PROPOSED RULEMAKING
STATE BOARD OF MEDICINE
[ 49 PA. CODE CHS. 16 AND 18 ]
Registration of Naturopathic Doctors
[51 Pa.B. 7877]
[Saturday, December 18, 2021]The State Board of Medicine (Board) proposes to amend Chapters 16 and 18 (relating to State Board of Medicine—general provisions; and State Board of Medicine—practitioners other than medical doctors) to read as set forth in Annex A. Specifically, the Board is proposing amendments to §§ 16.1, 16.11—16.13, 18.13a, 18.15, 18.15a, and the addition of Subchapter M (relating to registration of naturopathic doctors) to Chapter 18 by adding §§ 18.901—18.913.
Effective Date
The proposed amendments will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.
Statutory Authority
The primary statutory authority to regulate the registration of naturopathic doctors is the Naturopathic Doctor Registration Act (NDRA) (63 P.S. §§ 272.101—272.301). Specifically, section 207 of the NDRA (63 P.S. § 272.207) provides that ''[t]he board shall enforce and administer the provisions of this act and shall promulgate regulations that are consistent with the intent of this act.'' Further, section 203(b) of the NDRA (63 P.S. § 272.203(b)), provides the authority of the Board to require naturopathic doctor registrations to be renewed ''. . .in a manner and at such intervals as the board shall determine by regulation. . . .'' Sections 202(6) and 203(c) of the NDRA (63 P.S. §§ 272.202(6)), set forth the authority of the Board to set fees for initial registration and biennial renewal of registration. The Board sets all fees by regulation.
The Board is taking this opportunity to update its regulations and to remove outdated provisions in the Board's existing regulations relating to ''drugless therapists'' under the authority of section 8 of the Medical Practice Act of 1985 (act) (63 P.S. § 422.8), which provides, in part, that, ''[t]he board, in the exercise of its duties under this act, shall have the power to adopt such regulations as are reasonably necessary to carry out the purposes of this act.'' This authority necessarily includes the power to repeal provisions of the regulations that are no longer necessary.
Background, Need for and Description of the Proposed Amendments
The Board proposes to amend § 16.1 (relating to definitions) to update the definitions of ''act'' and ''Board-regulated practitioner.'' The definition of ''act'' is being amended to update the citation to the Medical Practice Act of 1985 (63 P.S. §§ 422.1—422.53). The definition of ''Board-regulated practitioner'' is being amended to delete references to ''drugless therapists'' and add several license classifications which are currently missing from the definition. Specifically, the licensure classifications of respiratory therapist, genetic counselor, prosthetist, orthotist, pedorthist, orthotic fitter and naturopathic doctor would be added to the definition of ''Board-regulated practitioner'' in § 16.1. Persons applying for a registration issued by the Board would also be included in the definition of ''Board-regulated practitioner.''
Additionally, this proposed rulemaking will delete all regulatory references to ''drugless therapists.'' The Board last issued a new license to practice as a drugless therapist in 1951 (1 month after the State Board of Chiropractic began operations) and no longer has the authority to issue new drugless therapist licenses. See Reisinger v. Com., State Bd. of Med. Ed. & Licensure, 399 A.2d 1160 (Pa. Cmwlth. 1979). Reisinger involved an individual trained as a chiropractor and naturopathic doctor who petitioned for licensure as a ''drugless therapist,'' but was denied because the Board determined that it no longer had the authority to license drugless therapists. On appeal, the Commonwealth Court agreed, holding that although the Board could continue to register and regulate persons engaged in the practice of drugless therapy, ''the Board lacks the authority now to license Drugless Therapists.'' See id, 399 A.2d at 1163. Since 1951, the Board has continued to biennially register/renew existing drugless therapist licenses and has continued to regulate their practice, but has not issued new licenses. No individual currently holds an active license as a drugless therapist from the Board. The last remaining individual who held an active license as a drugless therapist did not renew his license in 2016 and it is the Board's understanding that he died in December of 2014, shortly after submitting his renewal application for the 2015-2016 renewal period. The prior two most recent licensees of the Board last renewed their licenses in 2008. Therefore, it appears that all individuals who held a license as a drugless therapist have either retired from practice or are deceased. Therefore, it is no longer necessary to keep any references to drugless therapists in the Board's regulations. This is especially true now that the Board will be registering individuals as naturopathic doctors under this proposed rulemaking.
As such, the Board proposes to amend § 16.11 (relating to licenses, certificates and registrations) to delete the reference to biennial registration of a drugless therapist license, and add the initial registration as a naturopathic doctor and the biennial registration of a naturopathic doctor. Section 16.12 (relating to general qualifications for licenses and certificates) is proposed to be amended to update its title and to extend its provisions to initial registrations issued by the Board. In addition, the fees associated with biennial renewal of the drugless therapist license are proposed to be deleted from § 16.13 (relating to licensure, certification, examination and registration fees), and the fees associated with naturopathic doctor registration, including the proposed initial registration fee of $100 and biennial registration renewal fee of $50, are being added.
