Key: (1) language to be deleted (2) new language
relating to occupations and professions; providing for registration of naturopathic doctors; establishing an advisory council; appropriating money;
proposing coding for new law as Minnesota Statutes, chapter 147E.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
The definitions in this section apply to this chapter.
"Advisory council" means the Registered Naturopathic Doctor Advisory Council established under section 147E.35.
"Approved naturopathic medical education program" means a naturopathic medical education program in the United States or Canada and meets the requirements for accreditation by the Council on Naturopathic Medical Education (CNME) or an equivalent federally recognized accrediting body for the naturopathic medical profession recognized by the board. This program must offer graduate-level full-time didactic and supervised clinical training leading to the degree of Doctor of Naturopathy or Doctor of Naturopathic Medicine. The program must be an institution, or part of an institution, of higher education that at the time the student completes the program is:
(1) either accredited or is a candidate for accreditation by a regional institution accrediting agency recognized by the United States Secretary of Education; or
(2) a degree granting college or university that prior to the existence of CNME offered a full-time structured curriculum in basic sciences and supervised patient care comprising a doctoral naturopathic medical education that is at least 132 weeks in duration, must be completed in at least 35 months, and is reputable and in good standing in the judgment of the board.
"Board" means the Board of Medical Practice or its designee.
"Contact hour" means an instructional session of 50 consecutive minutes, excluding coffee breaks, registration, meals without a speaker, and social activities.
"Homeopathic preparations" means medicines prepared according to the Homeopathic Pharmacopoeia of the United States.
"Registered naturopathic doctor" means an individual registered under this chapter.
"Minor office procedures" means 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 such methods.
"Naturopathic licensing examination" means the Naturopathic Physicians Licensing Examination or its successor administered by the North American Board of Naturopathic Examiners or its successor as recognized by the board.
"Naturopathic medicine" means a system of primary health care for the prevention, assessment, and treatment of human health conditions, injuries, and diseases that uses:
(1) services, procedures, and treatments as described in section 147E.05; and
(2) natural health procedures and treatments in section 146A.01, subdivision 4.
"Naturopathic physical medicine" includes, but is not limited to, the therapeutic use of the physical agents of air, water, heat, cold, sound, light, and electromagnetic nonionizing radiation and the physical modalities of electrotherapy, diathermy, ultraviolet light, hydrotherapy, massage, stretching, colon hydrotherapy, frequency specific microcurrent, electrical muscle stimulation, transcutaneous electrical nerve stimulation, and therapeutic exercise.
(a) The practice of naturopathic medicine includes, but is not limited to, the following services:
(1) ordering, administering, prescribing, or dispensing for preventive and therapeutic purposes: food, extracts of food, nutraceuticals, vitamins, minerals, amino acids, enzymes, botanicals and their extracts, botanical medicines, herbal remedies, homeopathic medicines, dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act, glandulars, protomorphogens, lifestyle counseling, hypnotherapy, biofeedback, dietary therapy, electrotherapy, galvanic therapy, oxygen, therapeutic devices, barrier devices for contraception, and minor office procedures, including obtaining specimens to assess and treat disease;
(2) performing or ordering physical examinations and physiological function tests;
(3) ordering clinical laboratory tests and performing waived tests as defined by the United States Food and Drug Administration Clinical Laboratory Improvement Amendments of 1988 (CLIA);
(4) referring a patient for diagnostic imaging including x-ray, CT scan, MRI, ultrasound, mammogram, and bone densitometry to an appropriately licensed health care professional to conduct the test and interpret the results;
(5) prescribing nonprescription medications and therapeutic devices or ordering noninvasive diagnostic procedures commonly used by physicians in general practice; and
(6) prescribing or performing naturopathic physical medicine.
(b) A registered naturopathic doctor may admit patients to a hospital if the naturopathic doctor meets the hospital's governing body requirements regarding credentialing and privileging process.
(a) The practice of naturopathic medicine does not include:
(1) administering therapeutic ionizing radiation or radioactive substances;
(2) administering general or spinal anesthesia;
(3) prescribing, dispensing, or administering legend drugs or controlled substances including chemotherapeutic substances; or
(4) performing or inducing abortions.
(b) A naturopathic doctor registered under this chapter shall not perform surgical procedures using a laser device or perform surgical procedures beyond superficial tissue.
