MISSISSIPPI LEGISLATURE

2018 Regular Session

To: Public Health and Welfare; Accountability, Efficiency, Transparency

By: Senator(s) Fillingane

Senate Bill 2749

AN ACT TO PROVIDE FOR THE LICENSING OF PRACTITIONERS OF NATUROPATHIC MEDICINE BY THE STATE BOARD OF MEDICAL LICENSURE; TO PROVIDE FOR CERTAIN DEFINITIONS; TO PROVIDE QUALIFICATIONS FOR LICENSURE; TO PROVIDE FOR THE SCOPE OF PRACTICE; TO PROVIDE CERTAIN PROHIBITIONS; TO PROVIDE CERTAIN EXEMPTIONS FROM THE LICENSE REQUIREMENT; TO PROVIDE CERTAIN DUTIES OF THE BOARD; TO PROVIDE FOR LICENSURE WITHOUT ADDITIONAL EXAMINATION; TO PROVIDE FOR LICENSE EXPIRATION AND RENEWAL; TO PROVIDE CERTAIN LICENSE FEES; TO PROVIDE CERTAIN DUTIES OF THE BOARD REGARDING INVESTIGATIONS, HEARINGS AND SUBPOENAS; TO CREATE A STUDY COMMITTEE ON NATUROPATHIC MEDICINE; TO AMEND SECTION 73-43-11, MISSISSIPPI CODE OF 1972, IN CONFORMITY; AND FOR RELATED PURPOSES.

     BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

     SECTION 1.  The following words, terms and phrases, as used in this act, shall have the following meanings ascribed to them except where the context clearly indicates a different meaning.

          (a)  "Board" means the State Board of Medical Licensure created under Section 73-43-1 et seq.

          (b)  "Director" means the Executive Director of the State Board of Medical Licensure.

          (c)  "Naturopathic medicine" means a system of primary health care for the prevention, diagnosis, and treatment of human health conditions, injury and disease; the promotion or restoration of health; and the support and stimulation of a patient's inherent self-healing processes through patient education and the use of naturopathic therapies and therapeutic substances.

          (d)  "Naturopathic physician" and all designations listed in Section 2 of this act means a practitioner of naturopathic medicine who has been properly licensed for that purpose by the board under this act.

          (e)  "Approved naturopathic medical program" means:

              (i)  A naturopathic medical education program in the United States providing the degree of Doctor of Naturopathy or Doctor of Naturopathic Medicine.  Such program shall offer graduate-level full-time didactic and supervised clinical training and shall be accredited, or has achieved candidacy status for accreditation by the Council on Naturopathic Medical Education (CNME) or an equivalent federally recognized accrediting body for naturopathic medical programs also recognized by the board.  Additionally, the program shall be an institution, or part of an institution of higher education that is either accredited or is a candidate for accreditation by a regional or national institutional accrediting agency recognized by the United States Secretary of Education;

              (ii)  A degree-granting college or university that, prior to the existence of the CNME, offered a full-time structured curriculum in basic sciences and supervised patient care comprising a doctoral naturopathic medical education.  The course, as a prerequisite to graduation therefrom, must have been not less than one hundred thirty-two (132) weeks in duration and required completion within a period of not less than thirty-five (35) months.  The college of naturopathic medicine must have been reputable and in good standing in the judgment of the board and, if still in existence, has current programmatic accreditation by the CNME or a federally recognized equivalent accrediting agency;

                     (iii)  A diploma-granting, degree-equivalent college or university that, if in Canada and prior to accreditation by the CNME, had provincial approval for participation in government funded student aid programs, and that offered a full-time structured curriculum in basic sciences and supervised patient care comprising a doctoral naturopathic medical education.  The course, as a prerequisite to graduation therefrom, must have been not less than one hundred thirty-two (132) weeks in duration and required completion within a period of not less than thirty-five (35) months.  The college of liberal arts and naturopathic medicine must have been reputable and in good standing in the judgment of the board and, if still in existence, has current programmatic accreditation by the CNME or a federally recognized equivalent accrediting agency.  Additionally, this college or university currently has provincial approval for participation in government funded student aid programs; or

              (iv)  A diploma-granting, degree-equivalent college or university in Canada that offers graduate-level full-time didactic and supervised clinical training and is accredited, or has achieved candidacy status for accreditation by the CNME or an equivalent federally recognized accrediting body for naturopathic medical programs also recognized by the board.  Additionally, this college or university must currently have provincial approval for participation in government funded student aid programs.

