SENATE FILE _____

BY  (PROPOSED COMMITTEE ON STATE GOVERNMENT BILL BY CHAIRPERSON DANIELSON)

A BILL FOR

An Act relating to the licensure of the practice of naturopathic medicine.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 147.1, subsections 3 and 6, Code 2011, are amended to read as follows:
   3.  “Licensed” or “certified”, when applied to a physician and surgeon, podiatric physician, osteopathic physician and surgeon,
 
naturopathic physician, physician assistant, psychologist, chiropractor, nurse, dentist, dental hygienist, dental assistant, optometrist, speech pathologist, audiologist, pharmacist, physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant, respiratory care practitioner, practitioner of cosmetology arts and sciences, practitioner of barbering, funeral director, dietitian, marital and family therapist, mental health counselor, social worker, massage therapist, athletic trainer, acupuncturist, nursing home administrator, hearing aid dispenser, or sign language interpreter or transliterator means a person licensed under this subtitle.
   6.  “Profession” means medicine and surgery, podiatry, osteopathic medicine and surgery,
 
naturopathic medicine, practice as a physician assistant, psychology, chiropractic, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, pharmacy, physical therapy, physical therapist assisting, occupational therapy, occupational therapy assisting, respiratory care, cosmetology arts and sciences, barbering, mortuary science, marital and family therapy, mental health counseling, social work, dietetics, massage therapy, athletic training, acupuncture, nursing home administration, hearing aid dispensing, or sign language interpreting or transliterating.
    Sec. 2.  Section 147.2, subsection 1, Code 2011, is amended to read as follows:
   1.  A person shall not engage in the practice of medicine and surgery, podiatry, osteopathic medicine and surgery,
 
naturopathic medicine, psychology, chiropractic, physical therapy, physical therapist assisting, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, occupational therapy, occupational therapy assisting, respiratory care, pharmacy, cosmetology arts and sciences, barbering, social work, dietetics, marital and family therapy or mental health counseling, massage therapy, mortuary science, athletic training, acupuncture, nursing home administration, hearing aid dispensing, or sign language interpreting or transliterating, or shall not practice as a physician assistant, unless the person has obtained a license for that purpose from the board for the profession.
    Sec. 3.  Section 147.13, subsection 1, Code 2011, is amended to read as follows:
   1.  For medicine and surgery, osteopathic medicine and surgery, and acupuncture,
 
and naturopathic medicine, the board of medicine.
    Sec. 4.  Section 147.74, Code 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  22A.  A naturopathic physician licensed under chapter 148F may use the words “naturopathic physician”, “naturopathic doctor”, “doctor of naturopathy”, “naturopathic medical doctor”, “doctor of naturopathic medicine”, “naturopath” or the initials “N.D.” or “N.M.D.” after the person’s name.
    Sec. 5.  Section 147.107, Code Supplement 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  8A.  A licensed naturopathic physician may prescribe all substances and devices consistent with the level of training of the naturopathic physician unless added to the exclusionary naturopathic formulary by the naturopathic advisory council.
    Sec. 6.  Section 148E.3, subsection 1, Code 2011, is amended to read as follows:
   1.  A person otherwise licensed to practice medicine and surgery, osteopathic medicine and surgery,
 
