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".
(c) The drug is designated by the board as a drug that may
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.
(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) "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.
(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 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.
(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.
(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 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.
(c) 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 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.
(c) Two public members.
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.
(c) Evaluate the content of any clinical, practical, or
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.
(c) One physician who is licensed under part 170 or 175. The
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.