          (f)  "Prescription drug" means any drug defined by Section 21 USCS 503(b) of the federal Food, Drug and Cosmetic Act if its label is required to bear the statement "RX only."

          (g)  "Naturopathic childbirth attendance" means the specialty practice of natural childbirth by a naturopathic physician that includes the management of normal pregnancy, normal labor and delivery, and the normal postpartum period, including normal newborn care.

          (h)  "Minor office procedures" means the 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.

          (i)  "Naturopathic formulary" means the list of medicines, nonprescription and prescription, which naturopathic physicians use in the practice of their profession, as determined by the formulary council and reviewed by the board.

          (j)  "Naturopathic formulary council" means that council comprised of members appointed pursuant to this act to determine and authorize the formulary list.

     SECTION 2.  (1)  Persons represent themselves as practitioners of naturopathic medicine when they use or adopt any of the following designations:  "doctors of naturopathic medicine" or "doctors of naturopathy."  Licensees shall use the title "naturopathic physician" and the recognized abbreviation "N.D."  Naturopathic physicians shall have the exclusive right to use the terms "naturopathic physician," "naturopathic doctor," "naturopath," "doctor of naturopathic medicine," "doctor of naturopathy," "naturopathic medicine," "naturopathic health care," "naturopathy," "N.D.," "ND," "NMD" and "N.M.D."

     (2)  No person shall represent himself or herself to the public as a naturopathic physician, a doctor of naturopathic medicine, a doctor of naturopathy, or as being otherwise authorized to practice naturopathic medicine in this state without first obtaining from the board a license to practice naturopathic medicine pursuant to the provisions of this act.

     (3)  The titles and terms in subsection (2) of this section identify naturopathic physicians and are restricted to describing and identifying licensed practitioners.

     SECTION 3.  To be eligible for a license to practice naturopathic medicine in the State of Mississippi, the following shall be required of the applicant:

          (a)  Submission to the board the following:

              (i)  An application for licensure designed and approved by the board;

              (ii)  An application fee established by the board;

              (iii)  Evidence that the applicant is a graduate of an approved naturopathic medical program in accordance with the requirements specified in Section 1(e) of this act and that they have successfully passed a competency-based national naturopathic licensing examination administered by the North American Board of Naturopathic Examiners, or a successor agency that has been nationally recognized to administer a naturopathic examination that represents federal standards of education and training;

              (iv)  For graduates of approved naturopathic schools as defined in Section 1(e)(ii) and (iii) of this act, eligibility for licensure may be granted with evidence of successful passage of a board approved state competency examination or Canadian provincial examination.

          (b)  An applicant must be able to provide documentation that attests to their good, ethical and professional reputation.

          (c)  An applicant must be physically and mentally capable of safely practicing naturopathic medicine with or without reasonable accommodation.

          (d)  An applicant must not have had a license to practice naturopathic medicine or other health care license, registration or certificate refused, revoked or suspended by any other jurisdiction for reasons that relate to the applicant's ability to skillfully and safely practice naturopathic medicine unless that license, registration or certification has been restored to good standing by that jurisdiction.

     SECTION 4.  (1)  A naturopathic physician, under the general supervision of a physician licensed in Mississippi, may order and perform physical and laboratory examinations consistent with naturopathic education and training, for diagnostic purposes, including, but not limited to, phlebotomy, clinical laboratory tests, orificial examinations and physiological function tests.

     (2)  A naturopathic physician may order diagnostic imaging studies consistent with naturopathic training.

     (3)  A naturopathic physician may dispense, administer, order, and prescribe or perform the following:

          (a)  Food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and their extracts, botanical medicines, homeopathic medicines, all dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act;

          (b)  Prescription substances as determined by the Naturopathic Formulary Council;

          (c)  Hot or cold hydrotherapy, naturopathic physical medicine, electromagnetic energy, colon hydrotherapy, therapeutic exercise;

          (d)  Devices, including, but not limited to, therapeutic devices, barrier contraception, and durable medical equipment;

          (e)  Health education and health counseling;

          (f)  Repair and care incidental to superficial lacerations and abrasions; and

          (g)  Musculoskeletal manipulation consistent with naturopathic education and training.

