HOUSE BILL No. 4152

 

January 31, 2013, Introduced by Reps. Lyons and Lipton and referred to the Committee on Health Policy.

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

(MCL 333.1101 to 333.25211) by adding section 16348a and part 186.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 16348a. The department shall annually establish a

 

schedule of fees for a person licensed or seeking a license as a

 

naturopathic physician under part 186 to offset the department's

 

administrative expenses under that part.

 

PART 186

 

NATUROPATHIC PHYSICIANS

 

     Sec. 18601. (1) For purposes of this part, the words and

 

phrases defined in sections 18603 to 18609 have the meanings

 

ascribed to them in those sections.

 

     (2) In addition to the definitions in this part, article 1

 

contains general definitions and principles of construction


 

applicable to all articles in the code and part 161 contains

 

definitions applicable to this part.

 

     Sec. 18603. (1) "Approved naturopathic medical program" means

 

any of the following:

 

     (a) A naturopathic medical education program that is located

 

in the United States, that provides the degree of doctor of

 

naturopathy or doctor of naturopathic medicine, and that meets all

 

of the following requirements:

 

     (i) Offers graduate-level full-time didactic and supervised

 

clinical training.

 

     (ii) Is accredited or has achieved candidacy status for

 

accreditation by the CNME or an equivalent federally recognized

 

accrediting body for naturopathic medical programs approved by the

 

board.

 

     (iii) Is an institution or part of an institution of higher

 

education that is 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 naturopathic medical education program offered by a

 

degree-granting college or university that was in existence before

 

the existence of the CNME and that meets all of the following

 

requirements:

 

     (i) Offered a full-time structured curriculum in basic sciences

 

and supervised patient care comprising a doctoral naturopathic

 

medical education.

 

     (ii) The program was at least 132 weeks in duration and

 

required completion of the program within a period of at least 35


 

months as a prerequisite to graduation.

 

     (iii) The college or university was reputable and in good

 

standing in the judgment of the board.

 

     (iv) If the program is still in existence, it is accredited by

 

the CNME or an equivalent federally recognized accrediting body for

 

naturopathic medical programs approved by the board.

 

     (c) A naturopathic medical education program offered by a

 

diploma-granting, degree-equivalent college or university located

 

in Canada that was in existence before the existence of the CNME

 

and that meets all of the following requirements:

 

     (i) Had provincial approval for participation in government-

 

funded student aid programs.

 

     (ii) Offered a full-time structured curriculum in basic

 

sciences and supervised patient care comprising a doctoral

 

naturopathic medical education.

 

     (iii) The program was at least 132 weeks in duration and

 

required completion of the program within a period of at least 35

 

months as a prerequisite to graduation.

 

     (iv) The college or university was reputable and in good

 

standing in the judgment of the board.

 

     (v) If the program is still in existence, it is accredited by

 

the CNME or an equivalent federally recognized accrediting body for

 

naturopathic medical programs, approved by the board.

 

     (vi) If the program is still in existence, the college or

 

university has provincial approval for participation in government-

 

funded student aid programs.

 

     (d) A naturopathic medical education program offered by a


 

diploma-granting, degree-equivalent college or university located

 

in Canada that provides the degree of doctor of naturopathy or

 

doctor of naturopathic medicine and that meets all of the following

 

requirements:

 

     (i) Offers graduate-level full-time didactic and supervised

 

clinical training.

 

     (ii) Is accredited or has achieved candidacy status for

 

accreditation by the CNME or an equivalent federally recognized

 

accrediting body for naturopathic medical programs approved by the

 

board.

 

     (iii) The college or university has provincial approval for

 

participation in government-funded student aid programs.

 

     (2) "Board" means the board of naturopathic medicine created

 

in section 18623.

 

     (3) "CNME" means the council on naturopathic medical

 

education.

 

     Sec. 18605. "Minor office procedure" means any of the

 

following:

 

     (a) The use of operative, electrical, or other 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 and the use of antiseptics and

 

local topical anesthetics in connection with those methods.

