RULES AND REGULATIONS
Title 49—PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF MEDICINE
[49 PA. CODE CH. 18]
Acupuncturists and Practitioners of Oriental Medicine
[53 Pa.B. 5759]
[Saturday, September 16, 2023]The State Board of Medicine (Board) hereby amends Chapter 18, Subchapter B (relating to registration and practice of acupuncturists and practitioners of Oriental medicine) to read as set forth in Annex A. Specifically, the Board amends §§ 18.11, 18.13, 18.13a, 18.15, 18.15a and 18.18 and adds § 18.20 (relating to professional liability insurance coverage for acupuncturists and practitioners of Oriental medicine).
Effective Date
This final-form rulemaking will be effective upon publication in the Pennsylvania Bulletin.
Statutory Authority
The primary statutory authority to regulate acupuncturists is granted by the Acupuncture Licensure Act (ALA) (63 P.S. §§ 1801—1806.1). Specifically, section 3(b) of the ALA (63 P.S. § 1803(b)) authorizes the Board to promulgate regulations requiring the proper training of individuals, including physicians, before they may be licensed to practice acupuncture in this Commonwealth and further authorizes the Board to promulgate other regulations as may be deemed proper and necessary regarding the practice of acupuncture.
Background and Need for this Final-Form Rulemaking
Beginning in 2018, the Board undertook a comprehensive review of its regulatory scheme for acupuncturists and practitioners of Oriental medicine. As a result of that review, the Board proposed comprehensive amendments to Chapter 18, Subchapter B to (1) update outdated terminology, (2) delete outdated licensure provisions, (3) conform the regulations to the act of September 24, 2014 (P.L. 2472, No. 134), (4) restructure requirements in § 18.15 (relating to practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a medical doctor based on the type of license held, (5) expand the list of opportunities to demonstrate English language proficiency, (6) rename the subchapter to reflect the fact that since 2008, acupuncturists are licensed (not registered) and (6) impose a new requirement that acupuncturists obtain and maintain professional liability insurance of at least $1 million per occurrence or claims made.
Notice of the proposed rulemaking was published at 52 Pa.B. 985 (February 12, 2022). Publication was followed by a 30-day public comment period during which the Board received no public comments. The Independent Regulatory Review Commission (IRRC) submitted comments. Neither the House Professional Licensure Committee (HPLC), nor the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) submitted comments.
Summary and Responses to Comments
IRRC Comment
IRRC submitted the following five comments on the proposed rulemaking.
1. Compliance with the Regulatory Review Act
IRRC commented about the application checklist for initial licensure as a practitioner of Oriental medicine, which details the information required for licensure. IRRC asked the Board to ensure that the terminology in the checklist is consistent with the regulatory language in the final annex. Specifically, IRRC points to the checklist item entitled ''Malpractice Insurance'' and notes that this checklist item references ''acupuncture services,'' however, the proposed annex does not define what ''acupuncture services'' entail. The Board agrees that including the term ''services'' is confusing and unnecessary. Thus, the Board deletes the term ''services'' from both this final-form rulemaking, Regulatory Analysis Form (RAF) and both checklists. Additionally, the Board reviewed the remainder of the language used in both checklists and made the language consistent with the regulatory language in the annex.
Next, IRRC suggests that the Practitioner of Oriental Medicine checklist item entitled ''Malpractice Insurance'' should specify that the insurance must cover claims related to acupuncture and herbal therapy. To address this concern, the Board adds the recommended language indicating that the insurance must cover claims related to acupuncture and herbal therapy under the ''malpractice insurance'' checklist name on the practitioner of Oriental medicine checklist.
IRRC next refers to the checklist item entitled ''Exam Results'' and suggests that the Board should include all methods available to the applicant to demonstrate English language proficiency. To address this concern, the Board adds the following language: ''If your educational program was not conducted in English, arrange forTOEFL (Test of English as a Foreign Language), OET (Occupational English Test) or other equivalent English proficiency examinations scores to be submitted directly to the Board to establish English proficiency.'' Additionally, the Board noted in the checklist that all Board-approved English proficiency examinations will be listed on the Board's web site. This way, the applicant is notified of all ways they can establish English proficiency.
