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Key: (1) language to be deleted (2) new language

                            CHAPTER 177-H.F.No. 446 
                  An act relating to occupations and professions; 
                  establishing licensure for acupuncture practitioners 
                  by the board of medical practice; appropriating money; 
                  providing penalties; proposing coding for new law as 
                  Minnesota Statutes, chapter 147B. 
           Section 1.  [PURPOSE.] 
           Acupuncture practice is recognized as a clearly defined 
        system of health care with its own specialized body of 
        knowledge.  The knowledge and skills of the acupuncture 
        practitioner directly affect the quality and safety of treatment 
        received by the practitioner's client.  It is therefore in the 
        public interest to ensure that acupuncture practitioners meet 
        the generally accepted standards of competence in the 
        profession.  The purpose of Minnesota Statutes, chapter 147B, is 
        to limit the practice of acupuncture to persons who meet those 
        standards of competence.  
           Sec. 2.  [147B.01] [DEFINITIONS.] 
           Subdivision 1.  [APPLICABILITY.] The definitions in this 
        section apply to this chapter. 
           Subd. 2.  [ACUPRESSURE.] "Acupressure" means the 
        application of pressure to acupuncture points. 
           Subd. 3.  [ACUPUNCTURE PRACTICE.] "Acupuncture practice" 
        means a comprehensive system of health care using Oriental 
        medical theory and its unique methods of diagnosis and 
        treatment.  Its treatment techniques include the insertion of 
        acupuncture needles through the skin and the use of other 
        biophysical methods of acupuncture point stimulation, including 
        the use of heat, Oriental massage techniques, electrical 
        stimulation, herbal supplemental therapies, dietary guidelines, 
        breathing techniques, and exercise based on Oriental medical 
           Subd. 4.  [ACUPUNCTURE NEEDLE.] "Acupuncture needle" means 
        a needle designed exclusively for acupuncture purposes.  It has 
        a solid core, with a tapered point, and is 0.12 mm to 0.45 mm in 
        thickness.  It is constructed of stainless steel, gold, silver, 
        or other board-approved materials as long as the materials can 
        be sterilized according to recommendations of the National 
        Centers for Disease Control and Prevention. 
           Subd. 5.  [ACUPUNCTURE POINTS.] "Acupuncture points" means 
        specific anatomically described locations as defined by the 
        recognized acupuncture reference texts.  These texts are listed 
        in the study guide to the examination for the NCCA certification 
           Subd. 6.  [ACUPUNCTURE PRACTITIONER.] "Acupuncture 
        practitioner" means a person licensed to practice acupuncture 
        under this chapter. 
           Subd. 7.  [BOARD.] "Board" means the board of medical 
        practice or its designee. 
           Subd. 8.  [BLOOD BORNE DISEASE.] "Blood borne disease" 
        means a disease that is spread through exposure to blood, 
        inoculation or injection of blood, or exposure to 
        blood-contaminated body fluids or tissues.  Blood borne disease 
        includes infection caused by such agents as human 
        immunodeficiency virus (HIV) and hepatitis B virus (HBV). 
           Subd. 9.  [BREATHING TECHNIQUES.] "Breathing techniques" 
        means Oriental breathing exercises taught to a patient as part 
        of a treatment plan. 
           Subd. 10.  [CUPPING.] "Cupping" means a therapy in which a 
        jar-shaped instrument is attached to the skin and negative 
        pressure is created by using suction. 
           Subd. 11.  [DERMAL FRICTION.] "Dermal friction" means 
        rubbing on the surface of the skin, using topical ointments with 
        a smooth-surfaced instrument without a cutting edge that can be 
        sterilized or, if disposable, a one-time only use product. 
