Bill Text: MI HB4531 | 2015-2016 | 98th Legislature | Introduced
Bill Title: Health occupations; physicians; licensure of naturopathic physicians; provide for. Amends 1978 PA 368 (MCL 333.1101 - 333.25211) by adding sec. 16348a & pt. 186.
Spectrum: Slight Partisan Bill (Democrat 4-2)
Status: (Introduced - Dead) 2016-05-03 - Referred To Second Reading [HB4531 Detail]
Download: Michigan-2015-HB4531-Introduced.html
HOUSE BILL No. 4531
April 28, 2015, Introduced by Reps. Lyons, Schor, Darany, Irwin, Dillon and Crawford 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 an individual 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) 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.
(c) A naturopathic medical education program offered by a
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) "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 created in 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. (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 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) 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 section 18619(1)(g) or (h) in connection
with his or her practice: "naturopathy", "naturopathic health
care", "naturopath", "naturopathic practitioner", or "traditional
naturopathic practitioner".
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 engaging in the practice
of naturopathic medicine in this state, an applicant must be
physically and mentally capable of safely engaging in the practice
of 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, subject to section
18625(h), minor office procedures.
(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.
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 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.
(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) 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 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.
(g) 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.
(h) An individual who is educated and trained as a naturopath,
naturopathic practitioner, or traditional naturopathic practitioner
and provides naturopathic therapy within the scope of that
education and training.
(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, if 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 will 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) The 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 created
in 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 a financial or legal 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 constitutes a quorum.
(6) The board positions are uncompensated positions unless and
until the director considers compensation appropriate.
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 of naturopathic medicine must not exceed the
tasks, functions, and duties 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 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 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 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 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. 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 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 an 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) An 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 the individual's 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 the individual's 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 that 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 health facility or agency and a licensee shall promptly
report to the department the voluntary resignation of the licensee
from the staff of a health facility or agency, the voluntary
limitation of the licensee's staff privileges, or failure of the
licensee to reapply for hospital privileges at a facility or agency
if that action occurs while the licensee is under formal or
informal investigation by the health facility or agency or a
committee of the health 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.
Enacting section 1. This amendatory act takes effect 90 days
after the date it is enacted into law.
