Amendment ASA1-AB529

AB529-ASA1,10,15 448.56 (1) Written referral. Except as provided in this subsection and s. 448.52, a person may practice physical therapy only upon the written referral of a physician, naturopathic doctor, physician assistant, chiropractor, dentist, podiatrist, or advanced practice nurse prescriber certified under s. 441.16 (2). Written referral is not required if a physical therapist provides services in schools to children with disabilities, as defined in s. 115.76 (5), pursuant to rules promulgated by the department of public instruction; provides services as part of a home health care agency; provides services to a patient in a nursing home pursuant to the patient's plan of care; provides services related to athletic activities, conditioning, or injury prevention; or provides services to an individual for a previously diagnosed medical condition after informing the individual's physician, naturopathic doctor, physician assistant, chiropractor, dentist, podiatrist, or advanced practice nurse prescriber certified under s. 441.16 (2) who made the diagnosis. The examining board may promulgate rules establishing additional services that are excepted from the written referral requirements of this subsection.

AB529-ASA1,31 Section 31 . 448.56 (1m) (b) of the statutes is amended to read:

AB529-ASA1,10,22 448.56 (1m) (b) The examining board shall promulgate rules establishing the requirements that a physical therapist must satisfy if a physician, naturopathic doctor, physician assistant, chiropractor, dentist, podiatrist, or advanced practice nurse prescriber makes a written referral under sub. (1). The purpose of the rules shall be to ensure continuity of care between the physical therapist and the health care practitioner.

AB529-ASA1,32 Section 32 . 450.03 (1) (e) of the statutes is amended to read:

AB529-ASA1,11,5 450.03 (1) (e) Any person lawfully practicing within the scope of a license, permit, registration, certificate, or certification granted to provide home medical oxygen under s. 450.076, to practice professional or practical nursing or nurse-midwifery under ch. 441, to practice dentistry or dental hygiene under ch. 447, to practice medicine and surgery under ch. 448, to practice optometry under ch. 449, to practice naturopathic medicine under ch. 466, or to practice veterinary medicine under ch. 89, or as otherwise provided by statute.

AB529-ASA1,33 Section 33 . 450.10 (3) (a) 12. of the statutes is created to read:

AB529-ASA1,11,8 450.10 (3) (a) 12. A naturopathic doctor or limited-scope naturopathic doctor licensed under ch. 466.

AB529-ASA1,34 Section 34 . 462.04 of the statutes is amended to read:

AB529-ASA1,11,18 462.04 Prescription or order required. A person who holds a license or limited X-ray machine operator permit under this chapter may not use diagnostic X-ray equipment on humans for diagnostic purposes unless authorized to do so by prescription or order of a physician licensed under s. 448.04 (1) (a), a naturopathic doctor licensed under s. 466.04 (1), a dentist licensed under s. 447.04 (1), a podiatrist licensed under s. 448.63, a chiropractor licensed under s. 446.02, an advanced practice nurse certified under s. 441.16 (2), a physician assistant licensed under s. 448.04 (1) (f), or, subject to s. 448.56 (7) (a), a physical therapist who is licensed under s. 448.53 or who holds a compact privilege under subch. IX of ch. 448.

AB529-ASA1,35 Section 35 . Chapter 466 of the statutes is created to read:

AB529-ASA1,11,20 chapter 466

AB529-ASA1,11,21 naturopathic DOCTORS

AB529-ASA1,11,22 466.01 Definitions. In this chapter:

AB529-ASA1,11,23 (1) “Board" means the naturopathic medicine examining board.

AB529-ASA1,11,24 (2) “Drug” has the meaning given in s. 450.01 (10).

AB529-ASA1,12,2 (3) “Limited-scope naturopathic doctor" means an individual licensed under s. 466.04 (2).

AB529-ASA1,12,5 (4) “Minor office procedure" includes the methods for the repair and care incidental to superficial lacerations, superficial abrasions, and superficial lesions and the removal of foreign bodies located in the superficial tissues.

AB529-ASA1,12,6 (5) “Naturopathic doctor" means an individual licensed under s. 466.04 (1).

AB529-ASA1,12,12 (6) (a) “Naturopathic medicine” means, except as provided in par. (c), 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, including all of the following:

AB529-ASA1,12,15 1. Ordering and performing physical and laboratory examinations, for diagnostic purposes, consistent with naturopathic education and training, including all of the following:

AB529-ASA1,12,16 a. Diagnostic or evaluation methods.

AB529-ASA1,12,17 b. Physical examinations.

AB529-ASA1,12,18 c. Clinical laboratory tests.

AB529-ASA1,12,19 d. Diagnostic sonography.

AB529-ASA1,12,20 e. Electrocardiography.

AB529-ASA1,12,21 f. Phlebotomy.

AB529-ASA1,12,22 2. Ordering diagnostic imaging studies.

AB529-ASA1,12,23 3. Dispensing, administering, ordering, or performing any of the following:

AB529-ASA1,12,24 a. Health education and health counseling.

