House Study Bill 577 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON STATE GOVERNMENT BILL BY CHAIRPERSON VANDER LINDEN) A BILL FOR An Act relating to the licensure of naturopathic physicians. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 5098YC (4) 85 jr/nh
H.F. _____ Section 1. Section 147.1, subsections 3 and 6, Code 2014, 1 are amended to read as follows: 2 3. “Licensed” or “certified” , when applied to a physician 3 and surgeon, podiatric physician, osteopathic physician 4 and surgeon, naturopathic physician, physician assistant, 5 psychologist, chiropractor, nurse, dentist, dental hygienist, 6 dental assistant, optometrist, speech pathologist, audiologist, 7 pharmacist, physical therapist, physical therapist assistant, 8 occupational therapist, occupational therapy assistant, 9 orthotist, prosthetist, pedorthist, respiratory care 10 practitioner, practitioner of cosmetology arts and sciences, 11 practitioner of barbering, funeral director, dietitian, marital 12 and family therapist, mental health counselor, social worker, 13 massage therapist, athletic trainer, acupuncturist, nursing 14 home administrator, hearing aid dispenser, or sign language 15 interpreter or transliterator means a person licensed under 16 this subtitle . 17 6. “Profession” means medicine and surgery, podiatry, 18 osteopathic medicine and surgery, naturopathic medicine, 19 practice as a physician assistant, psychology, chiropractic, 20 nursing, dentistry, dental hygiene, dental assisting, 21 optometry, speech pathology, audiology, pharmacy, physical 22 therapy, physical therapist assisting, occupational therapy, 23 occupational therapy assisting, respiratory care, cosmetology 24 arts and sciences, barbering, mortuary science, marital 25 and family therapy, mental health counseling, social work, 26 dietetics, massage therapy, athletic training, acupuncture, 27 nursing home administration, hearing aid dispensing, sign 28 language interpreting or transliterating, orthotics, 29 prosthetics, or pedorthics. 30 Sec. 2. Section 147.2, subsection 1, Code 2014, is amended 31 to read as follows: 32 1. A person shall not engage in the practice of medicine 33 and surgery, naturopathic medicine, podiatry, osteopathic 34 medicine and surgery, psychology, chiropractic, physical 35 -1- LSB 5098YC (4) 85 jr/nh 1/ 11
H.F. _____ therapy, physical therapist assisting, nursing, dentistry, 1 dental hygiene, dental assisting, optometry, speech pathology, 2 audiology, occupational therapy, occupational therapy 3 assisting, orthotics, prosthetics, pedorthics, respiratory 4 care, pharmacy, cosmetology arts and sciences, barbering, 5 social work, dietetics, marital and family therapy or mental 6 health counseling, massage therapy, mortuary science, athletic 7 training, acupuncture, nursing home administration, hearing aid 8 dispensing, or sign language interpreting or transliterating, 9 or shall not practice as a physician assistant, unless the 10 person has obtained a license for that purpose from the board 11 for the profession. 12 Sec. 3. Section 147.13, subsection 1, Code 2014, is amended 13 to read as follows: 14 1. For medicine and surgery, osteopathic medicine and 15 surgery, and acupuncture, and naturopathic medicine, the board 16 of medicine. 17 Sec. 4. Section 147.74, Code 2014, is amended by adding the 18 following new subsection: 19 NEW SUBSECTION . 23A. A naturopathic physician licensed 20 under chapter 148G may use the words “naturopathic physician” , 21 “naturopathic doctor” , “doctor of naturopathy” , “naturopathic 22 medical doctor” , “doctor of naturopathic medicine” , “naturopath” 23 or the initials “N.D.” or “N.M.D.” after the person’s name. 24 Sec. 5. Section 147.107, Code 2014, is amended by adding the 25 following new subsection: 26 NEW SUBSECTION . 8A. A licensed naturopathic physician 27 may prescribe all substances and devices consistent with the 28 level of training of the naturopathic physician unless added 29 to the exclusionary naturopathic formulary by the naturopathic 30 advisory council. 31 Sec. 6. Section 148E.3, subsection 1, Code 2014, is amended 32 to read as follows: 33 1. A person otherwise licensed to practice medicine and 34 surgery, osteopathic medicine and surgery, naturopathic 35 -2- LSB 5098YC (4) 85 jr/nh 2/ 11
