Amendment ASA1-AB529

ASSEMBLY SUBSTITUTE AMENDMENT 1, TO ASSEMBLY BILL 529

December 22, 2021 - Offered by Representative J. Rodriguez.

AB529-ASA1,2,2 An Act to renumber 252.14 (1) (ar) 4q.; to amend 15.08 (1m) (b), 36.25 (11) (b), 48.981 (2m) (b) 1., 60.23 (9), 69.01 (6g), 77.54 (14) (b), 77.54 (14) (d), 118.15 (3) (a), 118.25 (1) (a), 118.29 (1) (e), 146.82 (3) (a), 146.89 (1) (r) 1., 155.01 (7), 252.11 (10), 255.06 (1) (d), 257.01 (5) (a) and (b), 448.03 (2) (a), 448.56 (1), 448.56 (1m) (b), 450.03 (1) (e), 462.04, 895.48 (1m) (a) (intro.) and 2. and 905.04 (1) (b) and (c), (2) and (3); to repeal and recreate 905.04 (title); and to create 15.08 (1m) (bm), 15.405 (7f), 48.981 (2) (a) 1m., 69.18 (1) (cj), 146.81 (1) (dc), 146.997 (1) (d) 4m., 180.1901 (1m) (h), 252.14 (1) (ar) 4s., 440.03 (13) (b) 39g. and 39h., 440.08 (2) (a) 47g. and 47h., 446.02 (9) (e), 450.10 (3) (a) 12., chapter 466, 905.04 (1) (br) and 990.01 (22m) of the statutes; relating to: the regulation and licensure of naturopathic doctors, creating a naturopathic medicine examining board, granting rule-making authority, and providing a penalty.

Analysis by the Legislative Reference Bureau

This substitute amendment differs from 2021 Senate Bill 532 in the following respects:

1. The substitute amendment makes various changes relating to the scope of practice for naturopathic medicine, including a) removing the authority for naturopathic doctors to prescribe drugs and various other provisions concerning the authority of naturopathic doctors with respect to prescription drugs and controlled substances, while providing that naturopathic doctors may recommend, dispense, or administer nonprescription drug products; b) further excluding certain spinal and joint adjustments and manipulations; c) expressly prohibiting the board from expanding the scope of practice of naturopathic medicine; d) providing that the board's rules may interpret the scope of practice of a naturopathic doctor, but may not expand that scope of practice beyond what is specified under the bill; and e) expressly providing that the scope of practice for a naturopathic doctor is distinct from the practice of medicine and surgery.

2. The substitute amendment a) removes the authority of naturopathic doctors to use the additional title “naturopathic medical doctor” and b) clarifies that the bill does not prohibit or restrict persons from using or assuming the title “naturopath.”

3. The substitute amendment makes various changes regarding the licensing of limited-scope naturopathic doctors, including a) modifying the licensure criteria and the period to apply for a limited-scope naturopathic doctor license, and b) allowing the board to establish minimum malpractice insurance requirements for limited-scope naturopathic doctors.

4. The substitute amendment clarifies that a naturopathic medical education program must be accredited, or have achieved candidacy status for such accreditation, by an accrediting body for naturopathic medical programs that is recognized by the federal Department of Education.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB529-ASA1,1 Section 1 . 15.08 (1m) (b) of the statutes is amended to read:

AB529-ASA1,3,7 15.08 (1m) (b) The public members of the chiropractic examining board, the dentistry examining board, the hearing and speech examining board, the medical examining board, the naturopathic medicine examining board, the physical therapy examining board, perfusionists examining council, respiratory care practitioners examining council and council on physician assistants, the board of nursing, the nursing home administrator examining board, the veterinary examining board, the optometry examining board, the pharmacy examining board, the marriage and family therapy, professional counseling, and social work examining board, the psychology examining board, and the radiography examining board shall not be engaged in any profession or occupation concerned with the delivery of physical or mental health care.

AB529-ASA1,2 Section 2 . 15.08 (1m) (bm) of the statutes is created to read:

AB529-ASA1,3,11 15.08 (1m) (bm) The public members of the naturopathic medicine examining board may not have any financial interest in naturopathic education, business, or practice.