(c) A naturopathic doctor shall not practice or claim to practice as a medical doctor, surgeon, osteopath, dentist, podiatrist, optometrist, psychologist, advanced practice professional nurse, physician assistant, chiropractor, physical therapist, acupuncturist, dietician, nutritionist, or any other health care professional, unless the naturopathic physician also holds the appropriate license or registration for the health care practice profession.
(a) The registered naturopathic doctor shall obtain a signed informed consent from the patient prior to initiating treatment and after advising the patient of the naturopathic doctor's qualifications including education and registration information; and outlining of the scope of practice of registered naturopathic doctors in Minnesota. This information must be supplied to the patient in writing before or at the time of the initial visit. The registrant shall present treatment facts and options accurately to the patient or to the individual responsible for the patient's care and make treatment recommendations according to standards of good naturopathic medical practice.
(b) Upon request, the registered naturopathic doctor must provide a copy of the informed consent form to the board.
(a) A registered naturopathic doctor shall maintain a record for seven years 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 an examination and assessment;
(4) record of the treatment provided to the patient; and
(5) evidence of evaluation and instructions given to the patient, including acknowledgment by the patient in writing that, if deemed necessary by the registered naturopathic doctor, the patient has been advised to consult with another health care provider.
(b) A registered naturopathic doctor shall maintain the records of minor patients for seven years or until the minor's 19th birthday, whichever is longer.
All records maintained on a naturopathic patient by a registered naturopathic doctor are subject to sections 144.291 to 144.298.
Subd. 4. State and municipal public health regulations. A registered naturopathic doctor shall comply with all applicable state and municipal requirements regarding public health.
(a) No individual may use the title "registered naturopathic doctor," "naturopathic doctor," "doctor of naturopathic medicine," or use, in connection with the individual's name, the letters "R.N.D." or "N.M.D.," or any other titles, words, letters, abbreviations, or insignia indicating or implying that the individual is a registered naturopathic doctor unless the individual has been registered as a registered naturopathic doctor according to this chapter.
(b) After July 1, 2009, individuals who are registered under this chapter and who represent themselves as practicing naturopathic medicine by use of a term in paragraph (a) shall conspicuously display the registration in the place of practice.
Nothing in this chapter may be construed to prohibit or to restrict:
(1) the practice of a profession by individuals who are licensed, certified, or registered under other laws of this state and are performing services within their authorized scope of practice;
(2) the provision of the complementary and alternative healing methods and treatments, including naturopathy, as described in chapter 146A;
(3) the practice of naturopathic medicine by an individual licensed, registered, or certified in another state and 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;
(4) the practice by a naturopathic doctor duly licensed, registered, or certified in another state, territory, or the District of Columbia when incidentally called into this state for consultation with a Minnesota licensed physician or Minnesota registered naturopathic doctor; or
(5) individuals not registered by this chapter from the use of individual modalities which comprise the practice of naturopathic medicine.
A person violating subdivision 1 is guilty of a misdemeanor.
To be eligible for registration, an applicant must:
(1) submit a completed application on forms provided by the board along with all fees required under section 147E.40 that includes:
(i) the applicant's name, Social Security number, home address and telephone number, and business address and telephone number;
(ii) the name and location of the naturopathic medical program the applicant completed;
(iii) a list of degrees received from other educational institutions;
(iv) a description of the applicant's professional training;
(v) a list of registrations, certifications, and licenses held in other jurisdictions;
(vi) a description of any other jurisdiction's refusal to credential the applicant;
(vii) a description of all professional disciplinary actions initiated against the applicant in any jurisdiction; and
(viii) any history of drug or alcohol abuse, and any misdemeanor or felony conviction;
(2) submit a copy of a diploma from an approved naturopathic medical education program;
(3) have successfully passed the Naturopathic Physicians Licensing Examination, a competency-based national naturopathic licensing examination administered by the North American Board of Naturopathic Examiners or successor agency as recognized by the board; passing scores are determined by the Naturopathic Physicians Licensing Examination;
(4) submit additional information as requested by the board, including providing any additional information necessary to ensure that the applicant is able to practice with reasonable skill and safety to the public;
(5) sign a statement that the information in the application is true and correct to the best of the applicant's knowledge and belief; and
(6) sign a waiver authorizing the board to obtain access to the applicant's records in this or any other state in which the applicant has completed an approved naturopathic medical program or engaged in the practice of naturopathic medicine.
