BillCam

SENATE BILL No. 826

February 15, 2018, Introduced by Senators JONES, KOWALL, MARLEAU, GREEN, KNOLLENBERG and WARREN and referred to the Committee on Regulatory Reform.

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 16265 and 17708 (MCL 333.16265 and 333.17708),

section 17708 as amended by 2016 PA 499, and by adding section

16348a and part 186.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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 a license 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 a licensed dentist, a licensed doctor

of medicine, a licensed doctor of osteopathic medicine and surgery,

a licensed doctor of podiatric medicine and surgery, a licensed

physician's assistant, a licensed optometrist certified under part

174 to administer and prescribe therapeutic pharmaceutical agents,

an advanced practice registered nurse as that term is defined in

section 17201 who meets the requirements of section 17211a, a

licensed veterinarian, a licensed doctor of naturopathic medicine,

or another 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) "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".

only be dispensed pursuant to a prescription.

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) 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 the

CNME or an equivalent federally recognized accrediting body for

naturopathic medical programs approved by the board.

diploma-granting, degree-equivalent college or university located

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

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 the

CNME or an equivalent 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 the CNME or an equivalent 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) "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 created in section 18625 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. (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 1 year after the effective date of

this section, an individual shall not engage in the practice of

naturopathic medicine unless 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.

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

out to be a naturopathic physician.

(d) An individual who sells vitamins and 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.

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 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.

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.

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 399h.

(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, subject to section

18623(f), minor office procedures.

practice of any other health profession, including, but not limited

to, performing chiropractic adjustments, 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.

Sec. 18619. The department shall establish procedures to

govern matters, directly or indirectly, involving any individual

who is related to an employee or agent of the department in any way

by blood or marriage.

Sec. 18621. The board of naturopathic medicine is created in

the department. The board consists of the following 7 members, each

of whom must meet the requirements of part 161:

(a) Four naturopathic physicians.

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

Sec. 18623. The board shall do all of the following:

(a) 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 of naturopathic medicine must not exceed the

tasks, functions, and duties described in section 18615.

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

the practice of naturopathic medicine in this state.

residency requirement.

(d) Promulgate rules for examination standards, consistent

with the standards under this part, for licensure and when those

examinations will be provided. In promulgating rules under this

subdivision, the board shall adopt a competency-based national

examination consistent with the requirements described in section

18613(1)(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) 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.

Sec. 18625. (1) The naturopathic formulary council is created.

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 who are licensed under part 177, appointed

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

of pharmacy.

Michigan board of medicine and the Michigan board of osteopathic

medicine and surgery may each provide a list of nominees for

purposes of this subdivision, and the board shall appoint this

member from 1 of those lists.

(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 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.

(5) The naturopathic formulary must 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 a prescription drug, or a device

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

specifically included in the naturopathic formulary.

Sec. 18627. A naturopathic physician shall observe and is

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 code. A violation

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

described in this section is considered a violation of this code

subject to the investigation and sanction provisions of sections

16221 and 16226.

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.