     (4)  A naturopathic physician may utilize routes of administration that include oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, intravenous, and intramuscular consistent with the education and training of a naturopathic physician.

     (5)  A naturopathic physician may perform those therapies as trained and educated, and approved by the board.

     SECTION 5.  A naturopathic physician licensed under this act shall not:

          (a)  Prescribe, dispense or administer any controlled substances or device identified in the federal Controlled Substances Act, 21 USCS Sections 801 through 971, except as authorized by this act;

          (b)  Perform surgical procedures except those minor office procedures authorized by this act;

          (c)  Practice or claim to practice as a medical doctor, osteopath, dentist, podiatrist, optometrist, psychologist, advanced practice registered nurse, physician assistant, chiropractor, physical therapist, acupuncturist, or any other health care professional not authorized in this act unless licensed by the State of Mississippi to do so;

          (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 extending beyond superficial tissue;

          (h)  Perform chiropractic adjustments or musculoskeletal manipulation that fall within the practice of chiropractic as defined under Section 73-6-1;

          (i)  Perform acupuncture, unless licensed as an acupuncturist under the Acupuncture Practice Act, Section 73-71-1 et seq.

     SECTION 6.  Nothing in this act shall be construed to prohibit or to restrict the practice of a profession by individuals who are licensed, certified, or registered under other laws of this state who are performing services within their authorized scope of practice.

     SECTION 7.  (1)  The board may issue a license without additional examination to any applicant who submits an application for licensure together with the appropriate fee, proof acceptable to the board of current naturopathic medicine licensure in good standing in another state, the District of Columbia or territory of the United States, whose standards for licensure are at least equivalent to those of this state.

     (2)  Any applicant seeking a license without additional examination pursuant to this section shall provide proof of licensure in good standing in all states in which he or she is or has been licensed.

     SECTION 8.  (1)  Each license issued pursuant to this act, or renewed pursuant to this section, shall expire two (2) years following its issuance or last renewal.

     (2)  The director may renew the license of any licensee who, upon the expiration of his or her license:

          (a)  Has submitted an application for renewal;

          (b)  Has paid a renewal fee established by the board;

          (c)  Meets the qualifications for licensure set forth in this act; and

          (d)  Meets the continuing education requirements established by the board.

     (3)  Any person who practices naturopathic medicine or naturopathy after their license has been revoked and registration annulled shall be deemed to have practiced naturopathic medicine or naturopathy without a license.  However, at any time after six (6) months after the date of the conviction, the board may grant a license to the person affected, restoring to them all the rights and privileges of and pertaining to the practice of naturopathic medicine or naturopathy as defined and regulated by this act.  The fee shall be set by the board.

     (4)  Where the board proposes to refuse to issue or renew a license, or proposes to revoke or suspend a license, the licensee shall be afforded notice and an opportunity for a hearing in accordance with due process.

     SECTION 9.  The amount to be charged for any fee imposed under this act shall approximate and reasonably reflect all costs necessary to defray the expenses of the board.  A separate fee may be charged for each service or activity, but no fee shall be charged for an activity not specified in this act.  An application fee shall not be combined with any other fee or charge, except as specifically set forth herein.  At the beginning of each fiscal year the board shall compute, for each separate service or activity, the appropriate fee for the fiscal year.

     SECTION 10.  (1)  Any person may report to the board in writing any information the person has reason to believe indicates that a naturopathic physician is or may be medically or legally incompetent, engaged in the unauthorized practice of naturopathic medicine, guilty of unprofessional conduct, or mentally or physically unable to engage safely in the practice of naturopathic medicine.

     (2)  The following persons shall report to the board in writing any information the person has reason to believe indicates that a naturopathic physician is or may be medically or legally incompetent, engaged in the unauthorized practice of naturopathic medicine, guilty of unprofessional conduct, or mentally or physically unable to engage safely in the practice of naturopathic medicine, within thirty (30) days of becoming aware of such information:

          (a)  All naturopathic physicians licensed under this act;

          (b)  All licensed health care providers;

          (c)  All health care institutions in the state;

          (d)  All state agencies; and

          (e)  All law enforcement agencies in the state.