(a) To be eligible for registration by endorsement or reciprocity, the applicant must hold a current naturopathic license, registration, or certification in another state, Canadian province, the District of Columbia, or territory of the United States, whose standards for licensure, registration, or certification are at least equivalent to those of Minnesota, and must:
(1) submit the application materials and fees as required by subdivision 1, clauses (1), (2), and (4) to (6);
(2) have successfully passed either:
(i) the Naturopathic Physicians Licensing Examination; or
(ii) if prior to 1986, the state or provincial naturopathic board licensing examination required by that regulating state or province;
(3) provide a verified copy from the appropriate government body of a current license, registration, or certification for the practice of naturopathic medicine in another jurisdiction that has initial licensing, registration, or certification requirements equivalent to or higher than the requirements in subdivision 1; and
(4) provide letters of verification from the appropriate government body in each jurisdiction in which the applicant holds a license, registration, or certification. Each letter must state the applicant's name, date of birth, license, registration, or certification number, date of issuance, a statement regarding disciplinary actions, if any, taken against the applicant, and the terms under which the license, registration, or certification was issued.
(b) An applicant applying for license, registration, or certification by endorsement must be licensed, registered, or certified in another state or Canadian province prior to January 1, 2005, and have completed a 60-hour course and examination in pharmacotherapeutics.
The board may issue a temporary registration to practice as a registered naturopathic doctor to an applicant who is licensed, registered, or certified in another state or Canadian province and is eligible for registration under this section, if the application for registration is complete, all applicable requirements in this section have been met, and a nonrefundable fee has been paid. The temporary registration remains valid only until the meeting of the board at which time a decision is made on the registered naturopathic doctor's application for registration.
Registrations issued under this chapter expire annually.
(a) To be eligible for registration renewal a registrant must:
(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 of a total of 25 hours of continuing education approved by the board as described in section 147E.25; and
(4) 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 nullified.
A registrant who changes addresses must inform the board within 30 days, in writing, of the change of address. All notices or other correspondence mailed to or served on a registrant by the board are considered as having been received by the registrant.
At least 45 days before the registration renewal date, the board shall send out a renewal notice to the last known address of the registrant on file. The notice must include a renewal application and a notice of fees required for renewal or instructions for online renewal. It must also inform the registrant that registration will expire without further action by the board if an application for registration renewal is not received before the deadline for renewal. The registrant's failure to receive this notice does not relieve the registrant of the obligation to meet the deadline and other requirements for registration renewal. Failure to receive this notice is not grounds for challenging expiration of registration status.
The renewal application and fee must be postmarked on or before December 31 of the year of renewal. If the postmark is illegible, the application is considered timely if received by the third working day after the deadline.
(a) A registrant may be placed in inactive status upon application to the board by the registrant and upon payment of an inactive status fee.
(b) Registrants seeking restoration to active from inactive status must pay the current renewal fees and all unpaid back inactive fees. They must meet the criteria for renewal specified in subdivision 5, including continuing education hours.
(c) Registrants whose inactive status period has been five years or longer must additionally have a period of no less than eight weeks of advisory council-approved supervision by another registered naturopathic doctor.
For any individual whose registration status has lapsed for two years or less, to regain registration status, the individual must:
(1) apply for registration renewal according to subdivision 5;
(2) document compliance with the continuing education requirements of section 147E.25 since the registrant's initial registration or last renewal; and
(3) submit the fees required under section 147E.40 for the period not registered, including the fee for late renewal.
The board shall not renew, reissue, reinstate, or restore a registration that has lapsed and has not been renewed within two annual registration renewal cycles starting January 2009. A registrant whose registration is canceled for nonrenewal must obtain a new registration by applying for registration and fulfilling all requirements then in existence for initial registration as a registered naturopathic doctor.
(a) A registrant holding an active registration as a registered naturopathic doctor in the state may, upon approval of the board, be granted registration cancellation if the board is not investigating the person as a result of a complaint or information received or if the board has not begun disciplinary proceedings against the registrant. Such action by the board must be reported as a cancellation of registration in good standing.
(b) A registrant who receives board approval for registration cancellation is not entitled to a refund of any registration fees paid for the registration year in which cancellation of the registration occurred.
