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Legislation

Legislation. 101. Federal and State Government and Role of ADA/CDA. Federal/State Government Structure Legislative Process ADA/CDA Public Policy Council Division of Government Affairs (ADA) VP Public Policy (CDA) LNCs, GRLs, LCs Current Nutrition Bills Lobbying.

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Legislation

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  1. Legislation 101

  2. Federal and State Government and Role of ADA/CDA • Federal/State Government Structure Legislative Process • ADA/CDA Public Policy Council Division of Government Affairs (ADA) VP Public Policy (CDA) LNCs, GRLs, LCs • Current Nutrition Bills • Lobbying

  3. FEDERAL/STATE (CA) GOVERNMENT – The 3 Branches • EXECUTIVE– The President/VP The Governor/Lt. Governor

  4. George Bush

  5. Dick Cheney

  6. The Governator

  7. Cruz Bustamante

  8. JUDICIAL-- Supreme Court/ State Supreme Court

  9. LEGISLATIVEBRANCH • Federal: 2 houses Senate (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)

  10. Senators Diane Feinstein/Barbara Boxer

  11. Congressman Wally Herger

  12. State Senator Stan Aanestad

  13. Assemblyman Rick Keene

  14. HOW A BILL BECOMES A LAW IN CALIFORNIA • Bill introduced by a member of Assembly or Senate • Bill goes to rulescommittee and assigned to a policy committee & then goes to a fiscalcommittee • Bill goes back to house of origin for a vote • Bill goes to second house & referred to a policycommittee and possibly a fiscalcommittee

  15. HOW A BILL BECOMES A LAW IN CALIFORNIA • Bill goes to floorof second house and is approved (may be amended); if amended must go back to house of origin for a vote • After passage by both houses, bill goes to Governor who has 12 days to sign it into law • Law takes effect following January 1st

  16. CDA’S FEDERAL LEGISLATIVE PROGRAM ADA Division of Government Affairs Legislative Network Coordinators (LNCs) North:Kim VagtSouth:Angela Metropulos Grass Roots Liaisons (GRL) Me for Wally Herger

  17. CDA’S STATE LEGISLATIVE PROGRAM CDA Executive Board President – Lisa Gibson Level 1 CDA Public Policy Council – VP Public Policy Elaine Keegan State Legislative Chairperson – Vacant Level 2

  18. CDA’S STATE LEGISLATIVE PROGRAM District & Practice Group Coordinators Level 3 Practice Group Public Policy Chairs CDEP Practice Group - Me District Public Policy Chairs GED district: Christie Crawford Legislative Contacts (LC) Me Level 4

  19. CDA Districts • 1 Bay Area • 2 Golden Empire • 3 Coastal Tri-Counties • 4 Los Angeles • 5 San Diego • 6 Central Valley • 7 San Jose • 8 Orange • 9 Diablo Valley • 10 Inland

  20. CDA Practice Groups • California Clinical Nutrition Management (CCNM) • California Dietetic Educators of Practitioners (CDEP) • California Dietetic Technicians in Practice (CDTP) • California Gerontological Nutrition (CGN) • Caifornia Pediatric Nutrition (CPN) • California School Food and Nutrition Services (CSFNS) • California Sports and Cardiovascular Nutrition (CSCAN) • Consultant Dietitians of California (CDC) • Public Health Nutrition of California (PHNC)

  21. LEGISLATIVE CONTACTGRASS ROOTS LIAISON • Legislative Contact (LC): Contact to State Legislators Assembly members State Senators • Grassroots Liaison (GRL): Contact to Federal Legislators Congress members Senators

  22. ADA’s Key Issues at Federal Level • Medical Nutrition Therapy (MNT) – Ensuring coverage of MNT by RDs for Medicare Part B • National Nutrition Monitoring Issues • Obesity Activities • Providing Nutrition Services for Older Americans and Children

  23. Medicare • Part A: Covers expenses associated with inpatient hospital/skilled nursing facility services. Nutrition services are included as an administrative cost. • Part B: Supplementary Medical Coverage for outpatient services. Seniors must pay for a carrier. Coverage of services provided by RDs is inconsistent.

  24. Medical Nutrition Therapy Act – a time line • Would provide Part B coverage for MNT by RDs • Bill first introduced to H.R. in 1995 • Goal was to have a a majority of members sponsor the bill • Quickly became clear that fiscal issues were of concern

  25. ADA commissioned the Lewin Group to conduct study – Results released in spring 1997 • Estimated that net 7-year costs for coverage of MNT for all Medicare beneficiaries of $370 million. Savings from decreased hospitalizations and physicians visits would be $1.2 billion from patients with diabetes and CVD alone. After year 3 savings>costs.