           Subd. 12.  [DIPLOMATE IN ACUPUNCTURE.] "Diplomate in 
        acupuncture" means a person who is certified by the NCCA as 
        having met the standards of competence established by the NCCA, 
        who subscribes to the NCCA code of ethics, and who has a current 
        and active NCCA certificate.  Current and active NCCA 
        certification indicates successful completion of continued 
        professional development and previous satisfaction of NCCA 
           Subd. 13.  [ELECTRICAL STIMULATION.] "Electrical 
        stimulation" means a method of stimulating acupuncture points by 
        an electrical current of .001 to 100 milliamps, or other current 
        as approved by the board.  Electrical stimulation may be used by 
        attachment of a device to an acupuncture needle or may be used 
        transcutaneously without penetrating the skin. 
           Subd. 14.  [HERBAL THERAPIES.] "Herbal therapies" are the 
        use of herbs and patent herbal remedies as supplements as part 
        of the treatment plan of the patient. 
           Subd. 15.  [INFECTION CONTROL.] "Infection control" means 
        programs, procedures, and methods to reduce the transmission of 
        agents of infection for the purpose of preventing or decreasing 
        the incidence of infectious diseases. 
           Subd. 16.  [NCCA.] "NCCA" means the National Commission for 
        the Certification of Acupuncturists, a not-for-profit 
        corporation organized under section 501(c)(4) of the Internal 
        Revenue Code. 
           Subd. 17.  [NEEDLE SICKNESS.] "Needle sickness" is a 
        temporary state of nausea and dizziness that is a potential side 
        effect to needle insertion and from which full recovery occurs 
        when the needles are removed. 
           Subd. 18.  [ORIENTAL MEDICINE.] "Oriental medicine" means a 
        system of healing arts that perceives the circulation and 
        balance of energy in the body as being fundamental to the 
        well-being of the individual.  It implements the theory through 
        specialized methods of analyzing the energy status of the body 
        and treating the body with acupuncture and other related 
        modalities for the purpose of strengthening the body, improving 
        energy balance, maintaining or restoring health, improving 
        physiological function, and reducing pain. 
           Sec. 3.  [147B.02] [LICENSURE.] 
           Subdivision 1.  [LICENSURE REQUIRED.] Except as provided 
        under subdivision 4, it is unlawful for any person to engage in 
        the practice of acupuncture without a valid license after June 
        30, 1997.  Each licensed acupuncture practitioner shall 
        conspicuously display the license in the place of practice. 
           Subd. 2.  [DESIGNATION.] A person licensed under this 
        chapter shall use the title of licensed acupuncturist or L.Ac. 
        following the person's name in all forms of advertising, 
        professional literature, and billings.  A person may not, in the 
        conduct of an occupation or profession pertaining to the 
        practice of acupuncture or in connection with the person's name, 
        use the words or letters licensed acupuncturist, Minnesota 
        licensed acupuncturist, or any other words, letters, 
        abbreviations, or insignia indicating or implying that a person 
        is an acupuncturist without a license issued under this 
        section.  A student attending an acupuncture training program 
        must be identified as a student acupuncturist. 
           Subd. 3.  [PENALTY.] A person who violates this section is 
        guilty of a misdemeanor and subject to discipline under section 
           Subd. 4.  [EXCEPTIONS.] (a) The following persons may 
        practice acupuncture within the scope of their practice without 
        an acupuncture license: 
           (1) a physician licensed under this chapter; 
           (2) an osteopath licensed under this chapter; 
           (3) a chiropractor licensed under chapter 148; 
           (4) a person who is studying in a formal course of study or 
        tutorial intern program approved by the acupuncture advisory 
        council established in section 147B.05 so long as the person's 
        acupuncture practice is supervised by a licensed acupuncturist; 
           (5) a visiting acupuncturist practicing acupuncture within 
        an instructional setting for the sole purpose of teaching at a 
        school registered with the Minnesota higher education 
        coordinating board, who may practice without a license for a 
        period of one year, with two one-year extensions permitted; and 
           (6) a visiting acupuncturist who is in the state for the 
        sole purpose of providing a tutorial or workshop not to exceed 
        30 days in one calendar year. 
           (b) This chapter does not prohibit a person who does not 
        have an acupuncturist license from practicing specific 
        noninvasive techniques, such as acupressure, that are within the 
        scope of practice as set forth in section 147B.06, subdivision 4.
