Iowa-2015-HSB51-Introduced

H.F. _____ Section 1. Section 147.1, subsections 3 and 6, Code 2015, 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 2015, 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 1086YC (3) 86 tr/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 2015, 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 2015, 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”, or 23 “naturopath”, or the initials “N.D.” or “N.M.D.” after the 24 person’s name. 25 Sec. 5. Section 147.107, Code 2015, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 8A. A licensed naturopathic physician 28 may prescribe all substances and devices consistent with the 29 level of training of the naturopathic physician unless added 30 to the exclusionary naturopathic formulary by the naturopathic 31 advisory council. 32 Sec. 6. Section 148E.3, subsection 1, Code 2015, is amended 33 to read as follows: 34 1. A person otherwise licensed to practice medicine and 35 -2- LSB 1086YC (3) 86 tr/nh 2/ 11

H.F. _____ surgery, osteopathic medicine and surgery, naturopathic 1 medicine, chiropractic, podiatry, or dentistry who is 2 exclusively engaged in the practice of the person’s profession. 3 Sec. 7. NEW SECTION . 148G.1 Definitions. 4 As used in this chapter, unless the context otherwise 5 requires: 6 1. “Approved naturopathic medical program” means any of the 7 following: 8 a. A naturopathic medical education program in the 9 United States providing the degree of doctor of naturopathy 10 or doctor of naturopathic medicine. Such program shall 11 offer graduate-level, full-time didactic and supervised 12 clinical training and shall be accredited or shall have 13 achieved candidacy status for accreditation by the council on 14 naturopathic medical education or by an equivalent federally 15 recognized accrediting body for naturopathic medical programs 16 also recognized by the board. Additionally, the program shall 17 be an institution of higher education, or part thereof, that 18 is either accredited or is a candidate for accreditation 19 by a regional or national institutional accrediting agency 20 recognized by the United States secretary 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 1086YC (3) 86 tr/nh 3/ 11

H.F. _____ exclusionary list of medicines, nonprescription and 1 prescription, which naturopathic physicians shall not use 2 in the practice of their profession, as determined by the 3 naturopathic 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 14 use of physiological, psychological, or mechanical methods, and 15 the use of natural medicines, prescription or legend drugs, 16 foods, 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 of 21 practice that is based on the natural healing capacity of 22 individuals, and may use physiological, psychological, or 23 mechanical methods, and may use natural medicines, prescription 24 or legend drugs, foods, herbs, or other natural remedies. 25 9. “Prescription drug” means any drug described in section 26 503(b) of the federal Food, Drug, and Cosmetic Act, 21 U.S.C. 27 §353, if its label is required to bear the symbol “RX only”. 28 Sec. 8. NEW SECTION . 148G.2 Licensure —— naturopathic 29 medicine. 30 1. Qualifications for licensure. An applicant for a license 31 to practice naturopathic medicine shall be granted a license 32 by the board if the applicant satisfies all of the following 33 requirements: 34 a. Submits an application for licensure designed and 35 -4- LSB 1086YC (3) 86 tr/nh 4/ 11

H.F. _____ approved by the naturopathic advisory council. 1 b. Pays an application fee established by the board. 2 c. Has graduated from an approved naturopathic medical 3 program. 4 d. Has passed a competency-based national naturopathic 5 licensing examination administered by the north American board 6 of naturopathic examiners or successor agency, that has been 7 nationally recognized to administer a naturopathic examination 8 representing federal standards of education and training. For 9 applicants who completed an approved naturopathic medical 10 program located in Canada, eligibility for licensure may be 11 granted with evidence of successful passage of a Canadian 12 provincial competency examination. 13 e. Provides evidence that the applicant is of good ethical 14 and professional reputation. An applicant shall not have had 15 a license to practice naturopathic medicine or other health 16 care license, registration, or certification refused, revoked, 17 or suspended by this state or any other jurisdiction for 18 reasons that relate to the applicant’s ability to skillfully 19 and safely practice naturopathic medicine unless that license, 20 registration, or certification has been restored to good 21 standing. 22 f. Provides evidence that the applicant is physically and 23 mentally capable of safely practicing naturopathic medicine 24 with or without reasonable accommodation. 25 2. Term of license. A license granted pursuant to this 26 section shall be renewed every two years. 27 Sec. 9. NEW SECTION . 148G.3 Use of title —— exceptions. 28 1. A person shall not represent that the person is a 29 naturopathic physician, a doctor of naturopathic medicine, a 30 doctor of naturopathy, a naturopath, or as being otherwise 31 authorized to practice naturopathic medicine in this state, or 32 use the initials “N.D.” or “N.M.D.” or any other titles, words, 33 letters, abbreviations, or insignia indicating or implying 34 that the individual is a licensed naturopathic physician 35 -5- LSB 1086YC (3) 86 tr/nh 5/ 11

