SB-0826, As Passed Senate, May 17, 2018

SUBSTITUTE FOR

SENATE BILL NO. 826

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 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.

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 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 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.

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.

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.

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 399h.

(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.

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.

residency requirement.

(d) Promulgate rules for examination standards, consistent

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

examinations will be provided. The rules shall 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.