(c) To obtain registration after cancellation, a registrant must obtain a new registration by applying for registration and fulfilling the requirements then in existence for obtaining initial registration as a registered naturopathic doctor.
A registrant may change the status of the registration to "emeritus" by filing the appropriate forms and paying the onetime fee of $50 to the board. This status allows the registrant to retain the title of registered naturopathic doctor but restricts the registrant from actively seeing patients.
(a) The board shall act on each application for registration according to paragraphs (b) to (d).
(b) The board shall determine if the applicant meets the requirements for registration under section 147E.15. The board or advisory council may investigate information provided by an applicant to determine whether the information is accurate and complete.
(c) The board shall notify each applicant in writing of action taken on the application, the grounds for denying registration if registration is denied, and the applicant's right to review under paragraph (d).
(d) Applicants denied registration may make a written request to the board, within 30 days of the board's notice, to appear before the advisory council or the board and for the advisory council to review the board's decision to deny the applicant's registration. After reviewing the denial, the advisory council shall make a recommendation to the board as to whether the denial shall be affirmed. Each applicant is allowed only one request for review each yearly registration period.
(a) A registrant applying for registration renewal must complete a minimum of 25 contact hours of board-approved continuing education in the year preceding registration renewal, with the exception of the registrant's first incomplete year, and attest to completion of continuing education requirements by reporting to the board.
(b) Of the 25 contact hours of continuing education requirement in paragraph (a), at least five hours of continuing education must be in pharmacotherapeutics.
The board shall approve continuing education programs that have been approved for continuing education credit by the American Association of Naturopathic Physicians or any of its constituent state associations, the American Chiropractic Association or any of its constituent state associations, the American Osteopathic Association Bureau of Professional Education, the American Pharmacists Association or any of its constituent state associations, or an organization approved by the Accreditation Council for Continuing Medical Education.
The board shall also approve continuing education programs that do not meet the requirements of subdivision 2 but meet the following criteria:
(1) the program content directly relates to the practice of naturopathic medicine;
(2) each member of the program faculty is knowledgeable in the subject matter as demonstrated by a degree from an accredited education program, verifiable experience in the field of naturopathic medicine, special training in the subject matter, or experience teaching in the subject area;
(3) the program lasts at least 50 minutes per contact hour;
(4) there are specific, measurable, written objectives, consistent with the program, describing the expected outcomes for the participants; and
(5) the program sponsor has a mechanism to verify participation and maintains attendance records for three years.
A registrant may not apply contact hours acquired in one one-year reporting period to a future continuing education reporting period.
The board shall periodically select a random sample of registrants and require those registrants to supply the board with evidence of having completed the continuing education to which they attested. Documentation may come directly from the registrants from state or national organizations that maintain continuing education records.
Continuing education program topics may include, but are not limited to, naturopathic medical theory and techniques including diagnostic techniques, nutrition, botanical medicine, homeopathic medicine, physical medicine, lifestyle modification counseling, anatomy, physiology, biochemistry, pharmacology, pharmacognosy, microbiology, medical ethics, psychology, history of medicine, and medical terminology or coding.
(a) A registrant may apply no more than five hours of practice management to a one-year reporting period.
(b) A registrant may apply no more than 15 hours to any single subject area.
The board may exempt any person holding a registration under this chapter from the requirements of subdivision 1 upon application showing evidence satisfactory to the board of inability to comply with the requirements because of physical or mental condition or because of other unusual or extenuating circumstances. However, no person may be exempted from the requirements of subdivision 1 more than once in any five-year period.
For purposes of this chapter, registered naturopathic doctors and applicants are subject to sections 147.091 to 147.162.
The board shall appoint a seven-member Registered Naturopathic Doctor Advisory Council consisting of one public member as defined in section 214.02, five registered naturopathic doctors who are residents of the state, and one licensed physician or osteopath with expertise in natural medicine.
The advisory council shall be organized and administered under section 15.059. Section 15.059, subdivision 2, does not apply to this section. Members shall serve two-year terms, and shall serve until their successors have been appointed. The council shall select a chair from its membership.