H.F. _____ medicine, chiropractic, podiatry, or dentistry who is 1 exclusively engaged in the practice of the person’s profession. 2 Sec. 7. NEW SECTION . 148G.1 Definitions. 3 As used in this chapter, unless the context otherwise 4 requires: 5 1. “Approved naturopathic medical program” means any of the 6 following: 7 a. A naturopathic medical education program in the 8 United States providing the degree of doctor of naturopathy 9 or doctor of naturopathic medicine. Such program shall 10 offer graduate-level, full-time didactic and supervised 11 clinical training and shall be accredited, or shall have 12 achieved candidacy status for accreditation by the council 13 on naturopathic medical education or by an equivalent 14 federally recognized accrediting body for naturopathic medical 15 programs also recognized by the board. Additionally, the 16 program shall be an institution, or part of an institution of 17 higher education that is either accredited or is a candidate 18 for accreditation by a regional or national institutional 19 accrediting agency recognized by the United States secretary 20 of education. 21 b. A diploma-granting, degree-equivalent college or 22 university in Canada that offers graduate-level, full-time 23 didactic and supervised clinical training and is accredited, or 24 has achieved candidacy status for accreditation by the council 25 on naturopathic medical education or an equivalent federally 26 recognized accrediting body for naturopathic medical programs 27 also recognized by the board; and the college or university 28 has provincial approval for participation in government-funded 29 student aid. 30 2. “Board” means the board of medicine established in 31 section 147.13. 32 3. “Director” means the executive director of the board of 33 medicine. 34 4. “Exclusionary naturopathic formulary” means the 35 -3- LSB 5098YC (4) 85 jr/nh 3/ 11
H.F. _____ exclusionary list of medicines, nonprescription and 1 prescription, which naturopathic physicians may not use in the 2 practice of their profession, as determined by the naturopathic 3 advisory council. 4 5. “Minor office procedures” means methods for the repair 5 and care incidental to superficial lacerations and abrasions, 6 superficial lesions, and the removal of foreign bodies located 7 in the superficial tissues. 8 6. “Naturopathic advisory council” means the naturopathic 9 advisory council established under this chapter. 10 7. “Naturopathic medicine” means a system of primary health 11 care for the prevention, diagnosis, and treatment of human 12 health conditions, injury, and disease, and the promotion or 13 restoration of health. “Naturopathic medicine” includes the use 14 of physiological, psychological, or mechanical methods, and the 15 use of natural medicines, prescription or legend drugs, foods, 16 herbs, or other natural remedies. 17 8. “Naturopathic physician” means a practitioner of 18 naturopathic medicine who has been properly licensed for that 19 purpose by the board of medicine under this chapter, who may 20 diagnose, treat, and help prevent diseases using a system 21 of practice that is based on the natural healing capacity 22 of individuals, and may use physiological, psychological, 23 or mechanical methods, and may use natural medicines, 24 prescription, or legend drugs, foods, herbs, or other natural 25 remedies. 26 9. “Prescription drug” means any drug described in section 27 503(b) of the federal Food, Drug and Cosmetic Act, 21 U.S.C. 28 §353, if its label is required to bear the symbol “RX only”. 29 Sec. 8. NEW SECTION . 148G.2 Licensure —— naturopathic 30 medicine. 31 1. Qualifications for licensure. An applicant for a license 32 to practice naturopathic medicine shall be granted a license 33 by the board if the applicant satisfies all of the following 34 requirements: 35 -4- LSB 5098YC (4) 85 jr/nh 4/ 11