naturopathic medicine, chiropractic, podiatry, or dentistry who is exclusively engaged in the practice of the person’s profession.
    Sec. 7.  NEW SECTION.  148F.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Approved naturopathic medical program” means any of the following:
   a.  A naturopathic medical education program in the United States providing the degree of doctor of naturopathy or doctor of naturopathic medicine. Such program shall offer graduate-level, full-time didactic and supervised clinical training and shall be accredited, or shall have achieved candidacy status for accreditation by the council on naturopathic medical education or by an equivalent federally recognized accrediting body for naturopathic medical programs also recognized by the board. Additionally, the program shall be an institution, or part of an institution of higher education that is either accredited or is a candidate for accreditation by a regional or national institutional accrediting agency recognized by the United States secretary of education.
   b.  A diploma-granting, degree-equivalent college or university in Canada that offers graduate-level, full-time didactic and supervised clinical training and is accredited, or has achieved candidacy status for accreditation by the council on naturopathic medical education or an equivalent federally recognized accrediting body for naturopathic medical programs also recognized by the board; and the college or university has provincial approval for participation in government-funded student aid.
   2.  “Board” means the board of medicine established in section 147.13.
   3.  “Director” means the executive director of the board of medicine.
   4.  “Exclusionary naturopathic formulary” means the exclusionary list of medicines, nonprescription and prescription, which naturopathic physicians may not use in the practice of their profession, as determined by the naturopathic advisory council.
   5.  “Minor office procedures” means methods for the repair and care incidental to superficial lacerations and abrasions, superficial lesions, and the removal of foreign bodies located in the superficial tissues.
   6.  “Naturopathic advisory council” means the naturopathic advisory council as established under this chapter.
   7.  “Naturopathic medicine” means a system of primary health care for the prevention, diagnosis, and treatment of human health conditions, injury, and disease, and the promotion or restoration of health. “Naturopathic medicine” includes the use of physiological, psychological, or mechanical methods, and the use of natural medicines, prescription or legend drugs, foods, herbs, or other natural remedies.
   8.  “Naturopathic physician” means a practitioner of naturopathic medicine who has been properly licensed for that purpose by the board of medicine under this chapter, who may diagnose, treat, and help prevent diseases using a system of practice that is based on the natural healing capacity of individuals, and may use physiological, psychological, or mechanical methods, and may use natural medicines, prescription, or legend drugs, foods, herbs, or other natural remedies.
   9.  “Prescription drug” means any drug described in section 503(b) of the federal Food, Drug and Cosmetic Act, 21 U.S.C. § 353, if its label is required to bear the symbol “RX only”.
    Sec. 8.  NEW SECTION.  148F.2  Licensure —— naturopathic medicine.
   1.  Qualifications for licensure.  An applicant for a license to practice naturopathic medicine shall be granted a license by the board if the applicant satisfies all of the following requirements:
   a.  Submits an application for licensure designed and approved by the naturopathic advisory council.
   b.  Pays an application fee established by the board.

