code 2585 – 2586:Business & Professions Code 2585 – 2586:

1/1/831/1/83 Dietitian title actDietitian title act1/1/961/1/96 Reimbursement Amend (SB 486) to permit Reimbursement Amend (SB 486) to permit

reimbursement to R.D.s and other nutrition reimbursement to R.D.s and other nutrition professionals (masters degree or higher); not professionals (masters degree or higher); not

a a provider type for Medi-Calprovider type for Medi-Cal

1/1/021/1/02 Expansion of RD practice & DTR scope of Expansion of RD practice & DTR scope of practice (AB 1444)practice (AB 1444)

PASSAGE OF AB 1444PASSAGE OF AB 1444(Amendment to Sec 2585 & 2586 of the B&P (Amendment to Sec 2585 & 2586 of the B&P

Code relating to nutrition advice)Code relating to nutrition advice)

2/23/012/23/01 – Introduced by Assembly Member Maddox – Introduced by Assembly Member Maddox

4/4/014/4/01 – Assembly Health Comm. (amended) – Assembly Health Comm. (amended)

5/2/015/2/01 – Assembly Appropriations Comm. (amended) – Assembly Appropriations Comm. (amended)

5/31/015/31/01 – Assembly (amended) – Assembly (amended)

7/3/017/3/01 – Senate B & P Comm. (amended) – Senate B & P Comm. (amended)

7/19/017/19/01 – Senate Appropriations Comm. (amended) – Senate Appropriations Comm. (amended)

9/4/019/4/01 – Senate (passed) – Senate (passed)

9/10/019/10/01 – Assembly (passed) – Assembly (passed)

10/8/0110/8/01 – Signed by Governor Davis – Signed by Governor Davis

1/1/021/1/02 – Law effective (Chapter 628 of 2001) – Law effective (Chapter 628 of 2001)

AB 1444 – HighlightsAB 1444 – Highlights

Permits RD to order lab tests per written treatment Permits RD to order lab tests per written treatment protocol by referring MD. Also allows RDs to protocol by referring MD. Also allows RDs to accept or transmit verbal or electronically accept or transmit verbal or electronically transmitted orders consistent with the written transmitted orders consistent with the written protocol.protocol.

Defined scope of practice for DTRsDefined scope of practice for DTRs Clarify the scope of practice form those with MS Clarify the scope of practice form those with MS

degree or higher in clinical nutrition.degree or higher in clinical nutrition. Defined the term MNT and state that RDs may Defined the term MNT and state that RDs may

provide MNT.provide MNT.

AB 769AB 769

2/19/03 2/19/03 AB 769 introducedAB 769 introduced 5/12/03 5/12/03 AB 769 passed off the Assembly Floor AB 769 passed off the Assembly Floor 6/24/03 6/24/03 AB 769 passed off the Senate FloorAB 769 passed off the Senate Floor 6/30/03 6/30/03 AB 769 passed the Assembly Floor to AB 769 passed the Assembly Floor to

concur with Senate amendmentconcur with Senate amendment 7/15/03 7/15/03 Governor signed AB 769 into law, Governor signed AB 769 into law,

Chapter 69, Statutes of 2003Chapter 69, Statutes of 2003 Jan 1, 2004Jan 1, 2004 AB 769 provisions to be added to AB 769 provisions to be added to

California Business & Professions Code, Section California Business & Professions Code, Section 25862586

AB 769 - HighlightsAB 769 - Highlights

Adds to Business & Professions Code 2586Adds to Business & Professions Code 2586 Permission for dietetics students in Permission for dietetics students in

accredited supervised practice programs to accredited supervised practice programs to perform activities in the RD or DTR scope perform activities in the RD or DTR scope of practice under supervision of RDof practice under supervision of RD

Allows temporary practice until exam is Allows temporary practice until exam is taken (6 months)taken (6 months)

LEGISLATIVE CONTACTLEGISLATIVE CONTACTGRASS ROOTS LIAISONGRASS ROOTS LIAISON

Role/ Responsibilities:Role/ Responsibilities: Carry CDA/ADA messages to the legislatorsCarry CDA/ADA messages to the legislators Respond to Action AlertsRespond to Action Alerts Report the legislative activity to CDA using the Report the legislative activity to CDA using the

Legislative Contact Report formLegislative Contact Report form Be a resource to the legislator on nutrition Be a resource to the legislator on nutrition

issuesissues Collect information about the legislatorCollect information about the legislator

LOBBYINGLOBBYINGInfluencing Public Policy Influencing Public Policy

& Legislation& Legislation

Letter writingLetter writing Visits to district office Visits to district office Action alertsAction alerts Attend Attend Public Policy Education DayPublic Policy Education Day in in

SacramentoSacramento Attend Attend ADA’s Public Policy WorkshopADA’s Public Policy Workshop in in

Washington, DCWashington, DC

For Up-To-Date Legislative For Up-To-Date Legislative InformationInformation

WebsitesWebsites ADA http://www.eatright.org/gov/

“government affairs”

CDACDA www.dietitian.orgwww.dietitian.org

click on “government affairs”click on “government affairs”

Legislation InfoLegislation Info www.leginfo.ca.govwww.leginfo.ca.gov

IF DIETETICS IS YOUR PROFESSION, IF DIETETICS IS YOUR PROFESSION, POLITICS IS YOUR BUSINESSPOLITICS IS YOUR BUSINESS