Senator Michael S. Kennedy proposes the following substitute bill:


1     
NATUROPATHIC PHYSICIAN AMENDMENTS

2     
2022 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Michael S. Kennedy

5     
House Sponsor: James A. Dunnigan

6     

7     LONG TITLE
8     General Description:
9          This bill modifies the prescribing authority of naturopathic physicians.
10     Highlighted Provisions:
11          This bill:
12          ▸     describes what categories of prescription drugs a naturopathic physician may
13     prescribe;
14          ▸     allows the Division of Occupational and Professional Licensing to determine
15     whether a naturopathic physician may prescribe newly created prescription drug
16     categories;
17          ▸     repeals the naturopathic formulary peer committee; and
18          ▸     makes technical changes.
19     Money Appropriated in this Bill:
20          None
21     Other Special Clauses:
22          None
23     Utah Code Sections Affected:
24     AMENDS:
25          58-71-102, as last amended by Laws of Utah 2014, Chapter 110
26          58-71-804, as last amended by Laws of Utah 2009, Chapter 42
27     ENACTS:
28          58-71-203, Utah Code Annotated 1953
29     REPEALS:
30          58-71-202, as last amended by Laws of Utah 2014, Chapter 110
31     

32     Be it enacted by the Legislature of the state of Utah:
33          Section 1. Section 58-71-102 is amended to read:
34          58-71-102. Definitions.
35          In addition to the definitions in Section 58-1-102, as used in this chapter:
36          (1) "Acupuncture" [has the same definition as] means the same as that term is defined
37     in Section 58-72-102.
38          (2) "Administrative penalty" means a monetary fine imposed by the division for acts or
39     omissions determined to constitute unprofessional or unlawful conduct, as a result of an
40     adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
41     Procedures Act.
42          (3) "Board" means the Naturopathic Physicians Licensing Board created in Section
43     58-71-201.
44          (4) "Controlled substance" means the same as that term is defined in Section 58-37-2.
45          [(4)] (5) "Diagnose" means:
46          (a) to examine in any manner another [person, parts of a person's] individual, parts of
47     an individual's body, substances, fluids, or materials excreted, taken, or removed from [a
48     person's] an individual's body, or produced by [a person's] an individual's body, to determine
49     the source, nature, kind, or extent of a disease or other physical or mental condition;
50          (b) to attempt to conduct an examination or determination described under Subsection
51     [(4)] (5)(a);
52          (c) to hold oneself out as making or to represent that one is making an examination or
53     determination as described in Subsection [(4)] (5)(a); or
54          (d) to make an examination or determination as described in Subsection [(4)] (5)(a)
55     upon or from information supplied directly or indirectly by another [person] individual,
56     whether or not in the presence of the [person making or attempting the diagnosis or
57     examination] individual the examination or determination concerns.
58          [(5)] (6) "Local anesthesia" means an agent, whether a natural medicine or
59     nonscheduled prescription drug, which:
60          (a) is applied topically or by injection associated with the performance of minor office
61     procedures;
62          (b) has the ability to produce loss of sensation [at the site of minor office procedures;
63     and] to a targeted area of an individual's body;
64          (c) does not cause loss of consciousness or produce general sedation[.]; and
65          (d) is part of the competent practice of naturopathic medicine during minor office
66     procedures.
67          [(6)] (7) "Medical naturopathic assistant" means an unlicensed individual working
68     under the direct and immediate supervision of a licensed naturopathic physician and engaged in
69     specific tasks assigned by the licensed naturopathic physician in accordance with the standards
70     and ethics of the profession.
71          [(7)] (8) (a) "Minor office procedures" means:
72          (i) the use of operative, electrical, or other methods for repair and care of superficial
73     lacerations, abrasions, and benign lesions;
74          (ii) removal of foreign bodies located in the superficial tissues, excluding the eye or
75     ear;
76          (iii) the use of antiseptics and local anesthetics in connection with minor office surgical
77     procedures; and
78          (iv) [if approved by the United States Food and Drug Administration,] percutaneous
79     injection into skin, tendons, ligaments, muscles, and joints with:
80          [(A) local anesthetics and nonscheduled prescription medications; and]
81          (A) local anesthesia or a prescription drug described in Subsection (9)(d); or
82          (B) natural substances.
83          (b) "Minor office procedures" does not include:
84          (i) general or spinal anesthesia;
85          (ii) office procedures more complicated or extensive than those set forth in Subsection
86     [(7)] (8)(a);
87          (iii) procedures involving the eye; and
88          (iv) any office procedure involving [tendons,] nerves, veins, or arteries.