AB529-ASA1,3 Section 3 . 15.405 (7f) of the statutes is created to read:

AB529-ASA1,3,15 15.405 (7f) Naturopathic medicine examining board. There is created a naturopathic medicine examining board in the department of safety and professional services consisting of the following members appointed for 4-year terms:

AB529-ASA1,3,16 (a) Four naturopathic doctors licensed under s. 466.04 (1).

AB529-ASA1,3,19 (b) One physician licensed under ch. 448 who works as a primary care physician and who has experience in naturopathic medicine or working with naturopathic doctors.

AB529-ASA1,3,20 (c) Two public members.

AB529-ASA1,4 Section 4 . 36.25 (11) (b) of the statutes is amended to read:

AB529-ASA1,4,3 36.25 (11) (b) The laboratory shall provide complete laboratory services in the areas of water quality, air quality, public health and contagious diseases for appropriate state agencies, and may perform examinations for licensed physicians, naturopathic doctors, veterinarians, local health officers, as defined in s. 250.01 (5), and resource management officials as may be necessary for the prevention and control of those diseases and environmental hazards which cause concern for public health and environmental quality.

AB529-ASA1,5 Section 5 . 48.981 (2) (a) 1m. of the statutes is created to read:

AB529-ASA1,4,5 48.981 (2) (a) 1m. A naturopathic doctor.

AB529-ASA1,6 Section 6 . 48.981 (2m) (b) 1. of the statutes is amended to read:

AB529-ASA1,4,10 48.981 (2m) (b) 1. “Health care provider" means a physician, as defined under s. 448.01 (5), a naturopathic doctor, as defined under s. 466.01 (5), a physician assistant, as defined under s. 448.01 (6), or a nurse holding a license under s. 441.06 (1) or a license under s. 441.10.

AB529-ASA1,7 Section 7 . 60.23 (9) of the statutes is amended to read:

AB529-ASA1,4,16 60.23 (9) Resident physicians, physician assistants and nurses health care providers in certain towns. In a town comprised entirely of one or more islands, annually appropriate money to retain a physician or, if no physician is available, a physician assistant, naturopathic doctor, or nurse practitioner, as a resident within the town.

AB529-ASA1,8 Section 8 . 69.01 (6g) of the statutes is amended to read:

AB529-ASA1,4,20 69.01 (6g) “Date of death" means the date that a person is pronounced dead by a physician, naturopathic doctor, coroner, deputy coroner, medical examiner, deputy medical examiner, or hospice nurse.

AB529-ASA1,9 Section 9 . 69.18 (1) (cj) of the statutes is created to read:

AB529-ASA1,5,2 69.18 (1) (cj) 1. For purposes of preparation of the certificate of death and in accordance with accepted medical standards, a naturopathic doctor who is directly involved with the care of a patient who dies may pronounce the date, time, and place of the patient's death if the patient was generally under the care of a naturopathic doctor at the time of death.

AB529-ASA1,5,4 2. Subdivision 1. may not be construed to authorize a naturopathic doctor to certify under sub. (2) (b) the cause of the patient's death.

AB529-ASA1,10 Section 10 . 77.54 (14) (b) of the statutes is amended to read:

AB529-ASA1,5,7 77.54 (14) (b) Furnished by a licensed physician, naturopathic doctor, surgeon, podiatrist, or dentist to a patient who is a human being for treatment of the patient.

AB529-ASA1,11 Section 11 . 77.54 (14) (d) of the statutes is amended to read:

AB529-ASA1,5,10 77.54 (14) (d) Sold to a licensed physician, naturopathic doctor, surgeon, podiatrist, dentist, or hospital for the treatment of a human being.

AB529-ASA1,12 Section 12 . 118.15 (3) (a) of the statutes is amended to read:

AB529-ASA1,5,23 118.15 (3) (a) Any child who is excused by the school board because the child is temporarily not in proper physical or mental condition to attend a school program but who can be expected to return to a school program upon termination or abatement of the illness or condition. The school attendance officer may request the parent or guardian of the child to obtain a written statement from a licensed physician, naturopathic doctor, dentist, chiropractor, optometrist, psychologist, physician assistant, or nurse practitioner, as defined in s. 255.06 (1) (d), or certified advanced practice nurse prescriber or Christian Science practitioner living and residing in this state, who is listed in the Christian Science Journal, as sufficient proof of the physical or mental condition of the child. An excuse under this paragraph shall be in writing and shall state the time period for which it is valid, not to exceed 30 days.