        PERIOD.] (a) From July 1, 1995, to June 30, 1997, a person may 
        qualify for licensure if the person has engaged in acupuncture 
        practice for at least three years in the period from July 1, 
        1991, to June 30, 1995, with at least 500 patient visits in each 
        of the three years with at least 100 different patients.  
        Acupuncture practice must be the primary means of treatment, not 
        an adjunctive therapy.  The person must also provide 
        documentation of successful completion of a clean needle 
        technique course approved by the acupuncture advisory board and 
        provide documentation of practice through at least four of the 
        following methods: 
           (1) original notarized letters from employers specifying 
        the dates and hours worked, nature of the practice, and number 
        of visits; 
           (2) notarized affidavits from a minimum of 20 patients with 
        current phone numbers and addresses for each, specifying the 
        time period of treatment and the nature of the treatment; 
           (3) notarized affidavits from at least two other health 
        care professionals, state or local acupuncture or Oriental 
        medicine associations, schools or colleges, with testimony based 
        on personal knowledge regarding the dates, volume, scope, and 
        type of practice; 
           (4) notarized affidavits from at least two other members 
        within the community with testimony based on personal knowledge 
        regarding the dates, volume, scope, and type of practice; and 
           (5) notarized copies of patient records.  The person must 
        also meet any other requirements established by the board. 
           (b) All documentation submitted in a foreign language must 
        be accompanied by an accurate translation in English.  Each 
        translated document must bear the affidavit of the translator 
        certifying that the translator is competent in both the language 
        of the document and in the English language and that the 
        translation is true and a complete translation of the foreign 
        language original and must be sworn before a notary public.  
        Translation of any document relative to a person's application 
        is at the expense of the applicant. 
           (c) Application for licensure under this subdivision must 
        be submitted to the board from July 1, 1995, to June 30, 1997.  
        All of the required patient visits must have been completed 
        before application for licensure. 
           Subd. 6.  [LICENSE BY RECIPROCITY.] The board shall issue 
        an acupuncture license to a person who holds a current license 
        or certificate as an acupuncturist from another jurisdiction if 
        the board determines that the standards for certification or 
        licensure in the other jurisdiction meet or exceed the 
        requirements for licensure in Minnesota and a letter is received 
        from that jurisdiction that the acupuncturist is in good 
        standing in that jurisdiction. 
           Subd. 7.  [LICENSURE REQUIREMENTS.] (a) After June 30, 
        1997, an applicant for licensure must: 
           (1) submit a completed application for licensure on forms 
        provided by the board, which must include the applicant's name 
        and address of record, which shall be public; 
           (2) unless licensed under subdivision 5 or 6, submit a 
        notorized copy of a current NCCA certification; 
           (3) sign a statement that the information in the 
        application is true and correct to the best of the applicant's 
        knowledge and belief; 
           (4) submit with the application all fees required; and 
           (5) sign a waiver authorizing the board to obtain access to 
        the applicant's records in this state or any state in which the 
        applicant has engaged in the practice of acupuncture.  
           (b) The board may ask the applicant to provide any 
        additional information necessary to ensure that the applicant is 
        able to practice with reasonable skill and safety to the public. 
           (c) The board may investigate information provided by an 
        applicant to whether the information is accurate and complete.  
        The board shall notify an applicant of action taken on the 
        application and the reasons for denying licensure if licensure 
        is denied. 
           Subd. 8.  [LICENSURE EXPIRATION.] Licenses issued under 
        this section expire annually. 
           Subd. 9.  [RENEWAL] (a) To renew a license an applicant 
           (1) annually, or as determined by the board, complete a 
        renewal application on a form provided by the board; 
           (2) submit the renewal fee; 
           (3) provide evidence annually of one hour of continuing 
        education in the subject of infection control, including blood 
        borne pathogen diseases; 
           (4) provide documentation of current and active NCCA 
        certification; or 
           (5) if licensed under subdivision 5 or 6, meet one-half the 
        then current NCCA professional development activity requirements.