The Board also amends the language in both the acupuncture checklist and the practitioner of Oriental medicine checklist entitled ''Exam Results'' to include ''or other examination provider approved by the Board'' to allow applicants to seek Board approval of other acupuncture or East Asian herbology examinations. Additionally, the Board noted in the checklists that all Board-approved acupuncture and East Asian herbology examinations will be listed on the Board's web site. This way, as the Board approves additional examinations, they will be clearly listed for applicants to review prior to applying for licensure.
2. § 18.11. Definitions.—Clarity
In its second comment, IRRC questions the definitions of ''acupuncture examination'' and ''East Asian herbology examination'' and notes that the definitions for both provide that the Board recognizes the NCAAOM component examinations. IRRC questions whether this language precludes all other examinations that may come along in the future. In this final-form rulemaking, the Board deletes its recognition of the NCAAOM component examination from the definition section. The Board also amends § 18.13(a)(2) (relating to requirements as an acupuncturist) to require the NCCAOM examination component in acupuncture and sterilization procedures, its successor examination or other equivalent Board-approved examination should an examination be presented to the Board at some point in the future. Additionally, the Board amends § 18.13(b)(1) to adopt the NCCAOM examination component in Chinese herbology, its successor examination or other equivalent Board-approved East Asian herbology examination. In both amendments, the Board adds language that all Board-approved examinations will be made available on the Board's web site.
Next, IRRC commented regarding the Board's adoption of the NCAAOM examinations for licensure, indicating that the recognition is substantive and should not be included in the definition section, but must instead be in the body of the regulation. To correct this, the Board moves the examination approval language for acupuncturists to § 18.13 in subsection (a)(2) and the examination approval language for the East Asian herbology examination to § 18.13a (relating to requirements for licensure as a practitioner of Oriental medicine) in subsection (b)(1).
In response to IRRC's final comment under this section, the Board inserts a definition of the ''Occupational English Test'' in § 18.11 (relating to definitions) of this final-form rulemaking. This definition includes successor examinations.
3. § 18.13. Requirements for licensure as an acupuncturist.—Clarity and lack of ambiguity; Need for the regulation; and Economic and fiscal impacts of the regulation
IRRC's third comment relates to the amendments that updates the list of acceptable methods for demonstratingEnglish language proficiency for applicants who did not take their acupuncture examination in English. Specifically, IRRC listed three concerns with the Board's proposed amendments to § 18.13(a)(2)(ii) relating to the phrase ''or similar score acceptable to the Board.'' First, there is concern that the current language does not account for the TOEFL test variants as described by the Board in the Preamble and RAF. Second, the current language, ''or similar score acceptable to the Board'' uses nonregulatory language because it is not clear and unambiguous as it is not a binding norm that could be predicted by the regulated community. Third, there is concern that the Board is impermissibly changing a regulatory requirement without a new rulemaking. To address these concerns, the Board amends § 18.13(a)(2)(ii) to provide greater clarity and more regulatory certainty.
In this final-form rulemaking, the Board amends § 18.13(a)(2)(ii) to clarify that an applicant must achieve a scaled score of at least 83 on the TOEFL® IBT (Internet-based test), which is the most recent version of the examination. The Board deletes the phrase ''or similar score acceptable to the Board'' and replaces it with the acceptable scores for the outdated versions of the TOEFL®. The comparable score for the TOEFL® CBT (computer-based test) is 220 which the Board will accept for that version of the examination. The comparable score for the TOEFL® PBT (paper-based test) is 557—560; however, since the Board's regulations previously accepted a scaled score of 550 on the PBT, the Board will continue accepting that same score to maintain consistency on this version of the examination. The Board obtained comparable score information from the 2005 TOEFL Score Comparison Table which was created by Educational Testing Services (ETS), the company that currently manages the TOEFL. See TOEFL IBT Score Comparison Tables (xtremepape.rs) at https:// papers.xtremepape.rs/TOEFL/Toefl%20iBT%20Official%20 Douments/TOEFL_iBT_Score_Comparison_Tables.pdf. The Board includes the acceptable scores for the outdated versions of the TOEFL. While the CBT and PBT versions of the examination have been discontinued, including these examinations will enable the Board to accept a passing score on these versions of the examination for those individuals who have taken the examination in the past. Finally, this final-form rulemaking adds language that allows the Board to accept future versions of the TOEFL so that when future versions are adopted, the Board's regulations will recognize those examinations immediately.