89          [(8)] (9) "Natural medicine" means any:
90          [(a) food, food extracts, dietary supplements as defined by the federal Food, Drug, and
91     Cosmetics Act, all homeopathic remedies, and plant substances that are not designated as
92     prescription drugs or controlled substances;]
93          (a) food, food extract, dietary supplement as defined by the Federal Food, Drug, and
94     Cosmetic Act, 21 U.S.C. Sec. 301 et seq., homeopathic remedy, or plant substance that is not
95     designated a prescription drug or controlled substance;
96          (b) over-the-counter [medications] medication;
97          (c) other nonprescription [substances] substance, the prescription or administration of
98     which is not otherwise prohibited or restricted under federal or state law; or
99          [(d) prescription drugs:]
100          [(i) that, except as provided in Subsection (8)(e), are not controlled substances as
101     defined in Section 58-37-2;]
102          [(ii) the prescription of which is consistent with the competent practice of naturopathic
103     medicine; and]
104          [(iii) the prescription of which is approved by the division in collaboration with the
105     naturopathic formulary advisory peer committee; and]
106          [(e) testosterone, if the testosterone is:]
107          [(i) bio-identical;]
108          [(ii) designed to be:]
109          [(A) administered topically, for transdermal absorption; or]
110          [(B) absorbed across the mucosal membranes of the mouth; and]
111          [(iii) prescribed or administered, in accordance with the requirements of federal and
112     state law, solely for the purpose of treating a patient with a low testosterone level in order to
113     restore the patient to a normal testosterone level.]
114          (d) prescription drug:
115          (i) the prescription of which is consistent with the competent practice of naturopathic
116     medicine;
117          (ii) that is not a controlled substance except for testosterone; and
118          (iii) that is not any of the following as determined by the federal Food and Drug
119     Administration's general drug category list:
120          (A) an anticoagulant for the management of a bleeding disorder;
121          (B) an anticonvulsant;
122          (C) an antineoplastic;
123          (D) an antipsychotic;
124          (E) a barbiturate;
125          (F) a cytotoxic;
126          (G) a sedative;
127          (H) a sleeping drug;
128          (I) a tranquilizer; or
129          (J) any drug category added after April 1, 2022, unless the division determines the drug
130     category to be consistent with the practice of naturopathic medicine under Section 58-71-203.
131          [(9)] (10) (a) "Naturopathic childbirth" means uncomplicated natural childbirth assisted
132     by a naturopathic physician[, and includes the use of:].
133          (b) "Naturopathic childbirth" includes the use of:
134          (i) natural medicines; and
135          (ii) uncomplicated episiotomy.
136          [(b)] (c) "Naturopathic childbirth" does not include the use of:
137          (i) forceps delivery;
138          (ii) general or spinal anesthesia;
139          (iii) caesarean section delivery; or
140          (iv) induced labor or abortion.
141          [(10)] (11) (a) "Naturopathic mobilization therapy[": (a)] means manually
142     administering mechanical treatment of body structures or tissues for the purpose of restoring
143     normal physiological function to the body by normalizing and balancing the musculoskeletal
144     system of the body;
145          (b) "Naturopathic mobilization therapy" does not mean manipulation or adjustment of
146     the joints of the human body beyond the elastic barrier; and
147          (c) "Naturopathic mobilization therapy" does not include manipulation as used in Title
148     58, Chapter 73, Chiropractic Physician Practice Act.
149          [(11)] (12) (a) "Naturopathic physical medicine" means the use of the physical agents
150     of air, water, heat, cold, sound, light, and electromagnetic nonionizing radiation, and the
151     physical modalities of electrotherapy, acupuncture, diathermy, ultraviolet light, ultrasound,
152     hydrotherapy, naturopathic mobilization therapy, and exercise.
153          (b) "Naturopathic physical medicine" does not include the practice of physical therapy
154     or physical rehabilitation.
155          [(12)] (13) "Practice of naturopathic medicine" means:
156          (a) a system of primary health care for the prevention, diagnosis, and treatment of
157     human health conditions, injuries, and diseases that uses education, natural medicines, and
158     natural therapies, to support and stimulate the patient's intrinsic self-healing processes:
159          (i) using naturopathic childbirth, but only if:
160          (A) the licensee meets standards of the American College of Naturopathic
161     Obstetricians (ACNO) or [its] ACNO's successor as determined by the division in collaboration
162     with the board; and
163          (B) the licensee follows a written plan for naturopathic physicians practicing
164     naturopathic childbirth approved by the division in collaboration with the board, which
165     includes entering into an agreement with a consulting physician and surgeon or osteopathic
166     physician, in cases where the scope of practice of naturopathic childbirth may be exceeded and