Next, the Board proposes amendments to Chapter 18, Subchapter B (relating to the registration and practice of acupuncturists and practitioners of Oriental medicine) to address the overlap between the practice of a naturopathic doctor and an acupuncturist or practitioner of Oriental medicine. Specifically, §§ 18.13a and 18.15a (relating to requirements for licensure as a practitioner of Oriental medicine; and scope of practice of acupuncturists and practitioners of Oriental medicine) are being amended to point out that these regulations do not limit the practice of a naturopathic doctor when recommending herbs, minerals and other supplements according to traditions other than Oriental medicine traditions. In addition, § 18.15 (relating to practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a physician) is being amended to provide an exception to the prohibition on the use of the title ''doctor'' for an acupuncturist who is also registered as a naturopathic doctor.
The Board proposes to add Subchapter M to Chapter 18 to implement the provisions of the NDRA. Section 18.901 (relating to purpose) notes that this subchapter implements the registration of naturopathic doctors as required under the NDRA. Section 18.902 (relating to definitions) will define necessary terms used in Subchapter M, including ''authorization to practice,'' ''CNME—Council on Naturopathic Medical Education,'' ''merchandise,'' ''naturopathic doctor,'' ''NABNE—North American Board of Naturopathic Examiners,'' ''NDRA,'' ''NPLEX—Naturopathic Physicians Licensing Examinations,'' and ''regionally accredited or pre-accredited college or university.'' Next, the Board proposes to include the process and requirements to apply for a registration as a naturopathic doctor in § 18.903 (relating to application for naturopathic doctor registration), including the qualifications for registration as a naturopathic doctor as set forth in section 202 of the NDRA. The Board also proposes to include the requirement that an applicant for registration as a naturopathic doctor shall have completed at least 3 hours of approved education/training in child abuse recognition and reporting requirements, as required under 23 Pa.C.S. § 6383(b)(3)(i) (relating to education and training). The Board is currently pursuing a separate rulemaking (16A-4941) setting forth the requirements for approved courses in child abuse recognition and reporting and intends to add an appropriate cross-reference once that rulemaking is final.
The Board is proposing to include the requirements for the biennial renewal of the naturopathic doctor registration in § 18.904 (relating to biennial registration of naturopathic doctor) as required by section 203(b) of the NDRA. Section 203(b) of the NDRA provides for renewal ''. . .in a manner and at such intervals as the board shall determine by regulation. . . .'' As such, the Board is proposing that all registrations of naturopathic doctors will expire on December 31st of each even-numbered year, to correspond with the expiration of all existing licenses issued by the Board. The Board proposes to set forth the manner of renewing in subsection (b), which sets forth the requirements for renewal as informed by the existing practice of the Board. The Board proposes to require, as a condition of biennial renewal, the completion of at least 2 hours of approved continuing education in child abuse recognition and reporting, as required under 23 Pa.C.S. § 6383(b)(3)(ii).
Similarly, the Board is proposing to provide for reactivation of inactive and expired registrations in § 18.905 (relating to inactive status; reactivation of inactive and expired registration). Again, the manner in which expired and inactive registrations are reactivated is informed by the Board's existing practices and includes payment of applicable fees and the completion of the required continuing education in child abuse recognition and reporting.
Proposed § 18.906 (relating to display of registration) would set forth the requirement that a naturopathic doctor prominently display the certificate of registration and evidence of biennial renewal in a publicly accessible location at the registrant's regular place of business and have evidence of current registration available for inspection when providing services at other locations.
In proposed § 18.907 (relating to acceptable titles and professional designations by registrants and non-registrants; prohibited titles) the Board clarifies the acceptable titles that may be used by registered naturopathic doctors, as well as non-registrants who may hold themselves out as naturopaths, traditional naturopaths and similar titles. Section 201 of the NDRA (63 P.S. § 272.201) provides that ''[i]t shall be unlawful for an individual to use the title of ''naturopathic doctor'' or ''doctor of naturopathic medicine'' unless that person is registered as a naturopathic doctor with the board.'' Proposed § 18.907 makes it clear that a naturopathic doctor who uses the designation ''Dr.'' shall further identify himself or herself as a ''naturopathic doctor,'' ''registered naturopathic doctor'' or ''doctor of naturopathic medicine'' and may not use any term or designation that implies that the naturopathic doctor is authorized to practice medicine or any other health care profession, unless the naturopathic doctor also holds a current and active authorization to practice the other profession issued by the appropriate licensing authority of this Commonwealth.