H.F. _____ a. Submits an application for licensure designed and 1 approved by the naturopathic advisory council. 2 b. Pays an application fee established by the board. 3 c. Has graduated from an approved naturopathic medical 4 program. 5 d. Has passed a competency-based national naturopathic 6 licensing examination administered by the north American board 7 of naturopathic examiners or successor agency, that has been 8 nationally recognized to administer a naturopathic examination 9 representing federal standards of education and training. For 10 applicants who completed an approved naturopathic medical 11 program located in Canada, eligibility for licensure may be 12 granted with evidence of successful passage of a Canadian 13 provincial competency examination. 14 e. Provides evidence that the applicant is of good ethical 15 and professional reputation. An applicant shall not have had 16 a license to practice naturopathic medicine or other health 17 care license, registration, or certificate refused, revoked, 18 or suspended by this state or any other jurisdiction for 19 reasons that relate to the applicant’s ability to skillfully 20 and safely practice naturopathic medicine unless that license, 21 registration, or certification has been restored to good 22 standing. 23 f. Provides evidence that the applicant is physically and 24 mentally capable of safely practicing naturopathic medicine 25 with or without reasonable accommodation. 26 2. Term of license. A license granted pursuant to this 27 section shall be renewed every two years. 28 Sec. 9. NEW SECTION . 148G.3 Use of title —— exceptions. 29 1. A person shall not represent that the person is a 30 naturopathic physician, a doctor of naturopathic medicine, a 31 doctor of naturopathy, a naturopath, or as being otherwise 32 authorized to practice naturopathic medicine in this state, or 33 use the titles “N.D.” or “N.M.D.” or any other titles, words, 34 letters, abbreviations, or insignia indicating or implying that 35 -5- LSB 5098YC (4) 85 jr/nh 5/ 11
H.F. _____ the individual is a licensed naturopathic physician unless 1 the individual has been licensed as a naturopathic physician 2 pursuant to this chapter without first obtaining from the board 3 a license to practice naturopathic medicine pursuant to the 4 provisions of this chapter. 5 2. The practice of naturopathic medicine by a naturopathic 6 physician licensed pursuant to this chapter does not constitute 7 the practice of medicine and surgery under chapter 148, the 8 practice of osteopathic medicine and surgery under chapter 148, 9 or the practice of nursing under chapter 152. 10 3. This chapter and chapter 147 do not prevent qualified 11 members of other professions including but not limited 12 to individuals licensed under chapter 148, 150, 150A, or 13 152 from providing services consistent with the nature of 14 naturopathic medicine, but these persons shall not use a title 15 or description denoting that they are licensed naturopathic 16 physicians. 17 Sec. 10. NEW SECTION . 148G.4 Duties of board. 18 The board shall adopt rules consistent with this chapter, 19 chapter 147, and as recommended by the naturopathic advisory 20 council which are necessary for the performance of the board’s 21 duties. 22 Sec. 11. NEW SECTION . 148G.5 Naturopathic advisory council. 23 1. A naturopathic advisory council is established, 24 consisting of the following members, appointed by the governor: 25 a. Prior to July 1, 2016, four members who are naturopathic 26 physicians who are residents of the state of Iowa and who are 27 currently licensed in good standing in another state. On 28 and after July 1, 2016, such members shall be naturopathic 29 physicians licensed under this chapter. 30 b. One member who is a pharmacist licensed in Iowa. 31 c. One member who is a medical or osteopathic physician 32 licensed in Iowa, who has expertise in integrative medicine. 33 d. One member representing the general public. 34 2. Members shall not receive per diem or expense payments. 35 -6- LSB 5098YC (4) 85 jr/nh 6/ 11
H.F. _____ 3. Members shall serve two-year terms, and shall serve until 1 their successors have been appointed. 2 4. The council shall select a chairperson from its 3 membership. 4 Sec. 12. NEW SECTION . 148G.6 Council powers and duties. 5 The naturopathic advisory council shall do all of the 6 following: 7 1. Advise the board regarding standards for licensed 8 naturopathic physicians. 9 2. Provide for distribution of information regarding 10 licensed naturopathic physician standards. 11 3. Advise the board on enforcement issues. 12 4. Review applications for licensure and license renewal 13 and recommend the granting or denial thereof. 14 5. Advise the board on issues related to receiving and 15 investigating complaints, conducting hearings, and imposing 16 disciplinary action in relation to complaints against licensed 17 naturopathic physicians. 18 6. Review naturopathic education and training for and 19 make specific recommendations to the board regarding the 20 qualifications to practice naturopathic childbirth attendance. 21 7. Recommend to the board any prescription drugs which 22 should be included on the exclusionary naturopathic formulary. 23 8. Advise the board regarding approval of continuing 24 education programs specific to naturopathic practice. 25 Sec. 13. NEW SECTION . 148G.7 Scope of practice. 26 A naturopathic physician may do any of the following: 27 1. Order and perform physical and laboratory examinations 28 consistent with naturopathic education and training for 29 diagnostic purposes, including but not limited to phlebotomy, 30 clinical laboratory tests, orificial examinations, and 31 physiological function tests. 32 2. Order diagnostic imaging studies consistent with 33 naturopathic training. All diagnostic tests not consistent 34 with naturopathic medical education and training must be 35 -7- LSB 5098YC (4) 85 jr/nh 7/ 11
H.F. _____ referred for performance and interpretation to an appropriately 1 licensed health care professional. 2 3. Dispense, administer, order, and prescribe, provide, or 3 perform the following, as applicable: 4 a. Food, extracts of food, nutraceuticals, vitamins, amino 5 acids, minerals, enzymes, botanicals and their extracts, 6 botanical medicines, homeopathic medicines, and all dietary 7 supplements and nonprescription drugs as defined by the federal 8 Food, Drug, and Cosmetic Act, 21 U.S.C. §301 et seq. 9 b. Prescription or legend drugs and hormonal replacement. 10 c. Hot or cold hydrotherapy, naturopathic physical medicine, 11 and therapeutic exercise. 12 d. Devices, including but not limited to therapeutic 13 devices, barrier contraception, and durable medical equipment. 14 e. Health education and health counseling. 15 f. Repair and care incidental to superficial lacerations and 16 abrasions. 17 g. Removal of foreign bodies located in the superficial 18 tissues. 19 h. Musculoskeletal manipulation consistent with 20 naturopathic education and training. 21 4. Utilize routes of administration that include oral, 22 nasal, auricular, ocular, rectal, vaginal, transdermal, 23 intradermal, subcutaneous, intravenous, and intramuscular 24 consistent with the education and training of a naturopathic 25 physician. 26 5. Perform all therapies as trained and educated, which are 27 approved by the naturopathic advisory council. 28 Sec. 14. NEW SECTION . 148G.8 Prohibitions. 29 A naturopathic physician licensed under this chapter shall 30 not do any of the following: 31 1. Perform or induce abortions. 32 2. Perform surgical procedures except those minor office 33 procedures authorized by this chapter. 34 3. Practice or claim to practice as a medical or osteopathic 35 -8- LSB 5098YC (4) 85 jr/nh 8/ 11
H.F. _____ physician, dentist, pharmacist, podiatrist, optometrist, 1 psychologist, advanced practice registered nurse, physician 2 assistant, chiropractor, physical therapist, acupuncturist, or 3 any other health care provider not authorized in this chapter 4 unless licensed by the state of Iowa as such. 5 4. Use general or spinal anesthetics. 6 5. Administer ionizing radioactive substances for 7 therapeutic purposes. 8 6. Administer or prescribe chemotherapeutic medications for 9 the purpose of cancer treatment. 10 7. Perform surgical procedures of the eye, ear, nerves, 11 veins, or arteries extending beyond superficial tissue. 12 Sec. 15. NEW SECTION . 148G.9 Exemptions. 13 Nothing in this chapter shall be construed to prohibit or 14 restrict: 15 1. The practice of a profession by an individual who is 16 licensed, certified, or registered under another law of this 17 state who is performing services within the individual’s 18 authorized scope of practice. 19 2. The practice of naturopathic medicine by an individual 20 employed by the government of the United States while the 21 individual is engaged in the performance of duties prescribed 22 by the laws and regulations of the United States. 23 3. The practice of naturopathic medicine by students 24 enrolled in an approved naturopathic medical program. The 25 performance of services shall be pursuant to a course of 26 instruction or assignments from an instructor and under the 27 supervision of the instructor. The instructor shall be a 28 naturopathic physician licensed pursuant to this chapter or a 29 duly licensed professional in the instructed field. 30 4. Persons from treating themselves and family members 31 based on religious or health beliefs. 32 5. Persons who sell vitamins and herbs from providing 33 information about their products. 34 6. Persons or practitioners from advising in the use 35 -9- LSB 5098YC (4) 85 jr/nh 9/ 11