167     specialty care and delivery is indicated, detailing the guidelines by which the naturopathic
168     physician will:
169          (I) refer patients to the consulting physician; and
170          (II) consult with the consulting physician;
171          (ii) using naturopathic mobilization therapy;
172          (iii) using naturopathic physical medicine;
173          (iv) using minor office procedures;
174          (v) prescribing or administering natural medicine;
175          (vi) prescribing medical equipment and devices, diagnosing by the use of medical
176     equipment and devices, and administering therapy or treatment by the use of medical devices
177     necessary and consistent with the competent practice of naturopathic medicine;
178          (vii) prescribing barrier devices for contraception;
179          (viii) using dietary therapy;
180          (ix) taking and using diagnostic x-rays, electrocardiograms, ultrasound, and
181     physiological function tests;
182          (x) taking of body fluids for clinical laboratory tests and using the results of the tests in
183     diagnosis;
184          (xi) taking of a history from and conducting of a physical examination upon a human
185     patient; and
186          [(xii) prescribing and administering natural medicines and medical devices, except a
187     naturopathic physician may only administer:]
188          [(A) a prescription drug, as defined in Section 58-17b-102, in accordance with
189     Subsection (8)(d); and]
190          [(B) local anesthesia that is not a controlled substance, and only in the performance of
191     minor office procedures;]
192          (xii) administering local anesthesia during the performance of a minor office
193     procedure.
194          (b) to maintain an office or place of business for the purpose of doing any of the acts
195     described in Subsection [(12)] (13)(a), whether or not for compensation; or
196          (c) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
197     treatment of human diseases or conditions, in any printed material, stationery, letterhead,
198     envelopes, signs, or advertisements, the designation "naturopathic physician," "naturopathic
199     doctor," "naturopath," "doctor of naturopathic medicine," "doctor of naturopathy,"
200     "naturopathic medical doctor," "naturopathic medicine," "naturopathic health care,"
201     "naturopathy," "N.D.," "N.M.D.," or any combination of these designations in any manner that
202     might cause a reasonable person to believe the individual using the designation is a licensed
203     naturopathic physician.
204          [(13)] (14) "Prescribe" means to issue a prescription:
205          (a) orally or in writing; or
206          (b) by telephone, facsimile transmission, computer, or other electronic means of
207     communication as defined by division rule.
208          [(14)] (15) "Prescription device" means an instrument, apparatus, implement, machine,
209     contrivance, implant, in vitro reagent, or other similar or related article, and any component
210     part or accessory, which is required under federal or state law to be prescribed by a practitioner
211     and dispensed by or through a person [or entity] licensed under this chapter or exempt from
212     licensure under this chapter.
213          [(15)] (16) "Prescription drug" means a drug that is required by federal or state law or
214     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
215          [(16)] (17) "Unlawful conduct" [is as defined in] means the same as that term is
216     defined in Sections 58-1-501 and 58-71-501.
217          [(17)] (18) "Unprofessional conduct" [is as defined in] means the same as that term is
218     defined in Sections 58-1-501 and 58-71-502, and as may be further defined by division rule.
219          Section 2. Section 58-71-203 is enacted to read:
220          58-71-203. Drug category review.
221          (1) As used in this section, "FDA" means the federal Food and Drug Administration.
222          (2) After April 1, 2022, if the FDA adds a new drug category to the FDA's general drug
223     category list, the division shall determine whether the drug category is consistent with the
224     practice of naturopathic medicine.
225          (3) To make the determination described in Subsection (2), the division shall consult
226     with:
227          (a) the board; and
228          (b) the board described in Section 58-67-201.
229          (4) In accordance with Title 63, Part 3, Utah Administrative Rulemaking Act, the
230     division shall make rules to implement this section.
231          Section 3. Section 58-71-804 is amended to read:
232          58-71-804. Insurance coverage not mandated.
233          (1) This chapter does not mandate health insurance coverage for naturopathic medical
234     services.
235          (2) This chapter does not establish a class of health care providers for the purposes of
236     Section 31A-22-618.
237          (3) This chapter does not mandate health insurance coverage for the prescription or
238     administration of testosterone[, as described in Subsection 58-71-102(8)(e),] by a naturopathic
239     physician.
240          Section 4. Repealer.
241          This bill repeals:
242          Section 58-71-202, Naturopathic formulary peer committee.