AB529-ASA1,13,2 b. Food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanical medicines, homeopathic medicines, and dietary supplements.

AB529-ASA1,13,4 c. Hot or cold hydrotherapy, naturopathic physical medicine, the use of therapeutic medical equipment, and therapeutic exercise.

AB529-ASA1,13,6 d. Devices, including therapeutic devices, barrier contraception, and durable medical equipment.

AB529-ASA1,13,8 4. Recommending, dispensing, and administering nonprescription drug products.

AB529-ASA1,13,9 5. Performing minor office procedures.

AB529-ASA1,13,13 6. Signing and attesting to any certificates, cards, forms or other required documentation that a physician may sign, so long as it is within the naturopathic doctor's scope of practice. This subdivision does not supersede any federal or state statute, rule, or regulation.

AB529-ASA1,13,16 (b) “Naturopathic medicine” includes ordering or performing any other diagnostic, therapeutic, or other procedure or practice identified in rules promulgated rule under s. 466.03 (2) (a).

AB529-ASA1,13,17 (c) “Naturopathic medicine” does not include any of the following:

AB529-ASA1,13,18 1. Performing any surgical procedure other than a minor office procedure.

AB529-ASA1,13,19 2. Using general or spinal anesthetics.

AB529-ASA1,13,20 3. Administering ionizing radioactive substances for therapeutic purposes.

AB529-ASA1,13,22 4. Performing surgical procedures involving the eye, ear, tendons, nerves, veins, or arteries that extend beyond superficial tissue.

AB529-ASA1,13,25 5. Performing any procedure or practice that is prohibited by the board by rule under s. 466.03 (2) (a) or that is excluded from the definition of naturopathic physical medicine under sub. (7) (b).

AB529-ASA1,14,2 (d) “Naturopathic medicine” is distinct from the practice of medicine and surgery, as defined in s. 448.01 (9).

AB529-ASA1,14,7 (7) (a) “Naturopathic physical medicine” includes, except as provided in par. (b), manually administering mechanical treatment of body structures or tissues for the purpose of restoring normal physiological function to the body by normalizing and balancing the musculoskeletal system of the body, such as massage, stretching, resistance, or joint play examination.

AB529-ASA1,14,8 (b) “Naturopathic physical medicine” does not include any of the following:

AB529-ASA1,14,10 1. The employment or application of chiropractic or spinal adjustments and the principles or techniques of chiropractic science as described in s. 446.01 (2) (b).

AB529-ASA1,14,13 2. The manipulation or adjustment of the spine or extremity joints of the human body beyond the elastic barrier, including small amplitude movement at or beyond the end range of normal joint motion.

AB529-ASA1,14,14 (8) “Nonprescription drug product" has the meaning given in s. 450.01 (13m).

AB529-ASA1,14,18 466.02 License required; use of titles. (1) (a) Except as provided in subs. (2) (a) and (b) and (3), no person may practice naturopathic medicine or make a representation that he or she is authorized to do so unless the person is licensed under this chapter.

AB529-ASA1,15,3 (b) 1. Except as provided in subs. (2) (b) and (3), no person may designate himself or herself as a naturopathic doctor or doctor of naturopathic medicine; use or assume the title “naturopathic doctor," “doctor of naturopathic medicine," or “doctor of naturopathy"; use the words “naturopathic medicine” or “naturopathic health care” in connection with his or her practice; append to the person's name the letters “N.D." or “ND"; use any other titles, words, letters, abbreviations, insignia, or designation that would imply that the individual is licensed, certified, or registered as a naturopathic doctor or doctor of naturopathic medicine; or claim to render naturopathic medicine or naturopathic health care services unless the person is licensed under s. 466.04 (1) or (2).

AB529-ASA1,15,6 2. This paragraph does not prohibit or restrict a person from designating himself or herself as a naturopath or from using or assuming the title “naturopath” if that designation or use does not otherwise violate subd. 1.

AB529-ASA1,15,7 (2) (a) Subsection (1) (a) does not require a license for any of the following:

AB529-ASA1,15,9 1. Any person lawfully practicing within the scope of a license, permit, registration, or certification granted by this state or the federal government.

AB529-ASA1,15,10 2. The provision of information in connection with the sale of vitamins or herbs.

AB529-ASA1,15,12 3. The provision of advice regarding the use of a therapy, including herbal medicine, homeopathy, nutrition, or other nondrug or nonsurgical therapy.

AB529-ASA1,15,15 4. Any individual acting under an exemption from the requirement to obtain a license to practice medicine and surgery under s. 448.03 (2), to the extent that the individual's activities also fall within the practice of naturopathic medicine.

AB529-ASA1,15,18 5. Any person who is providing patient services as directed, supervised, and inspected by a naturopathic doctor who has the power to direct, decide, and oversee the implementation of the patient services rendered.

AB529-ASA1,15,19 (b) Subsection (1) (a) and (b) does not require a license for any of the following:

AB529-ASA1,15,22 1. The practice of naturopathic medicine by an individual employed by the federal government while the individual is engaged in the performance of duties prescribed by federal law.