H.F. _____ of a therapy including but not limited to herbal medicine, 1 homeopathy, nutrition, or other nondrug or nonsurgical therapy 2 that is within the scope of practice of naturopathic physicians 3 as provided in this chapter as long as such therapy is lawful, 4 or, if a licensed health care provider, within the scope of 5 practice of the profession; and provided that such person is 6 not using a title protected pursuant to this chapter or holding 7 themselves out to be a naturopathic physician. 8 7. The practice of naturopathic medicine by persons who 9 are licensed to practice in any other state as practicing 10 naturopathic physicians, who enter this state to consult with 11 a licensed naturopathic physician in this state; provided, 12 however, that the consultation is to be limited to examination, 13 recommendation, or testimony in litigation. 14 Sec. 16. FUNDING. The board of medicine shall apply 15 to the department of administrative services to request an 16 allocation of moneys from the IowAccess revolving fund to fund 17 the estimated costs for expansion of the advanced Maryland 18 automatic network disk archiver (AMANDA) system to allow 19 licensure of naturopathic physicians in the AMANDA system. 20 The board shall not implement a fee increase to make this 21 adjustment to the AMANDA system for naturopathic physicians. 22 EXPLANATION 23 The inclusion of this explanation does not constitute agreement with 24 the explanation’s substance by the members of the general assembly. 25 This bill requires the licensing of naturopathic physicians 26 and makes the provisions of Code chapter 147, including 27 penalty and other regulatory provisions, applicable to other 28 health professions applicable to the practice of naturopathic 29 medicine. The bill provides that the practice of naturopathic 30 medicine means the provision of naturopathic services defined 31 as a system of primary health care for the prevention, 32 diagnosis, and treatment of human health conditions, injury, 33 and disease, and the promotion or restoration of health. 34 Naturopathic medicine includes the use of physiological, 35 -10- LSB 5098YC (4) 85 jr/nh 10/ 11
H.F. _____ psychological, or mechanical methods, and the use of natural 1 medicines, prescription or legend drugs, foods, herbs, or 2 other natural remedies. The bill specifies qualifications 3 for licensure and the scope of practice for a naturopathic 4 physician, and details functions that a naturopathic physician 5 may not perform. 6 The practice of naturopathic medicine is regulated by the 7 board of medicine, with the advice of a naturopathic advisory 8 council. The council consists of seven members, four of 9 whom are naturopathic physicians, one medical or osteopathic 10 physician, a pharmacist, and one member representing the 11 general public. The council does not receive a per diem or 12 expenses. 13 The bill provides that qualified members of other 14 professions, including physicians and nurses, are not prevented 15 from providing services consistent with naturopathic medicine, 16 but these persons shall not use a title or description denoting 17 that they are naturopathic physicians. The bill sets out these 18 titles. 19 The bill provides for inclusion of licensed naturopathic 20 physicians in the AMANDA system. This system is a network 21 disk archiver system currently used by the boards of nursing, 22 dentistry, and medicine. 23 Code section 422.7(27) provides an income tax exemption for 24 payments received by an individual providing unskilled in-home 25 health-related care services to a member of the individual 26 caregiver’s family. This exemption is not available to health 27 care professionals licensed by the board of medicine. Under 28 the bill, naturopathic physicians are to be licensed by the 29 board of medicine, making them ineligible for this exemption. 30 -11- LSB 5098YC (4) 85 jr/nh 11/ 11