AB529-ASA1,13 Section 13 . 118.25 (1) (a) of the statutes is amended to read:

AB529-ASA1,6,4 118.25 (1) (a) “Practitioner" means a person licensed as a physician, naturopathic doctor, or as a physician assistant in any state or licensed or certified as an advanced practice nurse prescriber in any state. In this paragraph, “ physician” has the meaning given in s. 448.01 (5).

AB529-ASA1,14 Section 14 . 118.29 (1) (e) of the statutes is amended to read:

AB529-ASA1,6,8 118.29 (1) (e) “Practitioner" means any physician, naturopathic doctor, dentist, optometrist, physician assistant, advanced practice nurse prescriber, or podiatrist licensed in any state.

AB529-ASA1,15 Section 15 . 146.81 (1) (dc) of the statutes is created to read:

AB529-ASA1,6,11 146.81 (1) (dc) A naturopathic doctor or limited-scope naturopathic doctor licensed under ch. 466.

AB529-ASA1,16 Section 16 . 146.82 (3) (a) of the statutes is amended to read:

AB529-ASA1,6,21 146.82 (3) (a) Notwithstanding sub. (1), a physician, a naturopathic doctor, a limited-scope naturopathic doctor, a physician assistant, as defined in s. 448.01 (6), or an advanced practice nurse prescriber certified under s. 441.16 (2) who treats a patient whose physical or mental condition in the physician's, naturopathic doctor's, limited-scope naturopathic doctor's, physician assistant's, or advanced practice nurse prescriber's judgment affects the patient's ability to exercise reasonable and ordinary control over a motor vehicle may report the patient's name and other information relevant to the condition to the department of transportation without the informed consent of the patient.

AB529-ASA1,17 Section 17 . 146.89 (1) (r) 1. of the statutes is amended to read:

AB529-ASA1,7,3 146.89 (1) (r) 1. Licensed as a physician under ch. 448, naturopathic doctor under ch. 466, a dentist or dental hygienist under ch. 447, a registered nurse, practical nurse, or nurse-midwife under ch. 441, an optometrist under ch. 449, a physician assistant under ch. 448, a pharmacist under ch. 450, a chiropractor under ch. 446, a podiatrist under subch. IV of ch. 448, or a physical therapist under subch. III of ch. 448.

AB529-ASA1,18 Section 18 . 146.997 (1) (d) 4m. of the statutes is created to read:

AB529-ASA1,7,5 146.997 (1) (d) 4m. A naturopathic doctor licensed under ch. 466.

AB529-ASA1,19 Section 19 . 155.01 (7) of the statutes is amended to read:

AB529-ASA1,7,18 155.01 (7) “Health care provider" means a nurse licensed or permitted under ch. 441, a chiropractor licensed under ch. 446, a dentist licensed under ch. 447, a physician, physician assistant, perfusionist, podiatrist, physical therapist, physical therapist assistant, occupational therapist, or occupational therapy assistant licensed under ch. 448, a naturopathic doctor licensed under ch. 466, a person practicing Christian Science treatment, an optometrist licensed under ch. 449, a psychologist licensed under ch. 455, a physical therapist or physical therapist assistant who holds a compact privilege under subch. X of ch. 448, a partnership thereof, a corporation or limited liability company thereof that provides health care services, a cooperative health care association organized under s. 185.981 that directly provides services through salaried employees in its own facility, or a home health agency, as defined in s. 50.49 (1) (a).

AB529-ASA1,20 Section 20 . 180.1901 (1m) (h) of the statutes is created to read:

AB529-ASA1,7,22 180.1901 (1m) (h) Naturopathic medicine examining board under ch. 466, except that “health care professional" does not include a limited-scope naturopathic doctor licensed by the naturopathic medicine examining board under ch. 466.