IRRC recommends either deleting § 18.13(a)(2)(iv) or explaining why the language is necessary. Instead of deleting this language, the Board amends § 18.13(a)(2)(iv) to allow an applicant to demonstrate English proficiency by achieving a passing score on an English proficiency examination that is deemed equivalent by the Board to either the TOEFL or the OET. This amended language will allow the Board to approve other English proficiency examinations without having to amend its regulations. While there is no equivalent examination known to the Board at this point, the Board does not want to rule out the possibility. To provide greater clarity to the licensed community, the Board includes language that it will make available a list of all Board-approved English language proficiency examinations on its web site should there be any additional examinations deemed equivalent by the Board. This language is important because it gives the Board the authority to review new examinations to determine whether they are equivalent to the TOEFL or OET. This could potentially save applicants from having to retake an English proficiency examination if the examination they have already taken is deemed equivalent by the Board. It will also eliminate an unnecessary barrier to licensure because the Board will have a mechanism to approve equivalent English proficiency examinations without delay.
IRRC points out that the Board's response to RAF question # 17 notes that applicants will benefit from the expanded options for demonstrating English proficiency but does not discuss the financial impact on individuals. Similarly, the Board's response to RAF question # 19 does not provide a specific estimate of the cost or savings, or both, to the regulated community to comply with the English proficiency provisions in § 18.13(a)(2). To address these concerns, RAF question # 17 is amended to include language explaining the expanded options available to establish English proficiency and the financial impact these different options will have on the applicant. Specifically, the Board adds discussion on cost savings for applicants who would not have to pay for an English proficiency examination if they attended an English-speaking education program, took their examination in English or already took and passed the OET or any version of the TOEFL examination. If the applicant takes the OET examination to meet the English proficiency requirement, there would be an increased cost as compared to taking the TOEFL, which is the examination accepted under the existing regulations. While there may be an increased cost to take the OET, the individual is not required to take this examination. The Board is providing this as an option so that applicants have a variety of ways to show English proficiency.
The Board also amends the response to RAF question # 19 to include the financial costs and savings to the regulated community to comply with the English proficiency requirement. Applicants who did not take their examination in English, but who attended an English-speaking education program would save money on having to take an English proficiency examination. Additionally, applicants will save money on having to take the TOEFL examination, which costs about $100, if they can establish that they have already taken the OET examination, an older version of the TOEFL or another English proficiency examination that is deemed equivalent by the Board.
IRRC's final concern under the third comment relates to § 18.13(a)(2)(i), which requires that an applicant demonstrate that their acupuncture program was conducted in English by submitting the documents in English or by submitting an official translation. It has been noted by IRRC that there is no mention of this cost in the RAF. The final-form version of the RAF is revised to account for this cost.
4. § 18.15. Practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a physician; practice responsibilities of an acupuncturist who is a licensed medical doctor.—Clarity
The fourth comment submitted by IRRC relates to the Board's reference to ''acupuncture services'' in § 18.15(c) and the fact that ''acupuncture services'' is not defined. To address this concern, the Board deletes the term ''services'' throughout this final-form rulemaking so that only the term ''acupuncture'' remains. As mentioned in response to the first comment, the term ''acupuncture'' is already defined, so the term ''services'' is unnecessary.
5. § 18.18. Disciplinary and corrective measures.—Clarity
IRRC's fifth and final comment relates to section 3.2(c) of the ALA (63 P.S. § 1803.2(c)), which requires a licensee to notify the Board within 30 days of their failure to be covered by insurance. A failure to notify the Board is actionable under section 3 and section 5 of the ALA (63 P.S. § 1805). The license to practice will be automatically suspended upon failure to be covered by the required license and will not be restored until submission to the Board of satisfactory evidence that the licensee has the required professional liability insurance coverage. IRRC suggests that this non-compliance provision be incorporated in this final-form rulemaking. To address this concern, the Board amends § 18.18 (relating to disciplinary and corrective measures) by adding paragraph (6), which provides for disciplinary sanctions for a licensee's failure to notify the Board within 30 days of the licensee's failure to be covered by the required liability insurance. To clarify the disciplinary and corrective measures, the Board adds a cross reference to § 18.20 in § 18.18(a)(4). The Board also amends § 18.20 by adding subsection (e), which provides for automatic suspension for failure to be covered by insurance.
Fiscal Impact and Paperwork Requirements
The costs and additional paperwork associated with this final-form rulemaking are related to the requirement for acupuncturists and practitioners of Oriental medicine to obtain professional liability insurance and to provide proof to the Board, which was imposed by the General Assembly in 2014, and was implemented by the Board at that time. The Board estimates these costs to be approximately $425 annually per licensee. Additionally, there are costs related to the English proficiency examination if the applicant's examination was not conducted in English. The Board's existing regulations already require that in this scenario, an applicant must take the TOEFL examination to demonstrate English proficiency. This final-form rulemaking provides a new mechanism for applicants to demonstrate English proficiency with no additional cost to the applicant if their educational program was conducted in English. The Board also provides additional alternatives to the TOEFL examination, including the OET examination, which costs $400. Additionally, the applicant can now demonstrate English proficiency if they have taken an older version of the TOEFL examination or if they have taken another English proficiency examination which, after review by the Board, is deemed equivalent to the TOEFL and OET examinations. While the OET and other Board-approved English proficiency are both now additional options, the Board does not anticipate applicants using these options often. In the last 4 years, there have been no applicants who have had to demonstrate English proficiency through an examination. However, the Board wants to ensure that when an applicant does have to demonstrate English proficiency, they will be able to do so in the easiest way possible. There may be additional cost for applicants to translate their education verification, if the documents are not in English, which can run approximately $20—$25 per page.
Sunset Date
The Board continuously monitors the effectiveness of its regulations. Therefore, no sunset date has been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P.S. § 745.5(a)), on January 26, 2022, the Board submitted a copy of the proposed rulemaking published at 52 Pa.B. 985, and a copy of a RAF to IRRC and to the Chairpersons HPLC and the SCP/PLC for review and comment. A copy of this material is available to the public upon request.
Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing this final-form rulemaking, the Board has considered all comments received from IRRC. No public comments were received. The Board received no comments from the HPLC and the SCP/PLC.
Under section 5.1(a) of the Regulatory Review Act (71 P.S. § 745.5a(a)), on May 22, 2023, the Board delivered this final-form rulemaking to IRRC, the HPLC and the SCP/PLC. On June 2, 2023, the Board withdrew this final-form rulemaking. On June 9, 2023, the Board re-delivered this final-form rulemaking. Under section 5.1(g)(3) and (j.2) of the Regulatory Review Act on July 12, 2023, the final-form rulemaking was deemed approved by the HPLC and the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on July 13, 2023, and approved the final-form rulemaking.
Additional Information
Additional information may be obtained by writing to Saiyad Ali, Board Administrator, State Board of Medicine, P.O. Box 2649, Harrisburg, PA 17105-2649, ST-MEDICINE@pa.gov.
Findings
The State Board of Medicine finds that:
(1) Public notice was given under sections 201 and 202 of the act of July 31, 1968 (P.L. 769, No. 240), (45 P.S. §§ 1201 and 1202), referred to as the Commonwealth Documents Law, and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2 (relating to notice of proposed rulemaking required; and adoption of regulations).
(2) A public comment period was provided as required by law and all comments were considered in drafting this final-form rulemaking.
(3) The amendments to this final-form rulemaking do not enlarge the original purpose for the proposed regulation published at 52 Pa.B. 985.
(4) These amendments to the regulations of the State Board of Medicine are necessary and appropriate for the regulation of the practice of acupuncturists and practitioners of Oriental medicine in the Commonwealth.
Order
The Board, acting under its authorizing statute, orders that:
(a) The regulations of the State Board of Medicine, 49 Pa. Code Chapter 18, are amended by amending §§ 18.11, 18.13, 18.13a, 18.15, 18.15a and 18.18, and adding § 18.20 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(b) The Board shall submit a copy of this final-form rulemaking to the Office of the Attorney General and the Office of General Counsel for approval as required by law.
(c) The Board shall submit this final-form rulemaking to IRRC, the HPLC and the SCP/PLC as required by law.