   c.  Has graduated from an approved naturopathic medical program.
   d.  Has passed a competency-based national naturopathic licensing examination administered by the north American board of naturopathic examiners or successor agency, that has been nationally recognized to administer a naturopathic examination representing federal standards of education and training. For applicants who completed an approved naturopathic medical program located in Canada, eligibility for licensure may be granted with evidence of successful passage of a Canadian provincial competency examination.
   e.  Provides evidence that the applicant is of good ethical and professional reputation. An applicant shall not have had a license to practice naturopathic medicine or other health care license registration or certificate refused, revoked, or suspended by this state or any other jurisdiction for reasons that relate to the applicant’s ability to skillfully and safely practice naturopathic medicine unless that license, registration, or certification has been restored to good standing.
   f.  Provides evidence that the applicant is physically and mentally capable of safely practicing naturopathic medicine with or without reasonable accommodation.
   2.  Term of license.  A license granted pursuant to this section shall be renewed every two years.
    Sec. 9.  NEW SECTION.  148F.3  Use of title —— exceptions.
   1.  A person shall not represent that the person is a naturopathic physician, a doctor of naturopathic medicine, a doctor of naturopathy, a naturopath, or as being otherwise authorized to practice naturopathic medicine in this state, or use the titles “N.D.” or “N.M.D.” or any other titles, words, letters, abbreviations, or insignia indicating or implying that the individual is a licensed naturopathic physician unless the individual has been licensed as a naturopathic physician pursuant to this chapter without first obtaining from the board a license to practice naturopathic medicine pursuant to the provisions of this chapter.
   2.  The practice of naturopathic medicine by a naturopathic physician licensed pursuant to this chapter does not constitute the practice of medicine and surgery under chapter 148, the practice of osteopathic medicine and surgery under chapter 148, or the practice of nursing under chapter 152.
   3.  This chapter and chapter 147 do not prevent qualified members of other professions including but not limited to individuals licensed under chapter 148, 150, 150A, or 152 from providing services consistent with the nature of naturopathic medicine, but these persons shall not use a title or description denoting that they are licensed naturopathic physicians.
    Sec. 10.  NEW SECTION.  148F.4  Duties of board.
   The board shall adopt rules consistent with this chapter, chapter 147, and as recommended by the naturopathic advisory council which are necessary for the performance of its duties.
    Sec. 11.  NEW SECTION.  148F.5  Naturopathic advisory council.
   1.  A naturopathic advisory council is established, consisting of the following members, appointed by the governor:
   a.  Four members who are naturopathic physicians who are residents of the state of Iowa and who are currently licensed in good standing in another state.
   b.  One member who is a pharmacist licensed in Iowa.
   c.  One member who is a medical or osteopathic physician licensed in Iowa, who has expertise in integrative medicine.
   d.  One member representing the general public.
   2.  Members shall not receive per diem or expense payments.
   3.  Members shall serve two-year terms, and shall serve until their successors have been appointed.
   4.  The council shall select a chairperson from its membership.
    Sec. 12.  NEW SECTION.  148F.6  Council powers and duties.
   The naturopathic advisory council shall do all of the following:
   1.  Advise the board regarding standards for licensed naturopathic physicians.
   2.  Provide for distribution of information regarding licensed naturopathic physician standards.
   3.  Advise the board on enforcement issues.
   4.  Review applications for licensure and license renewal and recommend the granting or denial thereof.
   5.  Advise the board on issues related to receiving and investigating complaints, conducting hearings, and imposing disciplinary action in relation to complaints against licensed naturopathic physicians.
   6.  Review naturopathic education and training for and make specific recommendations to the board regarding the qualifications to practice naturopathic childbirth attendance.
   7.  Recommend to the board any prescription drugs which should be included on the exclusionary naturopathic formulary.
   8.  Advise the board regarding approval of continuing education programs specific to naturopathic practice.
    Sec. 13.  NEW SECTION.  148F.7  Scope of practice.
   A naturopathic physician may do any of the following:
   1.  Order and perform physical and laboratory examinations consistent with naturopathic education and training for diagnostic purposes, including but not limited to phlebotomy, clinical laboratory tests, orificial examinations, and physiological function tests.
   2.  Order diagnostic imaging studies consistent with naturopathic training. All diagnostic tests not consistent with naturopathic medical education and training must be referred for performance and interpretation to an appropriately licensed health care professional.
   3.  Dispense, administer, order, and prescribe, provide, or perform the following, as applicable:
   a.  Food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and their extracts, botanical medicines, homeopathic medicines, and all dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 301 et seq.
   b.  Prescription or legend drugs and hormonal replacement.
   c.  Hot or cold hydrotherapy, naturopathic physical medicine, and therapeutic exercise.
   d.  Devices, including but not limited to therapeutic devices, barrier contraception, and durable medical equipment.
   e.  Health education and health counseling.
   f.  Repair and care incidental to superficial lacerations and abrasions.
   g.  Removal of foreign bodies located in the superficial tissues.
   h.  Musculoskeletal manipulation consistent with naturopathic education and training.
   4.  Utilize routes of administration that include oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, intravenous, and intramuscular consistent with the education and training of a naturopathic physician.
   5.  Perform all therapies as trained and educated, and approved by the naturopathic advisory council.
    Sec. 14.  NEW SECTION.  148F.8  Prohibitions.
   A naturopathic physician licensed under this chapter shall not do any of the following:
   1.  Perform or induce abortions.
   2.  Perform surgical procedures except those minor office procedures authorized by this chapter.
   3.  Practice or claim to practice as a medical or osteopathic physician, dentist, pharmacist, podiatrist, optometrist, psychologist, advanced practice registered nurse, physician assistant, chiropractor, physical therapist, acupuncturist, or any other health care provider not authorized in this chapter unless licensed by the state of Iowa as such.
   4.  Use general or spinal anesthetics.

   5.  Administer ionizing radioactive substances for therapeutic purposes.
   6.  Administer or prescribe chemotherapeutic medications for the purpose of cancer treatment.
   7.  Perform surgical procedures of the eye, ear, nerves, veins, or arteries extending beyond superficial tissue.
    Sec. 15.  NEW SECTION.  148F.9  Exemptions.
   Nothing in this chapter shall be construed to prohibit or restrict:
   1.  The practice of a profession by individuals who are licensed, certified, or registered under other laws of this state who are performing services within their authorized scope of practice.
   2.  The practice of naturopathic medicine by an individual employed by the government of the United States while the individual is engaged in the performance of duties prescribed by the laws and regulations of the United States.
   3.  The practice of naturopathic medicine by students enrolled in an approved naturopathic medical program. The performance of services shall be pursuant to a course of instruction or assignments from an instructor and under the supervision of the instructor. The instructor shall be a naturopathic physician licensed pursuant to this chapter or a duly licensed professional in the instructed field.
   4.  Persons from treating themselves and family members based on religious or health beliefs.
   5.  Persons who sell vitamins and herbs from providing information about their products.
   6.  Persons or practitioners from advising in the use of a therapy, including but not limited to:  herbal medicine, homeopathy, nutrition, or other nondrug or nonsurgical therapy that is within the scope of practice of naturopathic physicians as outlined in this chapter as long as such therapy is lawful, or, if a licensed health care provider, within the scope of practice of the profession; and provided that such person is not using a title protected pursuant to this chapter or holding themselves out to be a naturopathic physician.
   7.  The practice of naturopathic medicine by persons who are licensed to practice in any other state as practicing naturopathic physicians, who enter this state to consult with a licensed naturopathic physician in this state; provided, however, that the consultation is to be limited to examination, recommendation, or testimony in litigation.
    Sec. 16.  FUNDING.  The board of medicine shall apply to the department of administrative services to request an allocation of moneys from the IowAccess revolving fund to fund the estimated seventy-five thousand dollars for expansion of the advanced Maryland automatic network disk archiver (AMANDA) system to allow licensure of naturopathic physicians in the AMANDA system currently being developed for the boards of dentistry, nursing, and medicine. The board shall not implement a fee increase to make this adjustment to the AMANDA system for naturopathic physicians. Until such changes are made to the electronic licensing system the board shall license naturopathic physicians under the current procedures used to license medical and osteopathic physicians.
EXPLANATION
   This bill requires the licensing of naturopathic physicians and makes the provisions of Code chapter 147, including penalty and other regulatory provisions, applicable to other health professions applicable to the practice of naturopathic medicine. The bill provides that the practice of naturopathic medicine means the provision of naturopathic services defined as a system of primary health care for the prevention, diagnosis, and treatment of human health conditions, injury, and disease, and the promotion or restoration of health. Naturopathic medicine includes the use of physiological, psychological, or mechanical methods, and the use of natural medicines, prescription or legend drugs, foods, herbs, or other natural remedies. The bill specifies qualifications for licensure and the scope of practice for a naturopathic physician, and details functions that a naturopathic physician may not perform.
   The practice of naturopathic medicine is regulated by the board of medicine, with the advice of a naturopathic advisory council. The council consists of seven members, four of whom are naturopathic physicians, one medical or osteopathic physician, a pharmacist, and one member representing the general public. The council does not receive a per diem or expenses.
   The bill provides that qualified members of other professions, including physicians and nurses, are not prevented from providing services consistent with naturopathic medicine, but these persons shall not use a title or description denoting that they are naturopathic physicians. The bill sets out these titles.
   The bill provides for inclusion of licensed naturopathic physicians in the AMANDA system. This system is a network disk archiver system currently used by the boards of nursing, dentistry, and medicine.