The advisory council shall:
(1) advise the board regarding standards for registered naturopathic doctors;
(2) provide for distribution of information regarding registered naturopathic doctors standards;
(3) advise the board on enforcement of sections 147.091 to 147.162;
(4) review applications and recommend granting or denying registration or registration renewal;
(5) advise the board on issues related to receiving and investigating complaints, conducting hearings, and imposing disciplinary action in relation to complaints against registered naturopathic doctors;
(6) advise the board regarding approval of continuing education programs using the criteria in section 147E.25, subdivision 3; and
(7) perform other duties authorized for advisory councils by chapter 214, as directed by the board.
Notwithstanding section 15.059, the advisory council is permanent and does not expire.
Fees are as follows:
(1) registration application fee, $200;
(2) renewal fee, $150;
(3) late fee, $75;
(4) inactive status fee, $50; and
(5) temporary permit fee, $25.
The board may prorate the initial annual registration fee. All registrants are required to pay the full fee upon registration renewal.
An application for registration renewal submitted after the deadline must be accompanied by a late fee in addition to the required fees.
All of the fees in subdivision 1 are nonrefundable.
The appointments required under Minnesota Statutes, section 147E.35, must be completed by August 1, 2009. The Board of Medical Practice shall designate a member to convene the first meeting of the advisory council. For the purposes of the first appointments under Minnesota Statutes, section 147E.35, subdivision 1, a person who is eligible to apply for registration as a naturopathic doctor under Minnesota Statutes, section 147E.15, may be appointed as a registered naturopathic doctor. If the appointee fails to submit a timely application for registration or if the appointee's application is rejected, the board must remove the appointee from the council and appoint a successor.
By September 1, 2008, the commissioner of health shall convene a work group to develop recommendations and proposed legislation, as necessary, on regulating naturopathic practitioners who are practicing as naturopathic medical doctors or physicians and who have postgraduate degrees in naturopathic medicine. The recommendations must ensure the continued practice of traditional naturopathy by traditional naturopaths under Minnesota Statutes, chapter 146A. The recommendations shall include the following issues:
(1) the appropriate level of regulation for practitioners with a postgraduate degree in naturopathic medicine;
(2) the definitions to be used for the recommended regulatory scheme to ensure the distinction between the practice of naturopathic medicine and the practice of traditional naturopathy;
(3) the level of education and training, including appropriate credentialing of educational programs for the postgraduate degree level of practice;
(4) the scope of practice for naturopathic practitioners with a postgraduate degree in naturopathic medicine that would be exclusive to these practitioners and would reflect the level of education and training. The scope of practice must acknowledge and ensure the continued practice of all complementary and alternative health practices, including naturopathy, currently practiced under Minnesota Statutes, chapter 146A;
(5) the appropriate regulatory authority, including the possible establishment of a new regulatory board; and
(6) any other regulatory requirements for naturopathic medicine the work group deems necessary.
(a) The work group shall consist of the following members:
(1) three members appointed by the commissioner from organizations representing naturopathic physicians;
(2) three members appointed by the commissioner from organizations representing traditional naturopaths;
(3) one member appointed by the Acupuncture Association of Minnesota;
(4) one member appointed by the Minnesota Chiropractic Association;
(5) one member appointed by the Minnesota Medical Association; and
(6) one member appointed by the Office of Complementary and Alternative Medicine who does not practice as a traditional naturopath.
(b) The appointing authorities under paragraph (a) must complete their appointments no later than July 15, 2008. The commissioner's designee shall chair the meetings and provide staff support and meeting space for the work group. The members serve without compensation or reimbursement for any expenses.
In developing its recommendations, the work group shall review regulatory systems of the practice of naturopathy in other states. The work group shall base its recommendations on regulatory strategies that protect the public. The work group shall complete its recommendations by December 15, 2008, and the commissioner shall submit a report containing the work group's recommendations and proposed legislation to the chairs and ranking minority members of the legislative committees with jurisdiction over health care by January 15, 2009.
The work group shall expire on the date the report required under subdivision 3 is submitted to the specified legislative members.
This section is effective the day following final enactment.
(a) $8,000 in fiscal year 2009 is appropriated from the state government special revenue fund to the Board of Medical Practice for the registration of naturopathic doctors under Minnesota Statutes, chapter 147E.
(b) $25,000 in fiscal year 2009 is appropriated from the state government special revenue fund to the commissioner of health for the naturopathy work group. This is a onetime appropriation.
Sections 1 to 11 and 13 are effective July 1, 2009.
Presented to the governor May 19, 2008
Signed by the governor May 23, 2008, 11:55 a.m.