SENATE BILL NO. 990

March 24, 2022, Introduced by Senators RUNESTAD, LAUWERS, HUIZENGA and WOZNIAK and referred to the Committee on Health Policy and Human Services.

"Public health code,"

by amending sections 16141, 16145, 16265, 17708, and 18001 (MCL 333.16141, 333.16145, 333.16265, 333.17708, and 333.18001), sections 16141 and 16145 as amended by 1993 PA 80, section 17708 as amended by 2021 PA 53, and section 18001 as amended by 2018 PA 355, and by adding section 16348a and part 186.

the people of the state of michigan enact:

Sec. 16141. (1) The department shall furnish office services to the committee, the boards, and the task forces; have charge of their offices, records, and money collected; and perform managerial and administrative functions for them.

(2) The department shall appoint administrative and secretarial staff, clerks, and employees necessary to allow the proper exercise of the powers and duties of the committee, a board, or a task force. Salaries and other expenses incurred by the committee, a board, or a task force and staff and expenses for studies and activities authorized under this article shall must be paid out of funds appropriated by the legislature for those purposes.

(3) The department may promulgate rules to promote the effective and consistent administration of this article. However, except as provided in a specific part of this article, the department shall not promulgate rules that constitute the licensure, registration, or examination of health professionals.

Sec. 16145. (1) A board may adopt and have an official seal.

(2) A board or task force may promulgate rules necessary or appropriate to fulfill its functions as prescribed in this article.

(3) Only Except as provided in a specific part of this article, only a board or task force shall promulgate rules to specify requirements for licenses, registrations, renewals, examinations, and required passing scores.

Sec. 16265. (1) An individual licensed under this article to engage in the practice of chiropractic, dentistry, medicine, optometry, osteopathic medicine and surgery, podiatric medicine and surgery, psychology, or veterinary medicine, or naturopathic medicine shall not use the terms "doctor" or "dr." in any written or printed matter or display without adding thereto "of chiropractic", "of dentistry", "of medicine", "of optometry", "of osteopathic medicine and surgery", "of podiatric medicine and surgery", "of psychology", "of veterinary medicine", "of naturopathic medicine", or a similar term, respectively.

(2) An individual licensed under part 182 shall not use the terms "doctor" or "dr." without having been granted a doctoral degree in psychology from a regionally or nationally accredited college or university.

Sec. 16348a. The department shall annually establish a schedule of fees for an individual licensed or seeking licensure as a naturopathic physician under part 186 to offset the department's administrative expenses under that part.

Sec. 17708. (1) "Preceptor" means a pharmacist approved by the board to direct the training of an intern in an approved pharmacy.

(2) "Prescriber" means any of the following:

(a) A licensed dentist.

(b) A licensed doctor of medicine.

(d) A licensed doctor of podiatric medicine and surgery.

(e) A licensed physician's assistant.

(f) A licensed optometrist certified under part 174 to administer and prescribe therapeutic pharmaceutical agents.

(g) An advanced practice registered nurse as that term is defined in section 17201 who meets the requirements of section 17211a.

(h) A licensed veterinarian.

(i) A registered professional nurse who holds a specialty certification as a nurse anesthetist under section 17210 when he or she is engaging in the practice of nursing and providing the anesthesia and analgesia services described in section 17210(3). For purposes of this subdivision, the authority of a registered professional nurse who holds a specialty certification as a nurse anesthetist under section 17210 to prescribe pharmacological agents is limited to pharmacological agents for administration to patients as described in section 17210(3)(b), (c), or (d).

(j) A licensed doctor of naturopathic medicine.

(k) (j) Any other licensed health professional acting under the delegation and using, recording, or otherwise indicating the name of the delegating licensed doctor of medicine or licensed doctor of osteopathic medicine and surgery.

(3) "Prescription" means an order by a prescriber to fill, compound, or dispense a drug or device written and signed; written or created in an electronic format, signed, and transmitted by facsimile; or transmitted electronically or by other means of communication. An order transmitted in other than written or hard-copy form must be electronically recorded, printed, or written and immediately dated by the pharmacist, and that record is considered the original prescription. In a health facility or agency licensed under article 17 or other medical institution, an order for a drug or device in the patient's chart is considered for the purposes of this definition the original prescription. For purposes of this part, prescription also includes a standing order issued under section 17744e. Subject to section 17751(2) and (5), prescription includes, but is not limited to, an order for a drug, not including a controlled substance except under circumstances described in section 17763(e), written and signed; written or created in an electronic format, signed, and transmitted by facsimile; or transmitted electronically or by other means of communication by a physician prescriber, dentist prescriber, or veterinarian prescriber who is licensed to practice dentistry, medicine, osteopathic medicine and surgery, or veterinary medicine in another state.