AB529-ASA1,21 Section 21 . 252.11 (10) of the statutes is amended to read:

AB529-ASA1,8,6 252.11 (10) The state laboratory of hygiene shall examine specimens for the diagnosis of sexually transmitted diseases for any physician, naturopathic doctor, physician assistant, advanced practice nurse prescriber, or local health officer in the state, and shall report the positive results of the examinations to the local health officer and to the department. All laboratories performing tests for sexually transmitted diseases shall report all positive results to the local health officer and to the department, with the name of the physician, naturopathic doctor, physician assistant, or advanced practice nurse prescriber to whom reported.

AB529-ASA1,22 Section 22 . 252.14 (1) (ar) 4q. of the statutes is renumbered 252.14 (1) (ar) 4n.

AB529-ASA1,23 Section 23 . 252.14 (1) (ar) 4s. of the statutes is created to read:

AB529-ASA1,8,9 252.14 (1) (ar) 4s. A naturopathic doctor licensed under ch. 466.

AB529-ASA1,24 Section 24 . 255.06 (1) (d) of the statutes is amended to read:

AB529-ASA1,8,15 255.06 (1) (d) “Nurse practitioner" means a registered nurse who is licensed under ch. 441 or who holds a multistate license, as defined in s. 441.51 (2) (h), issued in a party state, as defined in s. 441.51 (2) (k), and whose practice of professional nursing under s. 441.001 (4) includes performance of delegated medical services under the supervision of a physician, naturopathic doctor, dentist, or podiatrist.

AB529-ASA1,25 Section 25 . 257.01 (5) (a) and (b) of the statutes are amended to read:

AB529-ASA1,8,22 257.01 (5) (a) An individual who is licensed as a physician, a physician assistant, or a podiatrist under ch. 448, licensed as a naturopathic doctor under ch. 466, licensed as a registered nurse, licensed practical nurse, or nurse-midwife under ch. 441, licensed as a dentist under ch. 447, licensed as a pharmacist under ch. 450, licensed as a veterinarian or certified as a veterinary technician under ch. 89, or certified as a respiratory care practitioner under ch. 448.

AB529-ASA1,9,5 (b) An individual who was at any time within the previous 10 years, but is not currently, licensed as a physician, a physician assistant, or a podiatrist under ch. 448, licensed as a naturopathic doctor under ch. 466, licensed as a registered nurse, licensed practical nurse or nurse-midwife, under ch. 441, licensed as a dentist under ch. 447, licensed as a pharmacist under ch. 450, licensed as a veterinarian or certified as a veterinary technician under ch. 89, or certified as a respiratory care practitioner under ch. 448, if the individual's license or certification was never revoked, limited, suspended, or denied renewal.

AB529-ASA1,26 Section 26 . 440.03 (13) (b) 39g. and 39h. of the statutes are created to read:

AB529-ASA1,9,7 440.03 (13) (b) 39g. Naturopathic doctor.

AB529-ASA1,9,8 39h. Naturopathic doctor, limited-scope.

AB529-ASA1,27 Section 27 . 440.08 (2) (a) 47g. and 47h. of the statutes are created to read:

AB529-ASA1,9,10 440.08 (2) (a) 47g. Naturopathic doctor: January 1 of each odd-numbered year.

AB529-ASA1,9,12 47h. Naturopathic doctor, limited-scope: January 1 of each odd-numbered year.

AB529-ASA1,28 Section 28 . 446.02 (9) (e) of the statutes is created to read:

AB529-ASA1,9,15 446.02 (9) (e) A naturopathic doctor or limited-scope naturopathic doctor acting within the scope of his or her license under ch. 466.

AB529-ASA1,29 Section 29 . 448.03 (2) (a) of the statutes is amended to read:

AB529-ASA1,9,23 448.03 (2) (a) Any person lawfully practicing within the scope of a license, permit, registration, certificate or certification granted to practice midwifery under subch. XIII of ch. 440, to practice professional or practical nursing or nurse-midwifery under ch. 441, to practice chiropractic under ch. 446, to practice dentistry or dental hygiene under ch. 447, to practice optometry under ch. 449, to practice acupuncture under ch. 451 or under any other statutory provision, to practice naturopathic medicine under ch. 466, or as otherwise provided by statute.

AB529-ASA1,30 Section 30 . 448.56 (1) of the statutes is amended to read:

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: