PROPOSED RULEMAKING
STATE BOARD OF MEDICINE
[49 PA. CODE CHS. 16 AND 18]
Registration and Practice of Acupuncturists
[35 Pa.B. 1210] The State Board of Medicine (Board) proposes to amend §§ 16.11, 16.13, 18.11--18.17 and 18.19 regarding the registration and practice of acupuncturists to read as set forth in Annex A.
A. Effective Date
The proposed rulemaking will be effective upon final-form publication in the Pennsylvania Bulletin.
B. Statutory Authority
The statutory authority for this proposal is the act of May 16, 2002 (P. L. 326, No. 49) (Act 49) which amended the Acupuncture Registration Act (act) (63 P. S. §§ 1801--1806). Section 3 of the act (63 P. S. § 1803) authorizes the Board to promulgate regulations as necessary to regulate the practice of acupuncture.
C. Background and Purpose
The proposed rulemaking would amend the Board's existing regulations so that they comport with the Act 49 amendments to the act.
D. Description of Amendments
Sections 16.11 and 16.13 (relating to licenses, certificates and registrations; and licensure, certification, examination and registration fees) would be amended to delete references to acupuncture supervisor and fees for acupuncture supervisor registration. Section 18.11 (relating to definitions) would be amended to include the statutorily expanded definition of ''acupuncture'' to include the use of supplemental techniques, the statutorily established definition of an ''acupuncture educational program'' and the statutorily established definition of ''supplemental techniques.'' Section 18.11 would also be amended to delete definitions rendered unnecessary by Act 49. Specifically, the definition of ''acupuncture program'' would be deleted as superseded by the term ''acupuncture educational program.'' Definitions regarding supervision of acupuncturists would also be deleted because Act 49 eliminated the supervisory requirement in regard to the practice of acupuncture. Section 18.11 would also be amended to reflect the name change of the National Commission for the Certification of Acupuncturists and Oriental Medicine.
Sections 18.12--18.15 would be amended and §§ 18.16 and 18.17 (relating to responsibilities of acupuncturist supervisor; and notice responsibilities) would be deleted to delete references to acupuncturist supervisor and provisions pertaining to the supervision of the practice of acupuncture.
Section 18.15 (relating to practice responsibilities of acupuncturist who is not a medical doctor) would be amended to incorporate statutorily established requirements that the acupuncturist ensure that prior to the application of acupuncture treatments the patient obtain a written referral from a licensed physician, that the patient has undergone a medical diagnostic examination, and that the results of the examination and the referral are maintained in the patient's record. Existing provisions pertaining to the acupuncturist's obligation to consult with the referring physician as necessary would be retained.
Lastly, § 18.19 (relating to registration during transitional period) pertains to outdated registration requirements under the original act and, therefore, would be deleted.
E. Fiscal Impact and Paperwork Requirements
The proposed rulemaking would have no adverse fiscal impact or additional paperwork requirements imposed on the Commonwealth, its political subdivisions or the private sector.
F. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
G. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on February 2, 2005, the Department submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections must specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Department, the General Assembly and the Governor of comments, recommendations or objections raised.
H. Public Comment
Interested persons are invited to submit written comments, recommendations or objections regarding the proposed rulemaking to Joanne Troutman, Health Licensing Division, Bureau of Professional and Occupational Affairs, P. O. Box 2649, Harrisburg, PA 17105-2649 within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin. Refer to Acupuncture Registration when submitting comments.
CHARLES D. HUMMER, Jr., M.D.,
ChairpersonFiscal Note: 16A-4919. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND
VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND
OCCUPATIONAL AFFAIRS
CHAPTER 16. STATE BOARD OF MEDICINE--GENERAL PROVISIONS
Subchapter B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION PROVISIONS § 16.11. Licenses, certificates and registrations.
* * * * * (c) The following registrations are issued by the Board:
* * * * * (3) [Registration as an acupuncturist supervisor.
(4)] Biennial registration of a license without restriction.
[(5)] (4) * * *
[(6)] (5) * * *
[(7)] (6) * * *
[(8)] (7) * * *
[(9)] (8) * * *
[(10)] (9) * * *
§ 16.13. Licensure, certification, examination and registration fees.
* * * * * (d) Acupuncturist [Registration] registration:
* * * * *
[Registration, acupuncture supervisor $30] * * * * *
CHAPTER 18. STATE BOARD OF MEDICINE--PRACTITIONERS OTHER THAN MEDICAL DOCTORS
Subchapter B. REGISTRATION AND PRACTICE OF ACUPUNCTURISTS § 18.11. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Acupuncture--
(i) The stimulation of certain points on or near the surface of the body by the insertion of needles to prevent or alleviate the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body.
(ii) The term also includes the use of supplemental techniques.
Acupuncture educational program--Training and instruction in acupuncture or supplemental acupuncture techniques offered by a degree-granting institution authorized by the Department of Education that leads to a master's degree, master's level certificate or diploma or first professional degree, that meets the relevant and appropriate requirements of 22 Pa. Code (relating to education) and 24 Pa.C.S. Chapter 65 (relating to private colleges, universities and seminaries) and that meets or exceeds the standards required for acupuncture or oriental medicine programs established by an accrediting agency recognized by the United States Department of Education.
Acupuncture examination--An examination offered or recognized by the Board to test whether an individual has accumulated sufficient academic knowledge with respect to the practice of acupuncture to qualify for the privilege of practicing as an acupuncturist. The Board recognizes the combination of the [NCCA] NCCAOM examinations in acupuncture and sterilization procedures as an acupuncture examination.
* * * * * [Acupuncture program--An academic and clinical program of study in acupuncture which has been approved by the Board or by an accrediting body recognized by the Board.]
* * * * * [Acupuncturist supervisor--A medical doctor registered with the Board as a supervisor of acupuncturists.
General supervision--An acupuncturist supervisor doing the following in supervising an acupuncturist:
(i) Performing a medical diagnostic examination or reviewing the results of a recently performed medical diagnostic examination with respect to an ailment or condition to be treated by acupuncture prior to the treatment.
(ii) Being personally available to the acupuncturist for consultation on the premises or being available by telephone contact, chart review or other means approved by the Board.
(iii) Placing conditions and restrictions on the course of treatment if that action is required as a matter of sound medical practice.
NCCA--The National Commission for the Certification of Acupuncturists.]
NCAAOM--The National Certification Commission for Acupuncture and Oriental Medicine.
Supplemental techniques--The use of traditional and modern oriental therapeutics, heat therapy, moxibustion, electrical and low level laser stimulation, acupressure and other forms of massage, herbal therapy and counseling that includes the therapeutic use of foods and supplements and lifestyle modifications.
§ 18.12. Registration as an acupuncturist [and as an acupuncturist supervisor].
[(a)] A medical doctor who intends to practice acupuncture and any other individual who intends to practice acupuncture [at the direction and under the supervision of a medical doctor] shall register with the Board as an acupuncturist.
[(b) Only a medical doctor registered as an acupuncturist supervisor may delegate the performance of acupuncture services to an acupuncturist. An acupuncturist who is not a medical doctor may only perform acupuncture services under the direction and supervision of an acupuncturist supervisor, unless otherwise authorized by statute.
(c) An acupuncturist supervisor may not delegate the performance of acupuncture services to an osteopathic doctor, dentist, podiatrist or a veterinary doctor who is approved by his respective licensing board to practice acupuncture, unless that person is also registered as an acupuncturist with the Board.]
§ 18.13. Requirements for registration as an acupuncturist [and an acupuncturist supervisor].
(a) The Board will register as an acupuncturist a person who satisfies the following requirements:
(1) Has successfully completed an acupuncture educational program which includes a course in needle sterilization techniques.
[(i) If the acupuncture education program is taken within the United States, the applicant shall complete 2 academic years of acupuncture training and shall complete 2 academic years of a college level educational program.
(ii) If the educational program is taken outside of the United States, an applicant shall graduate from a college with a program of study including Oriental medicine and document 300 class hours of study in acupuncture training.]
(2) Has obtained a passing grade on an acupuncture examination or has been certified by [NCAA during 1985-1986 via credential review. The Board accepts the passing grade on the certifying examination of the NCCA as determined by the NCCA, and accepts a passing grade on any state's acupuncture examination taken prior to January 1, 1987 as determined by the licensing or registering authority in the other state] NCCAOM. If the examination was not taken in English, but is otherwise acceptable and a passing score was secured, the Board will accept the examination result if the applicant has also secured a score of 550 on the test of English as a Foreign Language (TOEFL).
* * * * * [(d) The Board will register as an acupuncturist supervisor a medical doctor who satisfies the following requirements:
(1) Possesses a license without restriction.
(2) Submits an application to register as an acupuncturist supervisor accompanied by the required. For the fee amount, see § 16.13.]
§ 18.14. Biennial registration requirements.
* * * * * [(d) There is no biennial registration requirement for an acupuncturist supervisor.]
§ 18.15. Practice responsibilities of acupuncturist who is not a medical doctor.
(a) Responsibilities to patient. In relation to the acupuncture patient, the acupuncturist shall comply with the following:
(1) [Received, in writing, from the acupuncturist supervisor, approval to initiate acupuncture treatment.] Ensure that the patient has secured a written referral for treatment by acupuncture from a licensed physician.
(2) Comply strictly with conditions or restrictions that may be placed on the course of acupuncture treatment by the [acupuncturist supervisor] referring physician.
(3) Ensure that the patient has undergone a medical diagnostic examination or has had the results of a recently performed medical diagnostic examination reviewed by a licensed physician.
(4) Keep a copy of the referral and the results of the medical diagnostic examination in the patient's file.
(5) Not diagnose a physical or mental ailment or condition or prescribe or dispense a drug.
[(4)] (6) * * *
(b) Responsibility to [acupuncturist supervisor] referring physician. In relation to the [acupuncturist supervisor] referring physician, the acupuncturist shall comply with the following:
(1) Consult promptly with the [acupuncturist supervisor] referring physician regarding a new ailment or condition or a worsened ailment or condition of an acupuncture patient.
(2) Consult with the [acupuncturist supervisor] referring physician upon request of either the [acupuncturist supervisor] referring physician or the acupuncture patient.
[(3) Practice acupuncture only under the general supervision of an acupuncturist supervisor.]
(c) [Scope of acupuncturist's responsibility.
(1) An acupuncturist is responsible solely for acupuncture evaluation and acupuncture treatment. The medical diagnosis is the responsibility of the acupuncturist supervisor.
(2) An acupuncturist is not required to practice acupuncture in the physical presence of the acupuncturist supervisor or at the location where the acupuncturist supervisor provides medical services. Where the acupuncturist may provide acupuncture services, and whether the acupuncturist may provide acupuncture services without the acupuncture supervisor being physically present, shall be determined by the acupuncture supervisor.
(d)] Identification of acupuncturist. An acupuncturist who is not a medical doctor shall wear a tag or badge with lettering clearly visible to the patient bearing his name and the title ''acupuncturist.'' The use of the word doctor on this tag or badge is prohibited.
§ 18.16. [Responsibilities of acupuncturist supervisor] (Reserved).
[(a) Responsibility to acupuncture patient. In relation to the acupuncture patient, the acupuncturist supervisor shall comply with the following:
(1) Perform or review the results of a recently performed medical diagnostic examination with respect to an ailment or condition to be treated by acupuncture before the treatment.
(2) Advise the patient of the results of the medical diagnostic examination and the treatment alternatives.
(3) Place conditions or restrictions on the course of treatment in acupuncture to be provided by the acupuncturist, if conditions or restrictions are required as a matter of sound medical practice.
(4) Advise the patient in writing that he is available at reasonable times for consultation by appointment or by telephone. The written notice shall contain an address and telephone number at which the acupuncture supervisor can be reached.
(5) If he is not an acupuncturist, advise the patient in writing that he is not an acupuncturist, that he is not qualified to direct the course of acupuncture treatment and that he does not have responsibility for the course of acupuncture treatment.
(6) Monitor the patient's progress under acupuncture treatment and comply with normal responsibilities to a patient if the patient does not respond to treatment within the anticipated time.
(b) Responsibility to acupuncturist. In relation to the supervised acupuncturist, the acupuncturist supervisor shall satisfy the following:
(1) Advise the acupuncturist of the results of the medical diagnostic examination that are relevant to acupuncture treatment and of conditions or restrictions that are to be placed on the course of acupuncture treatment.
(2) Not delegate to the acupuncturist the right to prescribe or dispense drugs or the responsibility for diagnosing a physical or mental ailment or condition.
(3) Confer promptly with the acupuncturist in the event of the following:
(i) The acupuncturist supervisor decides to impose conditions or restrictions on the course of acupuncture treatment.
(ii) The patient has requested further consultation with the acupuncturist supervisor.
(iii) The patient's condition is not improving or the patient requires emergency medical treatment.
(4) Designate an alternative acupuncturist supervisor to provide general supervision of the acupuncturist during periods in which the acupuncturist supervisor is unable to provide general supervision, if the substitute acupuncturist supervisor agrees to accept the responsibility set forth in this section.
(c) Scope of acupuncturist supervisor's responsibility.
(1) In providing general supervision to the acupuncturist, the acupuncturist supervisor maintains the diagnostic responsibility and the medical doctor-patient relationship. It is the responsibility of the acupuncturist and not of the acupuncturist supervisor to conduct an acupuncture evaluation and to perform acupuncture treatment.
(2) An acupuncturist supervisor may not provide general supervision to more than two acupuncturists without applying for and receiving specific approval from the Board.]
§ 18.17. [Notice responsibilities] (Reserved).
[(a) The nonmedical doctor acupuncturist and the acupuncturist supervisor shall provide written notice to the Board prior to the date when the acupuncturist supervisor is to begin general supervision of the acupuncturist. The written notice shall comply with the following:
(1) Be filled out on a form supplied by the Board.
(2) Provide the name of the acupuncturist supervisor and the acupuncturist and a current address and the telephone number at which each can be reached.
(3) Contain an acknowledgement by the acupuncturist supervisor that he understands and agrees to accept his responsibilities to the supervised acupuncturist and the acupuncture patient as set forth in this subchapter.
(4) Contain an acknowledgement by the acupuncturist that he understands and accepts his responsibility to the acupuncturist supervisor and the acupuncture patient as set forth in this subchapter.
(5) Contain the verified signatures of the acupuncturist supervisor and the supervised acupuncturist.
(b) Written notice of termination of an arrangement between an acupuncturist supervisor and an acupuncturist shall be given to the Board by both individuals within 10 days following termination of the relationship. Notice may be provided by both through one document or by each through separate documents.]
§ 18.19. [Registration during transitional period] (Reserved).
[Acceptance of applications to register as acupuncturists and acupuncturist supervisors will begin on January 3, 1987. After July 1, 1987, no person may serve as an acupuncturist or as an acupuncturist supervisor unless registered as such with the Board.]
[Pa.B. Doc. No. 05-279. Filed for public inspection February 11, 2005, 9:00 a.m.]
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