 

     (b) Obtaining specimens to diagnose, assess, and treat

 

disease.

 

     Sec. 18607. (1) "Naturopathic formulary" or "formulary" means

 

the list of medicines, nonprescription and prescription, that


 

naturopathic physicians use in the practice of their profession, as

 

determined by the formulary council and reviewed by the board.

 

     (2) "Naturopathic formulary council" or "formulary council"

 

means the formulary council established under section 18627 to

 

determine and authorize the naturopathic formulary.

 

     (3) "Naturopathic medicine" means a system of practice that is

 

based on the natural healing capacity of individuals for the

 

diagnosis, treatment, and prevention of diseases.

 

     (4) "Naturopathic physician" means an individual who engages

 

in the practice of naturopathic medicine and who is required to be

 

licensed or otherwise authorized under this part to engage in that

 

practice.

 

     Sec. 18609. "Prescription drug" means that term as defined in

 

section 17708.

 

     Sec. 18611. (1) Beginning 180 days after the effective date of

 

this section, and except as otherwise provided in this part, an

 

individual shall not engage in the practice of naturopathic

 

medicine unless licensed or otherwise authorized under this

 

article.

 

     (2) The following words, titles, or letters or a combination

 

thereof, with or without qualifying words or phrases, are

 

restricted in use only to those individuals authorized under this

 

part to use the terms and in a way prescribed in this part: "doctor

 

of naturopathic medicine", "doctor of naturopathy", "naturopathic

 

physician", "naturopathic doctor", "naturopath", "naturopathic

 

medicine", "naturopathic health care", "naturopathy", "n.d.", and

 

"n.m.d".


 

     Sec. 18613. (1) To be eligible for a license to engage in the

 

practice of naturopathic medicine in this state, an applicant shall

 

submit all of the following to the board, as applicable:

 

     (a) An application for licensure designed and approved by the

 

department.

 

     (b) Except as otherwise provided in subdivision (c), evidence

 

that he or she is a graduate of an approved naturopathic medical

 

program and that he or she has successfully passed a competency-based

 

national naturopathic physicians licensing examination administered by

 

the North American board of naturopathic examiners, or by a successor

 

agency that is nationally recognized to administer a naturopathic

 

physicians licensing examination that represents federal standards of

 

education and training and that is approved by the board.

 

     (c) For a graduate of an approved naturopathic medical program

 

described in section 18603(1)(b) or (c), evidence of successful

 

passage of a board-approved state competency examination or Canadian

 

provincial examination.

 

     (d) Any other information or documents required under this

 

article or required by the board.

 

     (2) To be eligible for a license to engage in the practice of

 

naturopathic medicine in this state, an applicant shall be

 

physically and mentally capable of safely practicing naturopathic

 

medicine with or without reasonable accommodation.

 

     (3) An applicant is not eligible for a license to engage in

 

the practice of naturopathic medicine in this state if he or she

 

has had a license to practice naturopathic medicine or other health

 

care license, registration, or certificate refused, revoked, or


 

suspended by 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 by that jurisdiction.

 

     Sec. 18615. A naturopathic physician may do any of the

 

following, consistent with his or her naturopathic education and

 

training:

 

     (a) Order and perform physical and laboratory examinations for

 

diagnostic purposes, including, but not limited to, phlebotomy,

 

clinical laboratory tests, orificial examinations, or physiological

 

function tests.

 

     (b) Order diagnostic imaging studies.

 

     (c) Dispense, administer, order, or prescribe or perform any

 

of the following:

 

     (i) Food, extracts of food, nutraceuticals, vitamins, amino

 

acids, minerals, enzymes, botanicals and their extracts, botanical

 

medicines, homeopathic medicines, all dietary supplements, or

 

nonprescription drugs as defined by the federal food, drug, and

 

cosmetic act, 21 USC 301 to 399d.

 

     (ii) Prescription or nonprescription medicines as designated by

 

the naturopathic formulary council.

 

     (iii) Hot or cold hydrotherapy; naturopathic physical medicine;

 

electromagnetic energy; or therapeutic exercise.