           (b) An applicant shall submit any additional information 
        requested by the board to clarify information presented in the 
        renewal application.  The information must be submitted within 
        30 days after the board's request, or the renewal request is 
           Subd. 10.  [LICENSURE RENEWAL NOTICE.] At least 30 days 
        before the license renewal date, the board shall send out a 
        renewal notice to the last known address of the licensee.  The 
        notice must include a renewal application and a notice of fees 
        required for renewal.  If the licensee does not receive a 
        renewal notice, the licensee must still meet the requirements 
        for registration renewal under this section. 
           Subd. 11.  [RENEWAL DEADLINE.] The renewal application and 
        fee must be postmarked on or before June 30 of the year of 
        renewal or as determined by the board. 
           Subd. 12.  [INACTIVE STATUS.] (a) A license may be placed 
        in inactive status upon application to the board and upon 
        payment of an inactive status fee.  The board may not renew or 
        restore a license that has lapsed and has not been renewed 
        within two annual license renewal cycles. 
           (b) An inactive license may be reactivated by the license 
        holder upon application to the board.  A licensee whose license 
        is canceled for nonrenewal must obtain a new license by applying 
        for licensure and fulfilling all the requirements then in 
        existence for the initial license to practice acupuncture in the 
        state of Minnesota.  The application must include: 
           (1) evidence of current and active NCCA certification; 
           (2) evidence of the certificate holder's payment of an 
        inactive status fee; 
           (3) an annual fee; and 
           (4) all back fees since previous renewal. 
           (c) A person licensed under subdivision 5 who has allowed 
        the license to reach inactive status must become NCCA certified. 
           Subd. 13.  [TEMPORARY PERMIT.] The board may issue a 
        temporary permit to practice acupuncture to an applicant 
        eligible for licensure under this section only if the 
        application for licensure is complete, all applicable 
        requirements in this section have been met, and a nonrefundable 
        fee set by the board has been paid.  The permit remains valid 
        only until the meeting of the board at which a decision is made 
        on the acupuncturist's application for licensure. 
           Subdivision 1.  [NCCA REQUIREMENTS.] Unless a person is 
        licensed under section 147B.02, subdivision 5 or 6, each 
        licensee is required to meet the NCCA professional development 
        activity requirements to maintain NCCA certification.  These 
        requirements may be met through a board approved continuing 
        education program. 
           Subd. 2.  [BOARD APPROVAL.] The board shall approve a 
        continuing education program if the program meets the following 
           (1) it directly relates to the practice of acupuncture; 
           (2) each member of the faculty shows expertise in the 
        subject matter by holding a degree or certificate from an 
        educational institution, has verifiable experience in 
        traditional Oriental medicine, or has special training in the 
        subject area; 
           (3) the program lasts at least one contact hour; 
           (4) there are specific written objectives describing the 
        goals of the program for the participants; and 
           (5) the program sponsor maintains attendance records for 
        four years.  
           Subd. 3.  [CONTINUING EDUCATION TOPICS.] (a) Continuing 
        education program topics may include, but are not limited to, 
        Oriental medical theory and techniques including Oriental 
        massage; Oriental nutrition; Oriental herbology and diet 
        therapy; Oriental exercise; western sciences such as anatomy, 
        physiology, biochemistry, microbiology, psychology, nutrition, 
        history of medicine; and medical terminology or coding.  
           (b) Practice management courses are excluded under this 
           Subd. 4.  [VERIFICATION.] The board shall periodically 
        select a random sample of acupuncturists and require the 
        acupuncturist to show evidence of having completed the NCCA 
        professional development activities requirements.  Either the 
        acupuncturist, the state, or the national organization that 
        maintains continuing education records may provide the board 
        documentation of the continuing education program. 
           Sec. 5.  [147B.04] [BOARD ACTION ON APPLICATIONS.] 