(d) The Board shall certify this final-form rulemaking and shall deposit it with the Legislative Reference Bureau as required by law.
(e) This final-form rulemaking shall take effect immediately upon publication in the Pennsylvania Bulletin.
MARK B. WOODLAND, MS, MD,
Chairperson(Editor's Note: See 53 Pa.B. 4068 (July 29, 2023) for IRRC's approval order.)
Fiscal Note: Fiscal Note 16A-4956 remains valid for the final adoption of the subject regulations.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 18. STATE BOARD OF MEDICINE—PRACTITIONERS OTHER THAN MEDICAL DOCTORS
Subchapter B. LICENSURE AND PRACTICE OF ACUPUNCTURISTS AND PRACTITIONERS OF ORIENTAL MEDICINE § 18.11. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Acupuncture examination—An examination 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 in this Commonwealth.
Acupuncture medical program—An academic or clinical program of study in acupuncture which has been given category I continuing medical education credit by an institution accredited or recognized by the Accreditation Council on Continuing Medical Education to conduct category I continuing medical education courses.
Acupuncturist—An individual licensed to practice acupuncture by the Board.
East Asian herbology—The use of herbal preparations and products that contain as active ingredients parts of plants, minerals and other organic materials, or a combination thereof, administered according to East Asian medicine tradition to normalize function.
East Asian herbology examination—An examination recognized by the Board to test whether an acupuncturist has accumulated sufficient academic knowledge with respect to the practice of herbal therapy to qualify for licensure as a practitioner of Oriental medicine in this Commonwealth.
Herbal therapy—The application of East Asian herbology to the treatment of acupuncture patients.
NCCAOM—The National Certification Commission for Acupuncture and Oriental Medicine or its successor organization.
OET—The English language test for healthcare professionals or its successor examination.
Practitioner of Oriental medicine—An acupuncturist who is licensed by the Board to use herbal therapy.
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, and counseling that includes the therapeutic use of foods and supplements and lifestyle modifications.
TOEFL®—The Test of English as a Foreign Language offered by Educational Testing Service (ETS).
§ 18.13. Requirements for licensure as an acupuncturist.
(a) The Board will license 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.
(2) Has been certified by NCCAOM or has obtained a passing grade on the NCCAOM examination component in acupuncture and sterilization procedures, its successor examination or other equivalent Board-approved examination. The Board will make available a list of successor or other equivalent Board-approved examinations on its web site. 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 demonstrated English language proficiency by one of the following methods:
(i) The applicant's acupuncture educational program was conducted in English.
(ii) The applicant has achieved a scaled score of at least 83 on the TOEFL® Internet-based test (IBT), a 220 for the TOEFL® computer-based test (CBT) or a 550 on the TOEFL® paper based test (PBT) or an equivalent score on a successor examination of the TOEFL®. The Board will make available a list of Board-approved successor examinations on its web site.
(iii) The applicant has achieved a score of at least 350 on each of the four sub-tests of the OET for any of the health-related professions.
(iv) The applicant has achieved a passing score on an English language proficiency examination, equivalent to the TOEFL® or OET, as determined by the Board. The Board will make available a list of equivalent Board-approved English language proficiency examinations on its web site.
(b) The Board will license as an acupuncturist a medical doctor who satisfies the following requirements:
(1) Has successfully completed 200 hours of training in acupuncture medical programs including examinations required by those programs.
(2) Submits an application to register as an acupuncturist accompanied by the required fee as provided under § 16.13 (relating to licensure, certification, examination and registration fees).
(c) [Reserved].
§ 18.13a. Requirements for licensure as a practitioner of Oriental medicine.
(a) An acupuncturist who also intends to use herbal therapy is required to be licensed by the Board as a practitioner of Oriental medicine.
(b) The Board will license an acupuncturist as a practitioner of Oriental medicine if the licensee, in addition to meeting the requirements under § 18.13 (relating to requirements for licensure as an acupuncturist) has fulfilled one of the following:
(1) Successfully completed an acupuncture education program that includes the study of East Asian herbology and has passed an East Asian herbology examination. Board-approved East Asian herbology examinations include the NCCAOM examination component in Chinese herbology, its successor examination or other equivalent Board-approved East Asian herbology examination. The Board will make available a list of successor or other equivalent Board-approved examinations on its web site.