 

     (iv) Devices, including, but not limited to, therapeutic

 

devices, barrier contraception, or durable medical equipment.

 

     (v) Health education or health counseling.

 

     (vi) Repair and care incidental to superficial lacerations or


 

abrasions.

 

     (vii) Musculoskeletal manipulation.

 

     (d) Utilize routes of administration that include, but are not

 

limited to, oral, nasal, auricular, ocular, rectal, vaginal,

 

transdermal, intradermal, subcutaneous, intravenous, or

 

intramuscular consistent with his or her naturopathic education and

 

training.

 

     (e) Other naturopathic therapies as approved by the board.

 

     Sec. 18617. A naturopathic physician shall not do any of the

 

following:

 

     (a) Prescribe, dispense, or administer any controlled

 

substance or device identified in the federal controlled substances

 

act, 21 USC 801 to 971, except as authorized under this part.

 

     (b) Perform surgical procedures except those minor office

 

procedures authorized under this part.

 

     (c) Engage in the practice of or claim to engage in the

 

practice of any other health profession unless licensed to engage

 

in that health profession under this article.

 

     (d) Use general or spinal anesthetics.

 

     (e) Administer ionizing radioactive substances for therapeutic

 

purposes.

 

     (f) Perform surgical procedures using a laser device.

 

     (g) Perform surgical procedures involving the eye, ear,

 

tendons, nerves, veins, or arteries.

 

     (h) Perform chiropractic adjustments unless licensed as a

 

chiropractor under part 164.

 

     (i) Perform acupuncture, unless registered as an acupuncturist


 

under part 165.

 

     Sec. 18619. (1) This part does not prohibit or restrict any of

 

the following:

 

     (a) The practice of a profession or occupation by an

 

individual who is licensed, certified, registered, or otherwise

 

authorized under this act or other laws of this state and who is

 

performing services within his or her authorized scope of practice.

 

     (b) 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.

 

     (c) 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 under this part or a duly licensed professional in the

 

field of instruction.

 

     (d) Self-care by a patient or uncompensated care by a friend

 

or family member who does not represent or hold himself or herself

 

out to be a naturopathic physician.

 

     (e) An individual who sells vitamins and herbs from providing

 

information about his or her products.

 

     (f) An individual 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 under this part,


 

if all of the following requirements are met:

 

     (i) If the individual is not a health professional, the therapy

 

is within that individual's lawful rights to perform under a health

 

occupation. If the individual is a health professional, the therapy

 

is within the scope of practice of that profession under this

 

article.

 

     (ii) The individual is not using a word, a title, or letters

 

protected under this part and does not represent or hold himself or

 

herself out to be a naturopathic physician.

 

     (2) This part does not prohibit an individual who is licensed

 

to practice as a naturopathic physician in any other state or

 

district in the United States from entering this state to consult

 

with a naturopathic physician in this state, as long as that

 

consultation is limited to examination, recommendation, or

 

testimony in litigation.

 

     Sec. 18621. (1) The department shall do all of the following:

 

     (a) Promulgate all rules and conduct all hearings that are

 

required under this part.

 

     (b) Adopt the competency-based national examination consistent

 

with the requirements described in section 18613(1)(b) and (c) and

 

approved by the board as the naturopathic licensing examination.

 

     (c) Formulate rules and guidelines with appropriate notice to

 

those affected if notice can reasonably be given.

 

     (d) Designate the application form used by applicants and

 

process all applications.

 

     (e) Issue licenses and license renewals to all individuals who

 

meet the qualifications for licensure as described in this part and


 

as recommended by the board.

 

     (f) Establish procedures for the issuance of licenses and

 

license renewals to applicants who qualify for licensure by

 

reciprocity in this state, in lieu of taking the written

 

examination taken by all other individuals applying for licensure

 

in any other state, provided that the educational and examination

 

requirements for the state issuing the original license are

 

equivalent to those described in this part.

 

     (g) Determine the malpractice liability coverage requirements

 

for naturopathic physicians.