           Subdivision 1.  [VERIFICATION OF APPLICATION 
        INFORMATION.] The board or acupuncture advisory council 
        established under section 147B.05, with the approval of the 
        board, may verify information provided by an application for 
        licensure under section 147B.02 to determine if the information 
        is accurate and complete. 
           Subd. 2.  [NOTIFICATION OF BOARD ACTION.] Within 120 days 
        of receipt of the application, the board shall notify each 
        applicant in writing of the action taken on the application. 
        applicant denied licensure must be notified of the 
        determination, and the grounds for it, and may request a hearing 
        on the determination by filing a written statement of issues 
        with the board within 20 days after receipt of the notice from 
        the board.  After the hearing, the board shall notify the 
        applicant in writing of its decision. 
           Sec. 6.  [147B.05] [ACUPUNCTURE ADVISORY COUNCIL.] 
           Subdivision 1.  [CREATION.] The advisory council to the 
        board of medical practice for acupuncture consists of seven 
        members appointed by the board to three-year terms.  Four 
        members must be licensed acupuncture practitioners, one member 
        must be a licensed physician or osteopath who also practices 
        acupuncture, one member must be a licensed chiropractor who is 
        NCCA certified, and one member must be a member of the public 
        who has received acupuncture treatment as a primary therapy from 
        a NCCA certified acupuncturist. 
        QUORUM.] The advisory council is governed by section 15.059, 
        except that the council does not expire until June 30, 1999. 
           Subd. 3.  [DUTIES.] The advisory council shall: 
           (1) advise the board on issuance, denial, renewal, 
        suspension, revocation, conditioning, or restricting of licenses 
        to practice acupuncture; 
           (2) advise the board on issues related to receiving, 
        investigating, conducting hearings, and imposing disciplinary 
        action in relation to complaints against acupuncture 
           (3) maintain a register of acupuncture practitioners 
        licensed under section 147B.02; 
           (4) maintain a record of all advisory council actions; 
           (5) prescribe registration application forms, license 
        forms, protocol forms, and other necessary forms; 
           (6) review the patient visit records submitted by 
        applicants during the transition period; 
           (7) advise the board regarding standards for 
           (8) distribute information regarding acupuncture practice 
           (9) review complaints; 
           (10) advise the board regarding continuing education 
           (11) review the investigation of reports of complaints and 
        recommend to the board whether disciplinary action should be 
        taken; and 
           (12) perform other duties authorized by advisory councils 
        under chapter 214, as directed by the board. 
           Sec. 7.  [147B.06] [PROFESSIONAL CONDUCT.] 
           Subdivision 1.  [PRACTICE STANDARDS.] (a) Before treatment 
        of a patient, an acupuncture practitioner shall ask whether the 
        patient has been examined by a licensed physician or other 
        professional, as defined by section 145.61, subdivision 2, with 
        regard to the patient's illness or injury, and shall review the 
        diagnosis as reported. 
           (b) The practitioner shall obtain informed consent from the 
        patient, after advising the patient of the following information 
        which must be supplied to the patient in writing before or at 
        the time of the initial visit: 
           (1) the practitioner's qualifications including: 
           (i) education; 
           (ii) license information; and 
           (iii) outline of the scope of practice of acupuncturists in 
        Minnesota; and 
           (2) side effects which may include the following: 
           (i) some pain in the treatment area; 
           (ii) minor bruising; 
           (iii) infection; 
           (iv) needle sickness; or 
           (v) broken needles. 
           (c) The practitioner shall obtain acknowledgment by the 
        patient in writing that the patient has been advised to consult 
        with the patient's primary care physician about the acupuncture 
        treatment if the patient circumstances warrant or the patient 
        chooses to do so. 
           (d) The practitioner shall inquire whether the patient has 
        a pacemaker or bleeding disorder. 
           Subd. 2.  [STERILIZED EQUIPMENT.] An acupuncture 
        practitioner shall use sterilized equipment that has been 
        sterilized under standards of the National Centers for Disease 
        Control and Prevention. 