AB529-ASA1,15,25 2. A person who is licensed to practice naturopathic medicine in another state or country and is providing consultation to or with or a demonstration to or with a naturopathic doctor who is licensed under this chapter.

AB529-ASA1,16,5 3. The practice of naturopathic medicine by a student enrolled in an approved naturopathic medical program that qualifies under s. 466.04 (1) (d) 1., provided that the performance of services is pursuant to a course of instruction or assignments from an instructor and is under the supervision of the instructor. The student shall use the title “ND candidate” with the intended year of graduation.

AB529-ASA1,16,7 (3) The board may, by rule, establish additional exemptions from the prohibitions under sub. (1).

AB529-ASA1,16,9 466.03 Duties and powers of examining board. (1) The board shall promulgate rules that establish all of the following:

AB529-ASA1,16,11 (a) Standards of practice for and a code of ethics governing the professional conduct of naturopathic doctors and limited-scope naturopathic doctors.

AB529-ASA1,16,13 (b) Continuing education requirements for applicants seeking renewal of a naturopathic doctor license under this chapter.

AB529-ASA1,16,17 (bm) Continuing education requirements for applicants seeking renewal of a limited-scope naturopathic doctor license under this chapter. The board shall accept qualifying training that is completed to satisfy the requirement under s. 466.04 (2) (b) 5. d. as qualifying continuing education under this paragraph.

AB529-ASA1,16,20 (c) Examination standards and requirements for purposes of examinations required under s. 466.04 (1) (e), including required passing scores for examinations and the times when examinations are offered.

AB529-ASA1,16,21 (2) The board may promulgate rules to do any of the following:

AB529-ASA1,17,2 (a) Further interpret s. 466.01 (6) (a) and (c), including to identify diagnostic, therapeutic, or other practices or procedures that may be used by naturopathic doctors. The board may not authorize a naturopathic doctor to engage in any practice excluded from the definition of naturopathic medicine under s. 466.01 (6) (c) or otherwise expand the scope of practice of a naturopathic doctor or limited-scope naturopathic doctor beyond what is specified under s. 466.01 (6) (a).

AB529-ASA1,17,3 (am) Expressly prohibit diagnostic, therapeutic, or other practices.

AB529-ASA1,17,6 (b) Establish character and fitness requirements for initial licensure or renewal of a license under this chapter and evidence required to demonstrate satisfaction of such requirements.

AB529-ASA1,17,9 (c) Establish physical and mental competency requirements for initial licensure or renewal of a license under this chapter and evidence required to demonstrate satisfaction of such requirements.

AB529-ASA1,17,12 (d) Establish evidence of professional competency requirements for initial licensure or renewal of a license under this chapter, including evidence relating to an applicant's licensure status in other states.

AB529-ASA1,17,14 (e) Establish additional clinical, practical, or residency requirements for initial licensure under this chapter.

AB529-ASA1,17,16 (f) Adopt minimum malpractice insurance requirements for naturopathic doctors and limited-scope naturopathic doctors.

AB529-ASA1,17,19 (3) The board may, for purposes of s. 466.04 (1) (d) 1. e., 2. d., 3. d., and 4. e., disqualify any naturopathic medical program if the board determines the program does not adequately prepare students to practice naturopathic medicine.

AB529-ASA1,17,21 466.04 License; renewal. (1) Naturopathic doctor license. The board shall grant a naturopathic doctor license to a person who does all of the following:

AB529-ASA1,17,23 (a) Submits an application for the license to the department on a form provided by the department.

AB529-ASA1,17,24 (b) Pays the fee specified in s. 440.05 (1).

AB529-ASA1,18,2 (c) Subject to ss. 111.321, 111.322, and 111.335, submits evidence satisfactory to the board that the applicant does not have an arrest or a conviction record.

AB529-ASA1,18,4 (d) Submits evidence satisfactory to the board that he or she has completed one of the following:

AB529-ASA1,18,6 1. A naturopathic medical education program offered in the United States that satisfies all of the following:

AB529-ASA1,18,8 a. The program provides the degree of doctor of naturopathy or doctor of naturopathic medicine.

AB529-ASA1,18,10 b. The program offers graduate-level, full-time, didactic and supervised clinical training.

AB529-ASA1,18,14 c. The program is accredited, or has achieved candidacy status for such accreditation, by the Council on Naturopathic Medical Education or an equivalent accrediting body for naturopathic medical programs recognized by the federal department of education.

AB529-ASA1,18,18 d. The program is offered by an institution of higher education or part of an institution of higher education that is accredited, or is a candidate for such accreditation, by a regional accrediting organization or a national institutional accrediting agency recognized by the federal department of education.

AB529-ASA1,18,20 e. The program has not been disqualified by the board as an approved naturopathic medical educational program under s. 466.03 (3).

AB529-ASA1,18,22 2. A program at a diploma-granting, degree-equivalent institution of higher education located in Canada that satisfies all of the following:

AB529-ASA1,18,24 a. The program offers graduate-level, full-time didactic and supervised clinical training.