Next, the Board proposes to address informed consent and required disclosures in § 18.908 (relating to informed consent and disclosure of financial interests). In this section, the Board would require that the informed consent include notice that the naturopathic doctor is not a physician. Further, in subsection (b), the Board proposes a requirement that a naturopathic doctor inform the patient if the naturopathic doctor will receive any financial incentive for referring a patient to a purveyor of merchandise or services, or for recommending any merchandise to a patient.
In § 18.909 (relating to naturopathic records) the Board proposes standards for the creation and retention of patient records and would authorize a naturopathic doctor to charge patients no more than the applicable costs for production of health records as annually adjusted by the Secretary of Health and published in the Pennsylvania Bulletin. It would further prohibit a naturopathic doctor from requiring payment for naturopathic services rendered as a condition of releasing records to a patient or the patient's designee.
Proposed § 18.910 (relating to advertising) sets forth information that must be included in all advertisements for naturopathic services, as well as standards for what may not be included in advertisements. Items that must be included in all advertisements include the name of the naturopathic doctor as registered with the Board and the words ''naturopathic doctor'' or ''doctor of naturopathic medicine.'' Prohibitions include misrepresentations and other statements that are likely to mislead or deceive, those that create false or unjustified expectations as to results and those that imply that a manifestly incurable condition can be cured or that guarantee a cure of any condition. The Board is prohibiting statements recommending any modality or service that is inconsistent with the health, safety and welfare of the public. In addition, a registered naturopathic doctor may not include the term ''physician'' unless also licensed as a physician or physician assistant by the Board or the State Board of Osteopathic Medicine.
Proposed § 18.911 (relating to Code of Ethics) would establish the ethical principles for registered naturopathic doctors in this Commonwealth. This proposal was informed by the ethical standards of other health care professions regulated by the Board and the ethical standards for licensed naturopathic doctors in other states and by National organizations such as the American Association of Naturopathic Physicians. These standards include items relating to competence, confidentiality and privacy, informed consent and maintenance of professional boundaries. Specific unethical conduct is prohibited such as making misrepresentations relating to credentials, qualifications or affiliations; engaging in fraudulent, dishonest or deceitful conduct; exploiting the professional relationship including a person, sexual, romantic or financial relationship; and engaging in sexual misconduct.
Proposed § 18.912 (relating to sexual misconduct) would make it clear that sexual misconduct, to include sexual exploitation of a current or former patient or of an immediate family member of a patient, and sexual behavior with a current patient, constitute unprofessional conduct and subjects the naturopathic doctor to disciplinary action.
Finally, proposed § 18.913 (relating to grounds for discipline) sets forth the grounds for discipline of a naturopathic doctor, including those reasons set forth in section 204 of the NDRA (63 P.S. § 272.204), and additional reasons such as engaging in fraud in obtaining a registration as a naturopathic doctor; false or deceptive advertising; aiding, assisting, employing or advising an unregistered individual to hold themselves out in a manner which states or implies that the individual is a naturopathic doctor; paying or receiving a commission, bonus, kickback or rebate or engaging in a fee splitting arrangement based on patient referrals; promoting the sale of services, drugs, devices, appliances or goods to a patient so as to exploit the patient for financial gain; offering to treat or cure a disease by a secret method; failing to maintain records; and failing to cooperate with a lawful investigation of the Board. Subsection (b) summarizes the panoply of potential disciplinary and corrective actions that the Board may impose for violations as authorized by the NDRA, the act and 63 Pa.C.S. § 3108(b) (relating to civil penalties), including denying an application for registration, administering a public reprimand, imposing probation or other restrictions on a registration, requiring other corrective actions or assessing monetary civil penalties and costs of investigation.
Fiscal Impact and Paperwork Requirements
The only fiscal impacts of this proposed rulemaking are the fees imposed upon naturopathic doctors for initial registration ($100) or biennial renewal ($50). Naturopathic doctors applying for initial registration, biennial renewal of registration or reactivation of an inactive or expired registration will be required to submit online applications and submit required documentation to the Board.
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 November 30, 2021, the Board 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 House Professional Licensure Committee and the Senate Consumer Protection and 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 comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria in section 5.2 of the Regulatory Review Act (71 P.S. § 745.5b) which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor.
Public Comment
Interested persons are invited to submit written comments, suggestions or objections regarding this proposed rulemaking to Shana Walter, Counsel, State Board of Medicine, P.O. Box 69523, Harrisburg, PA 17106-9523, or by e-mail to RA-STRegulatoryCounsel@pa.gov, within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin. Include in the subject line ''16A-4953 (Registration of Naturopathic Doctors)'' when submitting comments.
MARK B. WOODLAND, MS, MD,
ChairpersonFiscal Note: 16A-4953. 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 A. BASIC DEFINITIONS AND INFORMATION § 16.1. Definitions.
The following words and terms, when used in this chapter and Chapters 17 and 18 (relating to State Board of Medicine—medical doctors; and State Board of Medicine—practitioners other than medical doctors), have the following meanings, unless the context clearly indicates otherwise:
* * * * * Act—The Medical Practice Act of 1985 (63 P.S. §§ 422.1—[422.45] 422.53).
Approved activity—A continuing medical education activity accepted for AMA PRA credit.
Board—The State Board of Medicine.
Board-regulated practitioner—A medical doctor, midwife, physician assistant, [drugless therapist,] athletic trainer, acupuncturist, practitioner of Oriental medicine, perfusionist, respiratory therapist, genetic counselor, prosthetist, orthotist, pedorthist, orthotic fitter, naturopathic doctor or an applicant for a license, registration or certificate that the Board may issue.
* * * * *
Subchapter B. GENERAL LICENSE, CERTIFICATION AND
REGISTRATION PROVISIONS§ 16.11. Licenses, certificates and registrations.
* * * * * (c) The following registrations are issued by the Board:
(1) Registration as a supervising physician of a physician assistant.
(1.1) Initial registration as a naturopathic doctor.
(2) Biennial registration of a license without restriction.
(3) Biennial registration of an extraterritorial license.
(4) Biennial registration of a midwife license.
(5) Biennial registration of a physician assistant license.
(6) [Biennial registration of a drugless therapist license] (Reserved).
(7) Biennial registration of a limited license-permanent.
* * * * * (18) Biennial registration of an orthotic fitter license.
(19) Biennial registration of a naturopathic doctor registration.
§ 16.12. General qualifications for licenses, registrations and certificates.
To qualify for [a] an initial license, registration or certificate issued by the Board, an applicant shall establish that the following criteria are satisfied:
* * * * * § 16.13. Licensure, certification, examination and registration fees.
* * * * * (d) Acupuncturist licenses:
(1) Acupuncturist:
Application
$30 Biennial renewal
$40 (2) Practitioner of Oriental medicine license:
Application
$30 Biennial renewal
$40 (e) [Drugless therapist license:
Biennial renewal
$40] (Reserved). * * * * * (q) Orthotic Fitters:
Application for orthotic fitter license
$25 Biennial renewal of orthotic fitter license
$75 Application for reactivation of orthotic fitter license
$25 Application for orthotic fitter temporary permit
$25 (r) Naturopathic doctor registration:
Application for initial registration
$100 Biennial renewal
$50
CHAPTER 18. STATE BOARD OF MEDICINE—PRACTITIONERS OTHER THAN MEDICAL DOCTORS
Subchapter B. REGISTRATION AND PRACTICE OF ACUPUNCTURISTS AND PRACTITIONERS OF ORIENTAL MEDICINE § 18.13a. Requirements for licensure as a practitioner of Oriental medicine.
* * * * * (d) This subsection does not apply to a medical doctor licensed as an acupuncturist nor does it restrict the practice of medicine by a medical doctor.
(e) This section does not limit the practice of a naturopathic doctor who is also licensed as an acupuncturist when recommending herbs, minerals and other supplements, or combinations, according to traditions other than Oriental medicine traditions.
§ 18.15. Practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a physician.
* * * * * (b) Identification of acupuncturist or practitioner of Oriental medicine. An acupuncturist who is not a medical doctor shall wear a tag or badge with lettering clearly visible to the patient bearing the acupuncturist's name and the title ''acupuncturist'' or ''practitioner of Oriental medicine,'' as appropriate. The use of the [word doctor] words ''doctor,'' ''physician'' or any title or abbreviation implying licensure as a physician on this tag or badge is prohibited; provided, however, that an individual licensed as an acupuncturist who also possesses a current and active registration as a naturopathic doctor may utilize the title ''Doctor of Naturopathic Medicine,'' ''Naturopathic Doctor'' or the abbreviation ''N.D.'' in addition to the title ''acupuncturist''.
§ 18.15a. Scope of practice of acupuncturists and practitioners of Oriental medicine.
* * * * * (c) This subsection does not limit the scope of practice of a medical doctor who is registered as an acupuncturist.
(d) This section does not limit the scope of practice of a naturopathic doctor when recommending herbs minerals and other supplements, or combinations, according to traditions other than Oriental medicine traditions.
(Editor's Note: The following subchapter is proposed to be added and printed in regular type to enhance readability.)
Subchapter M. REGISTRATION OF NATUROPATHIC DOCTORS Sec.
18.901. Purpose. 18.902. Definitions. 18.903. Application for naturopathic doctor registration. 18.904. Biennial registration of naturopathic doctor. 18.905. Inactive status; reactivation of inactive or expired registration. 18.906. Display of registration. 18.907. Acceptable titles and professional designations by registrants and non-registrants; prohibited titles. 18.908. Informed consent and disclosure of financial interests. 18.909. Naturopathic records. 18.910. Advertising. 18.911. Code of Ethics. 18.912. Sexual misconduct. 18.913. Grounds for discipline. § 18.901. Purpose.
This subchapter implements the Naturopathic Doctor Registration Act (63 P.S. §§ 272.101—272.301) pertaining to the registration of naturopathic doctors.
§ 18.902. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Authorization to practice—A license, registration, certificate, permit, authorization or approval issued by a Federal or state agency which authorizes the holder to advertise, engage in, or both advertise and engage in the practice of a profession or occupation.
CNME—Council on Naturopathic Medical Education—The accrediting body which accredits schools of naturopathic medicine for the education of naturopathic doctors.
Merchandise—Items that can be sold including vitamins, supplements, food, food extracts, homeopathic remedies, botanical medicines, herbs and natural substances.
NABNE—North American Board of Naturopathic Examiners—The organization which administers the Naturopathic Physicians Licensing Examinations (NPLEX).
Naturopathic doctor—An individual who holds an active registration issued by the Board under the NDRA.
NDRA—The Naturopathic Doctor Registration Act (63 P.S. §§ 272.101—272.301).
NPLEX—Naturopathic Physicians Licensing Examinations—The licensing examination accepted by the Board as a prerequisite to registration, consisting of Part I—Biomedical Science Examination and Part II—Core Clinical Science Examination, or its successor recognized by the Board.
Regionally accredited or pre-accredited college or university—A college or university which is accredited or pre-accredited by one of the following:
(1) Accrediting Commission of Career Schools and Colleges.
(2) Accrediting Council for Continuing Education and Training.
(3) Accrediting Council for Independent Colleges and Schools.
(4) Council on Occupational Education.
(5) Distance Education Accrediting Commission.
(6) Higher Learning Commission.
(7) Middle States Commission on Higher Education.
(8) Middle States Commission on Secondary Schools.
(9) New England Commission of Higher Education.
(10) New York State Board of Regents and the Commissioner of Education.
(11) Northwest Commission on Colleges and Universities.
(12) Southern Association of Colleges and Schools, Commission on Colleges.
(13) Western Association of Schools and Colleges, Accrediting Commission for Community and Junior Colleges.
(14) Western Association of Schools and Colleges, Senior Colleges and University Commission.
(15) Any other regional or national accrediting agency which has been recognized by the United States Department of Education as being a reliable authority concerning the quality of education or training offered by the institutions of higher education or higher education programs they accredit.
§ 18.903. Application for naturopathic doctor registration.
(a) An applicant for a registration to practice naturopathic medicine shall submit, on an application made available by the Board, a completed application for a registration, including the necessary supporting documents and pay the application fee in § 16.13 (relating to licensure, certification, examination and registration fees).
(b) Except as otherwise provided by law, the Board will issue a registration to practice naturopathic medicine to an applicant who meets all of the following requirements:
(1) Holds a bachelor's degree from a regionally accredited or pre-accredited college or university or the equivalent.
(2) Holds a doctoral degree from a naturopathic school accredited by the CNME which consists of at least 4,100 total credit hours in basic and clinical sciences and naturopathic philosophy and modalities, including at least 2,500 hours of academic instruction and at least 1,200 hours of supervised clinical training. Proof of the degree shall be sent directly from the applicant's education program and include an official transcript.
(3) Has passed Parts I and II of a competency-based National naturopathic licensing examination administered by the NABNE or a successor agency. An applicant who graduated prior to 1986 shall demonstrate a passing score on a state naturopathic examination.
(4) Holds a current basic cardio-pulmonary resuscitation (CPR) certificate issued by the American Heart Association, American Red Cross or a similar health authority or professional body approved by the Board.
(5) Has completed at least 3 hours of approved education/training in child abuse recognition and reporting requirements as set forth in 23 Pa.C.S. § 6383(b)(3)(i) (relating to education and training).
(6) Is of good moral character.
(c) The Board may deny an application for registration as a naturopathic doctor upon any of the grounds for disciplinary action in § 18.913 (relating to disciplinary action for applicants and naturopathic doctors).
§ 18.904. Biennial registration of naturopathic doctor.
(a) The registration of a naturopathic doctor will expire biennially on December 31 of each even-numbered year in accordance with § 16.15 (relating to biennial registration; inactive status and unregistered status). A naturopathic doctor may not use the title of ''naturopathic doctor,'' ''doctor of naturopathic medicine'' or any other term implying that the individual is currently registered as a naturopathic doctor unless the individual holds a current and unexpired registration.
(b) As a condition of biennial renewal, a naturopathic doctor shall:
(1) Submit a completed application, including payment of the biennial registration fee in § 16.13 (relating to licensure, certification, examination and registration fees).
(2) Disclose on the application any authorization to practice as a naturopathic doctor in another state, district, territory, possession or country.
(3) Disclose on the application disciplinary action pending before, or taken by, the appropriate licensing, registration or certification authority in another jurisdiction since the most recent application for biennial registration, whether or not authorized to practice or advertise in that other jurisdiction.
(4) Affirm that the applicant holds a current basic cardio-pulmonary resuscitation (CPR) certificate issued by the American Heart Association, American Red Cross or a similar health authority or professional body approved by the Board.
(5) Certify that the applicant has completed at least 2 hours of approved continuing education in child abuse recognition and reporting as set forth in 23 Pa.C.S. § 6383(b)(3)(ii) (relating to education and training).
§ 18.905. Inactive status; reactivation of inactive or expired registration.
(a) A naturopathic doctor may request in writing that the Board place the registration on inactive status. Confirmation of inactive status will be forwarded to the registrant. A naturopathic doctor may not use the title of ''naturopathic doctor,'' ''doctor of naturopathic medicine'' or any other term implying that the individual is currently registered as a naturopathic doctor while on inactive status.
(b) To reactivate an inactive or expired registration, the registrant shall apply for reactivation by completing an application for reactivation on a form made available by the Board. The registrant shall:
(1) Pay the current biennial registration fee specified in § 16.13 (relating to licensure, certification, examination and registration fees) and any applicable late fees required under section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P.S. § 1401-225).
(2) Disclose whether the registrant used the title of ''naturopathic doctor,'' ''doctor of naturopathic medicine'' or any other term implying that the individual was currently registered as a naturopathic doctor in this Commonwealth while the registration was inactive or expired.
(3) Disclose on the application any authorization to practice as a naturopathic doctor in another state, district, territory, possession or country.
(4) Disclose on the application disciplinary action pending before or taken by the appropriate licensing, registration or certification authority in another jurisdiction since the most recent application for biennial registration, whether or not authorized to practice or advertise in that other jurisdiction.
(5) Submit evidence the registrant holds a current basic cardio-pulmonary resuscitation (CPR) certificate issued by the American Heart Association, American Red Cross or a similar health authority or professional body approved by the Board.
(6) Verify completion of at least 2 hours of approved continuing education in child abuse recognition and reporting in the 2 years immediately preceding the application for reactivation as set forth in 23 Pa.C.S. § 6383(b)(3)(ii) (relating to education and training).
(c) A registrant who has not had clinical contact with patients for 4 years or more shall demonstrate current competency and qualification to hold forth as a naturopathic doctor by demonstrating a passing score on the NPLEX examination, completed within 12 months of the application to reactivate the registration.
(d) Payment of applicable late fees required under section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P.S. § 1401-225) does not preclude the Board from taking disciplinary action for utilizing the title of ''naturopathic doctor,'' ''doctor of naturopathic medicine'' or any other term implying that the individual was currently registered as a naturopathic doctor while holding an inactive or expired registration.
§ 18.906. Display of registration.
A naturopathic doctor registrant shall prominently display the certificate of registration and evidence of biennial renewal in a publicly accessible location at the registrant's regular place of business. The registrant shall have evidence of current registration available for inspection by authorized agents of the Board and by persons receiving services when the naturopathic doctor provides services at locations other than the registrant's regular place of business.
§ 18.907. Acceptable titles and professional designations by registrants and non-registrants; prohibited titles.
(a) An individual must have a current, active and unsuspended registration to claim to be, or hold oneself out as, a naturopathic doctor, registered naturopathic doctor, doctor of naturopathic medicine or use any similar title implying that the individual holds a current registration as a naturopathic doctor in this Commonwealth.
(b) An individual who has not registered with the Board may claim to be, and hold oneself out as, a naturopath or a traditional naturopath and use any similar title implying that the individual practices naturopathy so long as the title does not also imply that the individual is a naturopathic doctor registered with the Board.
(c) A naturopathic doctor who uses the designation ''Dr.'' shall further identify himself or herself as a ''naturopathic doctor,'' ''registered naturopathic doctor'' or ''doctor of naturopathic medicine'' and may not use any term or designation that would imply that the naturopathic doctor is licensed or authorized to practice medicine and surgery, dentistry, podiatry, optometry, psychology, nursing, physical therapy, acupuncture, chiropractic, genetic counseling, athletic training, massage therapy or any other health care profession, unless that individual also holds a current and active authorization to practice the other profession issued by the appropriate licensing authority of this Commonwealth.
§ 18.908. Informed consent and disclosure of financial interests.
(a) A naturopathic doctor shall obtain written informed consent from the patient prior to providing naturopathic services to the patient. The informed consent shall include notification to the patient that the naturopathic doctor is not a physician. This subsection shall not apply to registrants who are also currently and actively licensed to practice as a physician in this Commonwealth.
(b) A naturopathic doctor shall disclose to patients and prospective patients if the naturopathic doctor receives any commission, rebate, referral fee or similar financial incentive in connection with the referral of a patient to purveyors of merchandise or services, or for recommending any merchandise to a patient.
§ 18.909. Naturopathic records.
(a) A naturopathic doctor shall maintain patient records that accurately describe the patient's concerns, evidence the naturopathic doctor's plan of service and implementation of service and document the patient's response to any services provided.
(b) All patient records for minors and adults shall be retained for a minimum period of 7 years from the date of the service for which a naturopathic record entry is required. Patient records for minor patients shall also be retained until 1 year after the minor patient reaches majority, even if this means that the naturopathic doctor retains the record for a period of more than 7 years.
(c) Upon written request, a naturopathic doctor shall make true, correct and legible copies of the written records of service available to the patient or the person or persons designated by the patient.
(d) Payment for naturopathic services rendered may not be required as a condition to making the written records of service available to the patient or the patient's designee. A naturopathic doctor may require pre-payment of the costs to copy and produce the naturopathic records. The maximum applicable copying and reproduction costs for naturopathic service records shall be the same as those costs applicable to production of health records as annually adjusted by the Secretary of the Department of Health and published in the Pennsylvania Bulletin.
§ 18.910. Advertising.
(a) Any advertisement by a naturopathic doctor shall contain both of the following:
(1) The name of the naturopathic doctor as registered with the Board.
(2) The words ''naturopathic doctor'' or ''doctor of naturopathic medicine.''
(b) Advertisements by a naturopathic doctor may not contain any of the following:
(1) The word ''physician'' unless the naturopathic doctor is also currently and actively licensed as a physician or physician assistant in this Commonwealth.
(2) Any words or phrases indicating or implying that the naturopathic doctor is ''board certified'' or ''board eligible'' unless the certification body is also disclosed.
(3) Statements containing misrepresentations of facts.
(4) Statements that cannot be verified by the Board for truthfulness.
(5) Statements likely to mislead or deceive because of their context or because the statements make only a partial disclosure of relevant facts.
(6) Statements intended to, or likely to, create false or unjustified expectations of favorable results.
(7) Statements containing representations or implications that can reasonably be expected to cause an ordinary prudent person to misunderstand or be deceived.
(8) Statements that are untruthful and improbable or contain misstatements, falsehoods, misrepresentations, distorted or fabulous statements as to cures.
(9) Statements that misrepresent the nature, characteristics or qualities of natural substances or services provided by a naturopathic doctor.
(10) Statements that a manifestly incurable condition can be cured or that guarantee a cure of any condition.
(11) Statements promoting herbal, natural or dietary supplements as drugs.
(12) Statements recommending any modality of service that is inconsistent with the health, safety and welfare of the public.
§ 18.911. Code of Ethics.
(a) Naturopathic doctors shall concern themselves primarily with the welfare of the patient.
(b) A naturopathic doctor who suffers from a physical, mental or emotional impairment, including substance abuse, that impacts the individual's ability to practice naturopathic medicine shall seek professional treatment and refrain from the practice of naturopathic medicine until the impairment no longer exists or reasonable accommodations can be made.
(c) A naturopathic doctor shall:
(1) Respect and maintain the privacy and confidentiality of the patient.
(2) Disclose the patient's records or information about the patient only with the patient's consent or as required by law.
(3) Adequately safeguard confidential patient information, including storage and disposal of records.
(4) Provide sufficient information to a patient to allow the patient to make an informed decision regarding care, including:
(i) The purpose and nature of a naturopathic evaluation or service regimen.
(ii) Alternatives to naturopathic care.
(iii) Side effects and benefits of a proposed service regimen.
(iv) The estimated cost of services.
(v) The right of the patient to withdraw from services.
(5) Maintain professional boundaries, even when the patient initiates crossing the boundaries of the professional relationship.
(6) Decline to administer service if the naturopathic doctor believes that a service is contraindicated or unjustified.
(7) Make referrals only to registered naturopathic doctors or other qualified and duly licensed health care providers.
(8) Accurately inform the patient, other health care professionals and the public of the limitations of the practice of naturopathic medicine.
(9) Adequately assess the patient to determine if contraindications against naturopathic service exist and refer the patient to an appropriate health care practitioner.
(10) At all times respect the patient's dignity, autonomy and privacy.
(11) Cooperate with any lawful investigation conducted by the Board, including all of the following:
(i) Furnishing information requested in a timely manner as directed by the Board.
(ii) Complying with a subpoena.
(iii) Responding to a complaint at the request of the Board.
(iv) Providing meaningful and timely access to relevant patient records.
(12) Report to the Board misconduct in the practice of naturopathic medicine.
(d) A naturopathic doctor may not:
(1) Misrepresent credentials, qualifications or affiliations, and shall attempt to correct others who misrepresent the naturopathic doctor's credentials, qualifications or affiliations.
(2) Knowingly engage in or condone behavior that is fraudulent, dishonest or deceitful.
(3) Engage in a commercial activity which conflicts with the duties of a naturopathic doctor.
(4) Perform naturopathic medicine on a patient if a contraindication against naturopathic service exists.
(5) Intimidate, threaten, influence or attempt to influence any person regarding any violation of law or regulation.