(4) Subject to subsection (5), "prescription drug" means a drug to which 1 or more of the following apply:

(a) The drug is dispensed pursuant to a prescription.

(b) The drug bears the federal legend "CAUTION: federal law prohibits dispensing without prescription" or "Rx only".

(5) For purposes of this part, prescription drug also includes a drug dispensed pursuant to section 17744f.

(6) "Remote pharmacy" means a pharmacy described in sections 17742a and 17742b.

(7) Subsection (2)(i) does not require new or additional third party reimbursement or mandated worker's compensation benefits for anesthesia and analgesia services provided under section 17210(3) by a registered professional nurse who holds a specialty certification as a nurse anesthetist under section 17210.

Sec. 18001. (1) As used in this part:

(a) "Medical care services" means those services within the scope of practice of podiatric physicians licensed by the board, except those services that the board prohibits or otherwise restricts within a practice agreement or determines shall not be delegated by a podiatric physician without endangering the health and safety of patients as provided for in section 18048.

(b) "Participating podiatrist" means a podiatric physician or a podiatric physician designated by a group of podiatric physicians under section 18049 to represent that group.

(c) "Podiatric physician" or "podiatrist" means an individual who is licensed under this article to engage in the practice of podiatric medicine and podiatric surgery.

(d) "Practice agreement" means an agreement described in section 18047.

(e) "Practice as a physician's assistant" means the practice of podiatric medicine and podiatric surgery with a participating podiatric physician under a practice agreement.

(f) Except as otherwise provided in subdivision (g), "practice of podiatric medicine and podiatric surgery" or "practice of podiatric medicine and surgery" means any of the following:

(i) The evaluation, diagnosis, management, and prevention of conditions of the lower extremities, including local manifestations of systemic disease in the human foot and ankle, by attending to and advising patients and through the use of devices, diagnostic tests, drugs and biologicals, surgical procedures, or other means. The evaluation, diagnosis, management, and prevention of conditions of the lower extremities may include osseous and soft tissue procedures that address the pathology of the foot, ankle, and the contiguous attachments below the tibial tuberosity.

(ii) The treatment of ulcerations below the tibial tuberosity and of human nail diseases, callosities, and verruca.

(g) "Practice of podiatric medicine and podiatric surgery" or "practice of podiatric medicine and surgery" does not include amputations proximal to the tibiotalar joint, proximal osseous procedures that do not involve the tibiotalar joint, or the administration of intravenous sedation or general anesthesia.

(h) "Task force" means the joint task force created in section 17025.

(2) In addition to the definitions in this part, article 1 contains general definitions and principles of construction applicable to all articles in this code and part 161 contains definitions applicable to this 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 a 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 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) 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) Was offered by a college or university that was reputable and in good standing in the judgment of the board.

(iv) If the program is still offered, it is accredited by a 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 meets all of the following requirements:

(i) Was offered by a college or university that 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) 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) Was offered by a college or university that was reputable and in good standing in the judgment of the board.

(v) If the program is still offered, it is accredited by a federally recognized accrediting body for naturopathic medical programs approved by the board.

(vi) If the program is still offered, 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 a federally recognized accrediting body for naturopathic medical programs approved by the board.

(iii) Is offered by a college or university that has provincial approval for participation in government-funded student aid programs.

(2) "Device" means that term as defined in section 17703.

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 nonprescription and prescription drugs that naturopathic physicians use in the practice of their profession, as determined by the board.

(2) "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.

(3) "Naturopathic musculoskeletal mobilization" means the treatment of all body tissues by manual and other mechanical means, including high-velocity, low-amplitude mobilization at or beyond the end range of normal joint motion.

(4) "Naturopathic physician" means an individual who is licensed under this article to engage in the practice of naturopathic medicine.

Sec. 18609. (1) "Practice of naturopathic medicine" means performing any of the tasks, functions, or duties that are consistent with the individual's naturopathic education and training and described in section 18615.

(2) "Prescription drug" means that term as defined in section 17708.

Sec. 18611. (1) Beginning 180 days after rules are promulgated under section 18623, an individual shall not engage in the practice of naturopathic medicine unless he or she is licensed or otherwise authorized under this article.