(2) Has obtained NCCAOM certification in Chinese herbology or Oriental medicine, which includes passing the NCCAOM examination component in Chinese herbology.
(c) An acupuncturist registered with the Board prior to April 14, 2007, may obtain a license as a practitioner of Oriental medicine if the acupuncturist can demonstrate one of the following:
(1) Successful completion of an East Asian herbology or Oriental medicine education program recognized by the licensing authority of another state or United States territory for the practice of herbal therapy or Oriental medicine and successful completion of an examination in East Asian herbology or Oriental medicine recognized by the licensing authority of another state or United States territory for the practice of herbal therapy or Oriental medicine.
(2) NCCAOM certification in Chinese herbology or Oriental medicine.
(3) The achievement of cumulative qualifications that the Board determines to be equivalent to the standard requirements for registration as a practitioner of Oriental medicine.
(d) This section does not apply to a medical doctor licensed as an acupuncturist nor does it restrict the practice of medicine by a medical doctor.
§ 18.15. Practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a physician; practice responsibilities of an acupuncturist who is licensed as a medical doctor.
(a) Responsibilities to patient and public—acupuncturist who is not a physician. An acupuncturist who is not a physician:
(1) Shall perform an acupuncture evaluation and develop an acupuncture treatment plan.
(1.1) May treat an individual presenting with no symptoms of a condition for an unlimited period of time.
(2) May treat an individual presenting with symptoms of a condition for 60 calendar days from the date of the first treatment without the condition being diagnosed by a physician, dentist or podiatrist.
(3) May treat an individual presenting with symptoms of a condition beyond 60 calendar days from the date of first treatment if the patient has obtained an examination and diagnosis from a physician, dentist or podiatrist.
(4) Shall promptly refer the patient presenting with symptoms of a condition to a physician, dentist or podiatrist, as appropriate to the patient's condition, if the acupuncturist determines that further acupuncture treatment is contraindicated for the patient or determines that the patient's symptoms have worsened.
(5) Shall consult with the patient's physician, dentist, podiatrist or other health care practitioner upon request of the patient.
(6) Shall cooperate with the patient's physician, dentist or podiatrist in regard to the coordination of the patient's care, and comply with restrictions or conditions as directed by the physician, dentist or podiatrist.
(7) May not diagnose a physical or mental ailment or condition or prescribe or dispense a drug. This provision does not prohibit the use of diagnostic billing codes for billing or reimbursement purposes.
(8) Shall comply strictly with sterilization standards relative to aseptic practices.
(9) Shall maintain patient records in a manner consistent with § 16.95 (relating to medical records).
(10) Shall wear a tag or badge with lettering clearly visible to the patient bearing the acupuncturist's name and the title ''Acupuncturist.'' The use of the words doctor, physician or any title or abbreviation implying licensure as a physician on this tag or badge is prohibited.
(b) [Reserved].
(b.1) Additional responsibilities to patient and public—practitioner of Oriental medicine who is not a physician. In addition to the responsibilities in subsection (a)(1)—(9), a licensed practitioner of Oriental medicine who provides, or contemplates providing, herbal therapy:
(1) Shall perform an herbal therapy evaluation and, if appropriate, develop an appropriate treatment plan utilizing, in whole or in part, East Asian herbology modalities.
(2) Shall promptly refer a patient presenting with symptoms of a condition to a physician, dentist or podiatrist, as appropriate to the patient's condition, if the practitioner of Oriental medicine determines that further treatment of the patient by East Asian herbology modalities is contraindicated for the patient, may interfere with known drugs prescribed to the patient, or determines that the patient's symptoms have worsened.
(3) Shall wear a tag or badge with lettering clearly visible to the patient bearing the licensee's name, as well as the title ''Practitioner of Oriental Medicine.'' The use of the words doctor, physician or any title or abbreviation implying licensure as a physician on this tag or badge is prohibited.
(c) Responsibilities to patient and public—acupuncturist who is currently licensed as a medical doctor. An acupuncturist who also holds a current and active license as a medical doctor in this Commonwealth:
(1) Shall include in the patient's medical records evidence of having performed an acupuncture evaluation and development of an acupuncture treatment plan for patients considered for, or who receive, acupuncture.