H.F. _____ without first obtaining from the board a license to practice 1 naturopathic medicine pursuant to the provisions of this 2 chapter. 3 2. The practice of naturopathic medicine by a naturopathic 4 physician licensed pursuant to this chapter does not constitute 5 the practice of medicine and surgery under chapter 148, the 6 practice of osteopathic medicine and surgery under chapter 148, 7 or the practice of nursing under chapter 152. 8 3. This chapter and chapter 147 shall not prevent a 9 qualified member of another profession, including but not 10 limited to an individual licensed under chapter 148, 150, 150A, 11 or 152, from providing services consistent with the nature of 12 naturopathic medicine, but such person shall not use a title or 13 description denoting that the person is a licensed naturopathic 14 physician. 15 Sec. 10. NEW SECTION . 148G.4 Duties of board. 16 The board shall adopt rules consistent with this chapter and 17 chapter 147, and as recommended by the naturopathic advisory 18 council, which are necessary for the performance of the board’s 19 duties. 20 Sec. 11. NEW SECTION . 148G.5 Naturopathic advisory council. 21 1. A naturopathic advisory council is established, 22 consisting of the following members, appointed by the governor: 23 a. Prior to July 1, 2017, four members who are naturopathic 24 physicians who are residents of the state of Iowa and who are 25 currently licensed in good standing in another state. On 26 and after July 1, 2017, such members shall be naturopathic 27 physicians licensed under this chapter. 28 b. One member who is a pharmacist licensed in Iowa. 29 c. One member who is a medical or osteopathic physician 30 licensed in Iowa, who has expertise in integrative medicine. 31 d. One member representing the general public. 32 2. Members shall not receive per diem or expense payments. 33 3. Members shall serve two-year terms, and shall serve until 34 their successors have been appointed. 35 -6- LSB 1086YC (3) 86 tr/nh 6/ 11

H.F. _____ 4. The council shall select a chairperson from its 1 membership. 2 Sec. 12. NEW SECTION . 148G.6 Council duties. 3 The naturopathic advisory council shall do all of the 4 following: 5 1. Advise the board regarding standards for licensed 6 naturopathic physicians. 7 2. Provide for distribution of information regarding 8 licensed naturopathic physician standards. 9 3. Advise the board on enforcement issues. 10 4. Review applications for licensure and license renewal 11 and recommend the granting or denial thereof. 12 5. Advise the board on issues related to receiving and 13 investigating complaints, conducting hearings, and imposing 14 disciplinary action in relation to complaints against licensed 15 naturopathic physicians. 16 6. Review naturopathic education and training for and 17 make specific recommendations to the board regarding the 18 qualifications to practice naturopathic childbirth attendance. 19 7. Recommend to the board any prescription drugs which 20 should be included on the exclusionary naturopathic formulary. 21 8. Advise the board regarding approval of continuing 22 education programs specific to naturopathic practice. 23 Sec. 13. NEW SECTION . 148G.7 Scope of practice. 24 A naturopathic physician may do any of the following: 25 1. Order and perform physical and laboratory examinations 26 consistent with naturopathic education and training for 27 diagnostic purposes, including but not limited to phlebotomy, 28 clinical laboratory tests, orificial examinations, and 29 physiological function tests. 30 2. Order diagnostic imaging studies consistent with 31 naturopathic training. All diagnostic tests not consistent 32 with naturopathic medical education and training must be 33 referred for performance and interpretation to an appropriately 34 licensed health care professional. 35 -7- LSB 1086YC (3) 86 tr/nh 7/ 11

H.F. _____ 3. Dispense, administer, order, prescribe, provide, or 1 perform the following, as applicable: 2 a. Food, extracts of food, nutraceuticals, vitamins, amino 3 acids, minerals, enzymes, botanicals and their extracts, 4 botanical medicines, homeopathic medicines, and all dietary 5 supplements and nonprescription drugs as defined by the federal 6 Food, Drug, and Cosmetic Act, 21 U.S.C. §301 et seq. 7 b. Prescription or legend drugs and hormone replacement 8 therapy. 9 c. Hot or cold hydrotherapy, naturopathic physical medicine, 10 and therapeutic exercise. 11 d. Devices, including but not limited to therapeutic 12 devices, barrier contraception, and durable medical equipment. 13 e. Health education and health counseling. 14 f. Repair and care incidental to superficial lacerations and 15 abrasions. 16 g. Removal of foreign bodies located in the superficial 17 tissues. 18 h. Musculoskeletal manipulation consistent with 19 naturopathic education and training. 20 4. Utilize routes of administration that include oral, 21 nasal, auricular, ocular, rectal, vaginal, transdermal, 22 intradermal, subcutaneous, intravenous, and intramuscular 23 consistent with the education and training of a naturopathic 24 physician. 25 5. Perform all therapies as trained and educated which are 26 approved by the naturopathic advisory council. 27 Sec. 14. NEW SECTION . 148G.8 Prohibitions. 28 A naturopathic physician licensed under this chapter shall 29 not do any of the following: 30 1. Perform or induce abortions. 31 2. Perform surgical procedures except those minor office 32 procedures authorized by this chapter. 33 3. Practice or claim to practice as a medical or osteopathic 34 physician, dentist, pharmacist, podiatrist, optometrist, 35 -8- LSB 1086YC (3) 86 tr/nh 8/ 11