     (3)  A naturopathic physician's voluntary resignation from the staff of a health care institution, voluntary limitation of staff privileges, failure to reapply for hospital privileges at such an institution, shall be promptly reported to the board by the institution and the licensee if that action occurs while the licensee is under formal or informal investigation by the institution or a committee thereof for any reason related to possible medical incompetence, unprofessional conduct, or mental or physical impairment.

     (4)  Upon receiving a credible complaint or report concerning a licensee, or on its own motion, the board may investigate any evidence that appears to show a licensee is or may be medically incompetent, guilty of unprofessional conduct, or mentally or physically unable to engage safely in the practice of medicine.

     (5)  Any person, institution, agency, or organization required to report under this section who does so in good faith shall not be subject to civil damages or criminal prosecution for so reporting.

     (6)  Within ten (10) days of receipt thereof, the director shall acknowledge receipt of all reports required by this section and any complaint against a licensee submitted to the board. Within ten (10) days thereafter, the director shall inform any person or entity whose report or complaint has resulted in action by the board, of the final disposition of the matter.

     (7)  Any person or entity who fails to make a report required by this section may be assessed a reasonable administrative penalty by the board.  Assessment of an administrative penalty pursuant to this subsection shall be supported by substantial evidence and may be appealed to a court of competent jurisdiction of this state.  On appeal, the court may receive any relevant evidence supporting or opposing the assessment and may affirm or reverse the board's decision.

     SECTION 11.  (1)  The board shall establish a Naturopathic Advisory Committee to issue recommendations concerning the practice of naturopathic medicine in Mississippi based upon a review of naturopathic medical education and training in other states, and the proposed scope of practice of naturopathic medicine in Mississippi.

     (2)  The committee shall be composed of representation from each of the following to be appointed by the State Board of Medical Licensure not later than July 1, 2018:  one (1) physician licensed in Mississippi; one (1) certified nurse midwife; one (1) licensed naturopathic physician; the Chairman of the Senate Committee on Public Health and Welfare, or his designee, and the Chairman of the House Committee on Public Health and Human Services, or his designee.

     (3)  The committee shall meet upon the call of the board and shall make its recommendations to the 2019 Regular Session of the Legislature.

     (4)  The board shall provide administrative support for the committee.  The members shall receive no compensation for attending committee meetings except legislative members may receive expense reimbursement in the same manner as attending out-of-session committee meetings.

     SECTION 12.  Section 73-43-11, Mississippi Code of 1972, is amended as follows:

     73-43-11.  The State Board of Medical Licensure shall have the following powers and responsibilities:

          (a)  Setting policies and professional standards regarding the medical practice of physicians, osteopaths, podiatrists and physician assistants practicing with physician supervision;

          (b)  Considering applications for licensure;

          (c)  Conducting examinations for licensure;

          (d)  Investigating alleged violations of the Medical Practice Act;

          (e)  Conducting hearings on disciplinary matters involving violations of state and federal law, probation, suspension and revocation of licenses;

          (f)  Considering petitions for termination of probationary and suspension periods, and restoration of revoked licenses;

          (g)  To promulgate and publish reasonable rules and regulations necessary to enable it to discharge its functions and to enforce the provisions of law regulating the practice of medicine; however, the board shall not adopt any rule or regulation or impose any requirement regarding the licensing of physicians or osteopaths that conflicts with the prohibitions in Section 73-49-3;

          (h)  To enter into contracts with any other state or federal agency, or with any private person, organization or group capable of contracting, if it finds such action to be in the public interest and in the furtherance of its responsibilities;

          (i)  Perform the duties prescribed by Sections 73-26-1 through 73-26-5; * * *and

          (j)  Perform the duties prescribed by the Interstate Medical Licensure Compact, Section 73-25-101 * * *; and

          (k)  Perform the duties prescribed by this act relating to the licensure of individuals to practice naturopathic medicine in Mississippi.

     SECTION 13.  This act shall take effect and be in force from and after July 1, 2018.