(2) Shall comply strictly with sterilization standards relative to aseptic practices when providing acupuncture to patients.
§ 18.15a. Scope of practice of acupuncturists and practitioners of Oriental medicine.
(a) An acupuncturist may practice acupuncture and use supplemental techniques, including the use of non-prescription topical remedies which contain as active ingredients parts of plants, minerals and other organic materials, but may not use herbal therapy as defined in § 18.11 (relating to definitions) unless licensed by the Board as a practitioner of Oriental medicine.
(b) A practitioner of Oriental medicine may practice acupuncture and use supplemental techniques including herbal therapy. A practitioner of Oriental medicine is not prohibited from dispensing or administering therapeutic herbs that contain ingredients that are similar or equivalent to active ingredients in drugs as classified by the Federal Food and Drug Administration, unless otherwise prohibited by law or regulation.
(c) This section does not limit the scope of practice of a medical doctor who is licensed as an acupuncturist.
§ 18.18. Disciplinary and corrective measures.
(a) The Board may impose any of the disciplinary sanctions authorized under section 42 of the act (63 P.S. § 422.42) or 63 Pa.C.S. § 3108(b) (relating to civil penalties) for any of the following:
(1) Failing to comply with the duties and requirements in § 18.15 (relating to practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a physician; practice responsibilities of medical doctor licensed as an acupuncturist).
(2) Practicing or holding out as being able to practice acupuncture without a current and valid license to practice acupuncture.
(3) Practicing or holding out as being able to practice East Asian herbology without a current and valid license as a practitioner of Oriental medicine.
(4) Practicing acupuncture or East Asian herbology without current professional liability insurance coverage as required under section 3.2 of the Acupuncture Licensure Act (63 P.S. § 1803.2) and § 18.20 (relating to professional liability insurance coverage for acupuncturists and practitioners of Oriental medicine).
(5) Engaging in conduct prohibited under section 41 of the act (63 P.S. § 422.41) for Board-regulated practitioners.
(6) Failure to notify the Board within 30 days of licensee's failure to be covered by insurance under as required under section 3.2 of the Acupuncture Licensure Act and § 18.20.
(b) The Board will order the emergency suspension of the license of an acupuncturist or practitioner of Oriental medicine who presents an immediate and clear danger to the public health and safety, as required under section 40 of the act (63 P.S. § 422.40).
(c) The license of an acupuncturist or practitioner of Oriental medicine shall automatically be suspended, as required under section 40 of the act.
§ 18.20. Professional liability insurance coverage for acupuncturists and practitioners of Oriental medicine.
(a) A licensed acupuncturist shall maintain a level of professional liability insurance coverage in the minimum amount of $1 million per occurrence or claims made, as required under section 3.2 of the Acupuncture Licensure Act (63 P.S. § 1803.2).
(b) Proof of professional liability insurance coverage may include:
(1) A certificate of insurance or copy of the declaration page from a personally purchased professional liability insurance policy setting forth the effective date, expiration date and dollar amount of coverage.
(2) A certificate of insurance or copy of the declaration page from an employer purchased professional liability insurance policy describing the licensee by name as a covered party under the policy, the effective date, expiration date and dollar amount of coverage.
(3) Evidence of a plan of self-insurance approved by the Insurance Commissioner of the Commonwealth under regulations of the Insurance Department in 31 Pa. Code Chapter 243 (relating to medical malpractice and health-related self-insurance plans).
(c) A licensee who does not have current professional liability insurance coverage as required under section 3.2 of the Acupuncture Licensure Act may not practice as an acupuncturist or as a practitioner of Oriental medicine in this Commonwealth.
(d) The professional liability insurance coverage for a licensed practitioner of Oriental medicine shall cover claims related to acupuncture as well as claims related to the provision of herbal therapy.
(e) The license of an acupuncturist or practitioner of Oriental medicine shall automatically be suspended upon failure to be covered by the required professional liability insurance required in this section and shall not be restored until submission to the Board of satisfactory evidence that the licensee has the required professional liability insurance coverage.
[Pa.B. Doc. No. 23-1244. Filed for public inspection September 15, 2023, 9:00 a.m.]
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