        REGULATIONS.] An acupuncture practitioner shall comply with all 
        applicable state and municipal requirements regarding public 
           Subd. 4.  [SCOPE OF PRACTICE.] The scope of practice of 
        acupuncture includes, but is not limited to, the following: 
           (1) using Oriental medical theory to assess and diagnose a 
           (2) using Oriental medical theory to develop a plan to 
        treat a patient.  The treatment techniques that may be chosen 
           (i) insertion of sterile acupuncture needles through the 
           (ii) acupuncture stimulation including, but not limited to, 
        electrical stimulation or the application of heat; 
           (iii) cupping; 
           (iv) dermal friction; 
           (v) acupressure; 
           (vi) herbal therapies; 
           (vii) dietary counseling based on traditional Chinese 
        medical principles; 
           (viii) breathing techniques; or 
           (ix) exercise according to Oriental medical principles. 
           Subd. 5.  [PATIENT RECORDS.] An acupuncturist shall 
        maintain a patient record for each patient treated, including: 
           (1) a copy of the informed consent; 
           (2) evidence of a patient interview concerning the 
        patient's medical history and current physical condition; 
           (3) evidence of a traditional acupuncture examination and 
           (4) record of the treatment including points treated; and 
           (5) evidence of evaluation and instructions given to the 
        Referral to other health care practitioners is required when an 
        acupuncturist practitioner sees patients with potentially 
        serious disorders including, but not limited to: 
           (1) cardiac conditions including uncontrolled hypertension; 
           (2) acute, severe abdominal pain; 
           (3) acute, undiagnosed neurological changes; 
           (4) unexplained weight loss or gain in excess of 15 percent 
        of the body weight in less than a three-month period; 
           (5) suspected fracture or dislocation; 
           (6) suspected systemic infections; 
           (7) any serious undiagnosed hemorrhagic disorder; and 
           (8) acute respiratory distress without previous history. 
           The acupuncturist shall request a consultation or written 
        diagnosis from a licensed physician for patients with 
        potentially serious disorders. 
           Subd. 7.  [DATA PRACTICES.] Data maintained on an 
        acupuncture patient by an acupuncture practitioner is subject to 
        section 144.336. 
           Sec. 8.  [147B.07] [DISCIPLINE; REPORTING.] 
           For purposes of this chapter, acupuncturist licensees and 
        applicants are subject to the provisions of sections 147.091 to 
           Sec. 9.  [147B.08] [FEES.] 
           Subdivision 1.  [ANNUAL REGISTRATION FEE.] The board shall 
        establish the fee of $150 for initial licensure and $150 annual 
        licensure renewal.  The board may prorate the initial licensure 
           Subd. 2.  [PENALTY FEE FOR LATE RENEWALS.] The penalty fee 
        for late submission for renewal application is $50. 
           Subd. 3.  [DEPOSIT.] Fees collected by the board under this 
        section must be deposited in the state government special 
        revenue fund. 
           Sec. 10.  [INITIAL ADVISORY COUNCIL.] 
           (a) Notwithstanding Minnesota Statutes, section 147B.05, 
        the four members of the advisory council required by that 
        section to be acupuncture practitioners, who are appointed to 
        the initial advisory committee, need not be licensed under 
        Minnesota Statutes, section 147B.02, but must satisfy the 
        qualifications for licensure provided in section 147B.02, 
        subdivision 7, and must have been engaged in acupuncture 
        practice a minimum of three years. 
           (b) Two members of the initial advisory committee appointed 
        must have an initial term of one year, two members an initial 
        term of two years, and three members an initial term of three 
           Sec. 11.  [APPROPRIATION.] 
           $10,000 in fiscal year 1996 and $10,000 in fiscal year 1997 
        are appropriated from the state government special revenue fund 
        to the state board of medical practice to license acupuncture 
        practitioners under this act. 
           Sec. 12.  [EFFECTIVE DATE.] 
           This act is effective July 1, 1995. 
           Presented to the governor May 15, 1995 
           Signed by the governor May 17, 1995, 2:00 p.m.

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Revisor of Statutes