 

     (h) Investigate complaints of unprofessional or illegal

 

conduct by a naturopathic physician.

 

     (i) Determine whether a naturopathic physician shall be the

 

subject of a disciplinary hearing.

 

     (j) Designate and impose sanctions and penalties for violation

 

of this part or rules promulgated under this part.

 

     (k) Provide for the rules for continuing education of

 

naturopathic physicians.

 

     (l) Bring proceedings in the courts for the enforcement of this

 

part.

 

     (m) Establish procedures to govern matters, directly or

 

indirectly, involving any individual related to the director in any

 

way by blood or marriage.

 

     (n) Delegate to the board the performance of any

 

administrative, nondisciplinary, and non-rule-making functions

 

assigned to the director under this part.

 

     (2) The director shall consult the board on matters involving


 

all of the following:

 

     (a) The qualifications of candidates who apply for licensure

 

to engage in the practice of naturopathic medicine in this state.

 

     (b) The content of any clinical, practical, or residency

 

requirement.

 

     (c) The content of rules and guidelines and proposed rules and

 

guidelines governing the practice of naturopathic medicine in this

 

state.

 

     (d) Investigation of all credible complaints from naturopathic

 

physicians and the public and on the technical aspects of the

 

complaint.

 

     (e) The requirements for issuance and renewal of licenses

 

under this part.

 

     (3) The director shall not discriminate against any individual

 

holding or applying for a license to engage in the practice of

 

naturopathic medicine by reason of sex, age, race, color, creed, or

 

national origin.

 

     Sec. 18623. (1) The board of naturopathic medicine is

 

established within the department. The board consists of 7 members

 

appointed by the governor, as follows:

 

     (a) Except as otherwise provided in this subdivision, 3

 

naturopathic physicians who are licensed and in good standing in

 

this state. For the initial board, a naturopathic physician

 

licensed and in good standing in another state may be appointed to

 

the board if he or she is a resident of this state and has been

 

engaged in the practice or instruction of naturopathic medicine for

 

at least 5 years.


 

     (b) Two physicians who are licensed under part 170 or 175.

 

     (c) Two members of the general public who are not and never

 

have been licensed health professionals under this act and who do

 

not have an interest in naturopathic education, business, or

 

practice.

 

     (2) The governor shall appoint naturopathic physicians to the

 

board from a list of naturopathic physicians eligible to serve on

 

the board that is submitted to the governor by the Michigan

 

association of naturopathic physicians or the American association

 

of naturopathic physicians or a successor to those associations.

 

     (3) For the purpose of staggering terms, the governor shall

 

initially appoint to the board 3 members for terms of 4 years each,

 

2 members for terms of 3 years each, and 2 members for terms of 2

 

years each. As the terms of board members expire, the governor

 

shall appoint successors for terms of 4 years, and those members

 

shall serve until their successors are appointed.

 

     (4) The governor may remove any member of the board for cause

 

before the expiration of the member's term.

 

     (5) Within 30 days after its appointment, and at least

 

annually thereafter, the board shall hold a meeting and elect a

 

chairperson. The board may hold additional meetings on the call of

 

the chair or at the written request of any 2 members of the board.

 

The board may appoint any committees that it considers necessary to

 

carry out its duties. A majority of the board shall constitute a

 

quorum.

 

     (6) The board positions shall remain uncompensated positions

 

unless and until considered appropriate by the director.


 

     Sec. 18625. The board may adopt any policies and procedures

 

necessary to carry out the purposes of this part and may recommend

 

disciplinary action as provided under this part. The board shall do

 

all of the following:

 

     (a) Perform any administrative, nondisciplinary, and non-rule-

 

making functions assigned to the board by the director as provided

 

under this part.

 

     (b) Determine the qualifications of individuals applying for

 

licensure under this part and define, by rule, the appropriate

 

scope of practice of naturopathic medicine in this state. However,

 

the scope of practice shall not exceed that described in section

 

18615.

 

     (c) Review the content of rules and proposed rules governing

 

the practice of naturopathic medicine in this state.