  26. July of 1997 Clinton signed a Medicare Reform bill as part of the Balanced Budget Act of 1997. • Diabetes Self-Management Bill passed. Diabetes education (including nutrition services) will be covered. • Money for study to be performed by NAS (IOM) – The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population – Results released in Dec. 1999

  27. Highlights • Nutrition assessment reduces hospital costs • Aggressive therapy benefits diabetics • RD intervention improves lipid values, saves medication cost for hyperlipidemia • Recommend that MNT (with MD referral) be a covered benefit under Medicare.

  28. Push to cover additional diseases • Medicare Wellness Act of 2000 – passed in Dec. Added RD coverage for kidney disease. • HR 1 – passed 2003 – the Medicare Prescription Drug, Improvement and Modernization Act. Effective Date Jan. 2005. • New beneficiary has 6 months to get complete physical • MD can make referral to RD for preventative services • Will CMS (Centers for Medicare + Medicaid Services) cover for diseases other than diabetes + kidney disease??

  29. Continue to push for CVD • HR 1225 and S 632, which establish a new cardiovascular benefit in traditional Medicare. 

  30. State Issues • Modernizing Laws Regulating Nutrition Practice • 1999 -Passage of SB 148 – Health Care coverage of PKU – mandates that every health care service plan contract in CA provide coverage for testing and treatment of PKU (monitoring blood levels, providing for formulas and food)

  31. 1999 -passage of SB 64 – Diabetes Management and Treatment Law – requires that all insurance policies and plans that cover hospital, medical or surgical expenses in CA to provide coverage for equipment, supplies and educational services for the management of diabetes

  32. CALIFORNIA LAWSREGULATING NUTRITION PRACTICE Business & Professions Code 2068: 1/1/81 Permits anyone to give advice about proper nutrition Prohibits giving information that claims a food or food supplement can cure or treat a disease condition

  33. CALIFORNIA LAWSREGULATING NUTRITION PRACTICE Business & Professions Code 2585 – 2586: 1/1/83Dietitian title act 1/1/96Reimbursement Amend (SB 486) to permit reimbursement to R.D.s and other nutrition professionals (masters degree or higher); not a provider type for Medi-Cal 1/1/02Expansion of RD practice & DTR scope of practice (AB 1444)

  34. PASSAGE OF AB 1444(Amendment to Sec 2585 & 2586 of the B&P Code relating to nutrition advice) 2/23/01 – Introduced by Assembly Member Maddox 4/4/01 – Assembly Health Comm. (amended) 5/2/01 – Assembly Appropriations Comm. (amended) 5/31/01 – Assembly (amended) 7/3/01 – Senate B & P Comm. (amended) 7/19/01 – Senate Appropriations Comm. (amended) 9/4/01 – Senate (passed) 9/10/01 – Assembly (passed) 10/8/01 – Signed by Governor Davis 1/1/02 – Law effective (Chapter 628 of 2001)

  35. AB 1444 – Highlights • Permits RD to order lab tests per written treatment protocol by referring MD. Also allows RDs to accept or transmit verbal or electronically transmitted orders consistent with the written protocol. • Defined scope of practice for DTRs • Clarify the scope of practice form those with MS degree or higher in clinical nutrition. • Defined the term MNT and state that RDs may provide MNT.

  36. AB 769 • 2/19/03 AB 769 introduced • 5/12/03 AB 769 passed off the Assembly Floor • 6/24/03 AB 769 passed off the Senate Floor • 6/30/03 AB 769 passed the Assembly Floor to concur with Senate amendment • 7/15/03 Governor signed AB 769 into law, Chapter 69, Statutes of 2003 • Jan 1, 2004 AB 769 provisions to be added to California Business & Professions Code, Section 2586

  37. AB 769 - Highlights • Adds to Business & Professions Code 2586 • Permission for dietetics students in accredited supervised practice programs to perform activities in the RD or DTR scope of practice under supervision of RD • Allows temporary practice until exam is taken (6 months)

  38. LEGISLATIVE CONTACTGRASS ROOTS LIAISON Role/ Responsibilities: • Carry CDA/ADA messages to the legislators • Respond to Action Alerts • Report the legislative activity to CDA using the Legislative Contact Report form • Be a resource to the legislator on nutrition issues • Collect information about the legislator

  39. LOBBYINGInfluencing Public Policy & Legislation • Letter writing • Visits to district office • Action alerts • Attend Public Policy Education Day in Sacramento • Attend ADA’s Public Policy Workshopin Washington, DC

  40. For Up-To-Date Legislative Information Websites • ADA http://www.eatright.org/gov/ “government affairs” • CDA www.dietitian.org click on “government affairs” • Legislation Info www.leginfo.ca.gov

  41. IF DIETETICS IS YOUR PROFESSION, POLITICS IS YOUR BUSINESS

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