H.F. _____ psychologist, advanced practice registered nurse, physician 1 assistant, chiropractor, physical therapist, acupuncturist, or 2 any other health care provider not authorized in this chapter 3 unless licensed by the state of Iowa as such. 4 4. Use general or spinal anesthetics. 5 5. Administer ionizing radioactive substances for 6 therapeutic purposes. 7 6. Administer or prescribe chemotherapeutic medications for 8 the purpose of cancer treatment. 9 7. Perform surgical procedures of the eye, ear, nerves, 10 veins, or arteries extending beyond superficial tissue. 11 Sec. 15. NEW SECTION . 148G.9 Exemptions. 12 This chapter shall not be construed to prohibit or restrict 13 any of the following: 14 1. The practice of a profession by an individual who is 15 licensed, certified, or registered under another law of this 16 state who is performing services within the individual’s 17 authorized scope of practice. 18 2. The practice of naturopathic medicine by an individual 19 employed by the government of the United States while the 20 individual is engaged in the performance of duties prescribed 21 by the laws and regulations of the United States. 22 3. The practice of naturopathic medicine by students 23 enrolled in an approved naturopathic medical program. The 24 performance of services shall be pursuant to a course of 25 instruction or assignments from an instructor and under the 26 supervision of the instructor. The instructor shall be a 27 naturopathic physician licensed pursuant to this chapter or a 28 duly licensed professional in the instructed field. 29 4. Persons from treating themselves and family members 30 based on religious or health beliefs. 31 5. Persons who sell vitamins and herbs from providing 32 information about their products. 33 6. Persons or practitioners from advising in the use 34 of a therapy including but not limited to herbal medicine, 35 -9- LSB 1086YC (3) 86 tr/nh 9/ 11

H.F. _____ homeopathy, nutrition, or other nondrug or nonsurgical therapy 1 that is within the scope of practice of naturopathic physicians 2 as provided in this chapter as long as such therapy is lawful, 3 or, if a licensed health care provider, within the scope of 4 practice of the profession; and provided that such person is 5 not using a title protected pursuant to this chapter or holding 6 themselves out to be a naturopathic physician. 7 7. The practice of naturopathic medicine by persons who 8 are licensed to practice in any other state as practicing 9 naturopathic physicians, who enter this state to consult with 10 a licensed naturopathic physician in this state; provided, 11 however, that the consultation is to be limited to examination, 12 recommendation, or testimony in litigation. 13 Sec. 16. FUNDING. The board of medicine shall apply to 14 the office of the chief information officer to request an 15 allocation of moneys from the IowAccess revolving fund to fund 16 the estimated costs for expansion of the advanced Maryland 17 automatic network disk archiver (AMANDA) system to allow 18 licensure of naturopathic physicians in the AMANDA system. 19 The board shall not implement a fee increase to make this 20 adjustment to the AMANDA system for naturopathic physicians. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 This bill requires the licensing of naturopathic physicians 25 and makes the provisions of Code chapter 147, including 26 penalty and other regulatory provisions, applicable to other 27 health professions applicable to the practice of naturopathic 28 medicine. The bill provides that the practice of naturopathic 29 medicine means the provision of naturopathic services defined 30 as a system of primary health care for the prevention, 31 diagnosis, and treatment of human health conditions, injury, 32 and disease, and the promotion or restoration of health. 33 Naturopathic medicine includes the use of physiological, 34 psychological, or mechanical methods, and the use of natural 35 -10- LSB 1086YC (3) 86 tr/nh 10/ 11

H.F. _____ medicines, prescription or legend drugs, foods, herbs, or 1 other natural remedies. The bill specifies qualifications 2 for licensure and the scope of practice for a naturopathic 3 physician, and details functions that a naturopathic physician 4 may not perform. 5 The practice of naturopathic medicine is regulated by the 6 board of medicine, with the advice of a naturopathic advisory 7 council. The council consists of seven members, four of 8 whom are naturopathic physicians, one medical or osteopathic 9 physician, a pharmacist, and one member representing the 10 general public. The council does not receive a per diem or 11 expenses. 12 The bill provides that qualified members of other 13 professions, including physicians and nurses, are not prevented 14 from providing services consistent with naturopathic medicine, 15 but these persons shall not use a title or description denoting 16 that they are naturopathic physicians. The bill sets out these 17 titles. 18 The bill provides for inclusion of licensed naturopathic 19 physicians in the AMANDA system. This system is a network 20 disk archiver system currently used by the boards of nursing, 21 dentistry, and medicine. 22 Code section 422.7(27) provides an income tax exemption for 23 payments received by an individual providing unskilled in-home 24 health-related care services to a member of the individual 25 caregiver’s family. This exemption is not available to health 26 care professionals licensed by the board of medicine. Under 27 the bill, naturopathic physicians are to be licensed by the 28 board of medicine, making them ineligible for this exemption. 29 -11- LSB 1086YC (3) 86 tr/nh 11/ 11