 

     (d) Evaluate the content of any clinical, practical, or

 

residency requirement.

 

     (e) Provide any other services and perform any other functions

 

as are necessary and desirable to fulfill its purposes.

 

     (f) Propose to the department rules for examination standards,

 

consistent with the standards under this part, for licensure and

 

when those examinations will be provided.

 

     (g) Establish a minimum amount and kind of continuing

 

education to be required annually for each naturopathic physician

 

seeking licensure renewal.

 

     (h) Limit the performance of minor office procedures to a

 

naturopathic physician who has graduated from an approved

 

naturopathic medical program that included minor office procedures


 

as part of its curriculum or who has up-to-date certification of

 

equivalent training, as determined by the board, if he or she

 

graduated from an approved naturopathic medical program that did

 

not include minor office procedures as part of the curriculum.

 

     (i) Limit the prescribing authority for prescription drugs to

 

a naturopathic physician who has graduated from an approved

 

naturopathic medical program that included pharmacology as part of

 

its curriculum or who has up-to-date certification of equivalent

 

training, as determined by the board, if he or she graduated from

 

an approved naturopathic medical program that did not include

 

pharmacology as part of the curriculum.

 

     (j) Investigate all credible complaints from naturopathic

 

physicians and the public as directed by the director.

 

     (k) Propose to the department rules to establish guidelines

 

for the disposition of disciplinary cases involving specific types

 

of violations. The guidelines may include minimum and maximum

 

fines, periods of supervision or probation, or conditions of

 

probation or reissuance of a license.

 

     (l) Provide evaluations regarding the requirements for issuance

 

and renewal of naturopathic medical licenses to the department.

 

     Sec. 18627. (1) The naturopathic formulary council is

 

established. The formulary council is separate and distinct from

 

the board and is composed of 5 members, as follows:

 

     (a) Two naturopathic physicians appointed by the board.

 

     (b) Two pharmacists licensed under part 177, appointed by the

 

board from a list of nominees provided by the Michigan board of

 

pharmacy.


 

     (c) One physician licensed under part 170 or 175, appointed by

 

the board from a list of nominees provided by the Michigan board of

 

medicine or the Michigan board of osteopathic medicine and surgery.

 

     (2) The naturopathic formulary council shall establish a

 

naturopathic formulary for use by naturopathic physicians. When it

 

adopts or revises the formulary, the formulary council shall

 

immediately transmit the formulary to the board. The board shall

 

request that the department adopt the formulary by rule.

 

     (3) The formulary council shall review the naturopathic

 

formulary annually or at any time at the request of the board.

 

     (4) The naturopathic formulary shall not go beyond the scope

 

of natural medicines or prescription drugs and devices covered by

 

approved naturopathic education and training or board-approved

 

continuing education.

 

     (5) The naturopathic formulary shall not include medicines or

 

devices that are inconsistent with the training provided by

 

approved naturopathic medical programs.

 

     (6) This section does not allow a naturopathic physician to

 

dispense, administer, or prescribe any prescription drug or device

 

as defined in part 177, unless that prescription drug or device is

 

specifically included in the naturopathic formulary.

 

     Sec. 18631. Naturopathic physicians shall observe and be

 

subject to all state, county, and municipal rules, ordinances, or

 

regulations in regard to the control of contagious and infectious

 

diseases, the reporting of births and deaths, and any and all other

 

matters pertaining to the public health in the same manner as is

 

required of other health professionals under this act. A violation


 

of any state, county, or municipal rule, ordinance, or regulation

 

described in this section is considered a violation of this act

 

subject to the investigation and sanction provisions of sections

 

16221 and 16226. The penalties and remedies under this part are

 

independent and cumulative. The use of 1 remedy by a person does

 

not bar the use of other lawful penalties or remedies by that

 

person or the use of a lawful penalty or remedy by another person.

 

     Sec. 18633. The board shall not reinstate the license of a

 

naturopathic physician until the board is satisfied that the

 

individual has complied with all of the terms and conditions set

 

forth in the final order and that he or she is capable of safely

 

engaging in the practice of naturopathic medicine.