(2) Subject to subsection (3), the following words, titles, or letters or combination of the following words, titles, or letters, with or without qualifying words or phrases, are restricted in use to only 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", "naturopathic medical doctor", "naturopathic medicine", "n.d.", and "n.m.d.".

(3) If he or she does not use the word or title "doctor", "physician", "medical doctor", or "medicine", subsection (2) does not restrict the use of any of the following words or titles by an individual described in subsection (4)(f) or (g) in connection with his or her practice: "naturopathy", "naturopathic health care", "naturopath", "naturopathic practitioner", or "traditional naturopathic practitioner".

(4) In addition to the exemptions from licensure under section 16171, 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 students enrolled in an approved naturopathic medical program. The performance of services must be pursuant to a course of instruction or assignments from an instructor and under the supervision of the instructor. The instructor must be a naturopathic physician licensed under this part or a duly licensed professional in the field of instruction.

(c) 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.

(d) An individual who sells vitamins or herbs from providing information about his or her products.

(e) 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) The individual is not a health professional and the therapy is within that individual's lawful rights to perform under a health occupation. If the individual is a health professional, the therapy must be within the scope of practice of that health 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.

(f) An individual who is educated and trained in naturopathy or naturopathic health care and provides naturopathic therapy within the scope of that education and training.

(g) An individual who is educated and trained as a naturopath, naturopathic practitioner, or traditional naturopathic practitioner and who provides naturopathic therapy within the scope of that education and training.

(h) A registered dietician or nutritional professional who meets the requirements of 42 USC 1395x(vv)(2)(A) and (B) from doing any of the following upon receiving a referral from a health professional:

(i) Prescribing dietary treatments.

(ii) Providing nutritional and dietary counseling.

(iii) Conducting nutritional and dietary assessments.

(iv) Developing, recommending, and ordering nutritional and dietary treatments, including therapeutic diets, for patients or groups of patients.

Sec. 18613. 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) A completed application for licensure.

(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 an 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.

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.

(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 399i.

(ii) Prescription or nonprescription drugs as designated by the board.

(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) Naturopathic musculoskeletal mobilization.

(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.

(b) Prescribe, dispense, or administer a prescription drug or device unless the prescription drug or device is included in the naturopathic formulary established under section 18623.

(c) Perform naturopathic musculoskeletal mobilization involving high-velocity, low-amplitude mobilization at or beyond the end range of normal joint motion, unless he or she meets the requirements to perform high-velocity, low-amplitude mobilization as established by the board by rule.

(d) Perform surgical procedures except, subject to section 18623(f), minor office procedures.

(e) Engage in the practice of or claim to engage in the practice of any other health profession, including, but not limited to, performing chiropractic adjustments, unless he or she is licensed to engage in that health profession under this article.

(f) Use general or spinal anesthetics.

(g) Administer ionizing radioactive substances for therapeutic purposes.

(h) Perform surgical procedures using a laser device.

(i) Perform surgical procedures involving the eye, ear, tendons, nerves, veins, or arteries.

Sec. 18621. The board of naturopathic medicine is created in the department. The board consists of the following 11 members, each of whom must meet the requirements of part 161:

(a) Six naturopathic physicians.

(b) One physician who is licensed under part 170 or 175.

(d) One chiropractor who is licensed under part 164.

(e) Two public members.

Sec. 18623. The department, in consultation with the board, shall do all of the following:

(a) Determine the qualifications of individuals applying for licensure under this part.

(b) Review the content of rules and proposed rules governing the practice of naturopathic medicine in this state.

(d) Promulgate rules for examination standards, consistent with the standards under this part, for licensure and when those examinations will be provided. The rules must include a competency-based national examination consistent with the requirements described in section 18613(b) and (c) as the naturopathic licensing examination.

(e) Subject to section 16204, establish a minimum amount and kind of continuing education to be required annually for each naturopathic physician as a condition for licensure renewal.

(f) 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.

(g) Establish a naturopathic formulary. All of the following apply to the naturopathic formulary established under this subdivision:

(i) The board shall review the naturopathic formulary annually or at any time at the request of the board.

(ii) The naturopathic formulary must 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.

(iii) The naturopathic formulary must not include prescription drugs or devices that are inconsistent with the training provided to graduates of an approved naturopathic medical program.

Sec. 18631. Each license granted or renewed under this part expires 4 years following the date it was granted or last renewed.

Sec. 18633. This part does not require new or additional third party reimbursement or mandated worker's compensation benefits for services rendered by an individual who is licensed under this part.

Enacting section 1. This amendatory act takes effect 90 days after the date it is enacted into law.