 

     Sec. 18635. (1) The board may issue a license without

 

additional examination to any applicant who submits an application

 

for licensure together with the appropriate fee and proof

 

acceptable to the department of current naturopathic medicine

 

licensure in good standing in another state, the District of

 

Columbia, or a territory of the United States, whose standards for

 

licensure are at least equivalent to those of this state.

 

     (2) Any applicant seeking a license without additional

 

examination under this section shall provide proof of licensure in

 

good standing in all jurisdictions in which he or she is or has

 

been licensed.

 

     Sec. 18637. (1) Each license issued or renewed under this part

 

expires 2 years following its issuance or last renewal.

 

     (2) The director may renew the license of any licensee whose

 

license has expired if he or she does all of the following:


 

     (a) Submits an application for renewal.

 

     (b) Pays the renewal fee.

 

     (c) Meets the qualifications for licensure under this part.

 

     (d) Meets the continuing education requirements established by

 

the board.

 

     Sec. 18639. An individual who engages in the practice of

 

naturopathic medicine after his or her license is revoked is

 

engaging in the practice of naturopathic medicine without a

 

license. However, at any time after the expiration of 6 months

 

after the date of the conviction that resulted in the license

 

revocation, the department may reinstate his or her license and

 

restore to him or her all the rights and privileges of and

 

pertaining to the practice of naturopathic medicine under this

 

part. The reinstatement fee shall be set by the board, in an amount

 

that does not exceed $150.00.

 

     Sec. 18641. (1) Any person may report to the department in

 

writing any information the person has reason to believe indicates

 

that a naturopathic physician is or may be medically or legally

 

incompetent, engaged in the unauthorized or illegal practice of

 

naturopathic medicine, guilty of unprofessional conduct, or

 

mentally or physically unable to engage safely in the practice of

 

naturopathic medicine.

 

     (2) Each of the following persons shall report to the

 

department in writing any information the person has reason to

 

believe indicates that a naturopathic physician is or may be

 

medically or legally incompetent, engaged in the unauthorized

 

practice of naturopathic medicine, guilty of unprofessional


 

conduct, or mentally or physically unable to engage safely in the

 

practice of naturopathic medicine, within 30 days of becoming aware

 

of such information:

 

     (a) A naturopathic physician licensed under this part.

 

     (b) A health professional licensed under this article.

 

     (c) A health facility or agency in this state.

 

     (d) A state department or agency.

 

     (e) A law enforcement agency in this state.

 

     (3) A naturopathic physician's voluntary resignation from the

 

staff of a health facility or agency, voluntary limitation of staff

 

privileges, or failure to reapply for hospital privileges at a

 

facility or agency shall be promptly reported to the department by

 

the health facility or agency and the licensee if that action

 

occurs while the licensee is under formal or informal investigation

 

by the facility or agency or a committee of the facility or agency

 

for any reason related to possible medical incompetence,

 

unprofessional conduct, or mental or physical impairment.

 

     (4) If it receives a credible complaint or report concerning a

 

licensee, or on its own motion, the department may investigate as

 

provided in section 16221.

 

     (5) A person that in good faith complies with this section is

 

not liable for damages in a civil action or subject to prosecution

 

in a criminal proceeding as a result of a report under this

 

section.

 

     (6) Within 10 days after receiving a report required under

 

this section, the director shall acknowledge receipt of the reports

 

and any complaint against a licensee submitted to the department.


 

Within 10 days after final disposition, the director shall inform

 

any person or entity whose report or complaint has resulted in

 

action by the department of the final disposition of the matter.

 

     (7) If a person fails to make a report required under this

 

section, the director, in his or her discretion and after

 

consultation with the board, may assess an administrative fine of

 

not more than $5,000.00 against that person, if assessment of that

 

fine is supported by substantial evidence. A person may appeal the

 

assessment of an administrative fine under this subsection in the

 

manner provided in the administrative procedures act of 1969.