(6) Aid or abet any individual violating or attempting to violate any provision of law or regulation.
(7) Accept a patient for service, or continue unnecessary service, when the patient cannot be reasonably expected to benefit from the service.
(8) Receive remuneration from, or provide remuneration to, or split a fee, for either making or accepting a referral of the patient to or from another health care provider.
(9) Make a guarantee or promise about the efficacy of a particular course of care, the naturopathic doctor's practice or the anticipated results of care.
(10) Exploit the professional relationship by either of the following:
(i) Continuing service unnecessarily.
(ii) Charging for a service not provided or different from what was actually provided.
(11) Exploit a relationship with a patient, staff member or student for the naturopathic doctor's personal advantage including, but not limited to, a personal, sexual, romantic or financial relationship.
(12) Engage in sexual misconduct.
(e) A naturopathic doctor may not perform a service or provide a service that the naturopathic doctor is not qualified to perform, or which is beyond the scope of the naturopathic doctor's education, training, capabilities or experience.
(f) A naturopathic doctor may not construe any failure to specify a particular ethical, legal or professional duty in this subchapter as a denial of the existence of other ethical, legal or professional duties or responsibilities that are equally as important and generally recognized in the naturopathic medicine profession.
§ 18.912. Sexual misconduct.
(a) Sexual exploitation by a naturopathic doctor of a current or former patient, or of an immediate family member of a patient, constitutes unprofessional conduct, is prohibited and subjects the naturopathic doctor to disciplinary action under section 204(8) of the NDRA (63 P.S. § 272.204(8)).
(b) Sexual behavior that occurs with a current patient, other than the naturopathic doctor's spouse, constitutes unprofessional conduct, is prohibited and subjects the practitioner to disciplinary action under section 204(8) of the NDRA.
(c) When a naturopathic doctor was involved with the management or directly provided naturopathic services to a patient other than the naturopathic doctor's spouse for a mental health disorder, any sexual behavior with that patient which occurs prior to the 2-year anniversary of the termination of the professional relationship constitutes unprofessional conduct, is prohibited and subjects the naturopathic doctor to disciplinary action under section 204(8) of the NDRA.
(d) A practitioner who engages in conduct prohibited by this section will not be eligible for placement into an impaired professional program in lieu of disciplinary or corrective actions.
(e) Consent is not a defense to conduct prohibited by this section.
§ 18.913. Grounds for discipline.
(a) The Board shall have the authority to impose disciplinary or corrective measures on a naturopathic doctor or applicant for registration as a naturopathic doctor for the reasons set forth in section 204 of the NDRA (63 P.S. § 272.204) and any of the following:
(1) Fraudulently or deceptively obtaining, or attempting to obtain, or using a registration or assisting another in fraudulently or deceptively obtaining or using a registration.
(2) Using false, deceptive or misleading advertising.
(3) Advertising, practicing or attempting to practice under a name other than the naturopathic doctor's name as registered with the Board; provided, however, that a naturopathic doctor may advertise utilizing a business name if the advertisement also includes the naturopathic doctor's name as registered by the Board.
(4) Aiding, assisting, employing or advising any unregistered individual to hold himself or herself out in a manner which states or implies the unregistered individual is a naturopathic doctor.
(5) Paying or receiving any commission, bonus, kickback or rebate, or engaging in any split-fee arrangement in any form with a licensed physician, organization, agency or other person, either directly or indirectly, for patients referred to other health care providers.
(6) Promoting the sale of services, drugs, devices, appliances or goods to a patient so as to exploit the patient for financial gain.
(7) Failing to keep written records justifying the course of service of a patient.
(8) Offering, undertaking or agreeing to cure or treat a disease by a secret method, treatment, product or medicine.
(9) Failing to cooperate with a lawful investigation of the Board.
(b) When the Board is empowered to take disciplinary or corrective action under the provisions of the NDRA, the Board's regulations or other statutory or regulatory authority, the Board may impose one or more of the following disciplinary or corrective actions as set forth in section 206 of the NDRA (63 P.S. § 272.206), section 42 of the act (63 P.S. § 422.42) and 63 Pa.C.S. § 3108 (relating to civil penalties):
(1) Deny the application for registration.
(2) Administer a public reprimand with or without probation.
(3) Revoke, suspend, limit or otherwise restrict a registration.
(4) Require the registrant to submit to the care, counseling or treatment of a physician or a psychologist designated by the Board.
(5) Require the registrant to take refresher educational courses or demonstrate passage of the NPLEX examination, or both.
(6) Stay enforcement of any suspension and place the registrant on probation with the right to vacate the probationary order for noncompliance.
(7) Impose a civil penalty of up to $1,000 in accordance with the NDRA.
(8) Impose a civil penalty of up to $10,000 in accordance with 63 Pa.C.S. § 3108(b); provided, however, that the Board will not impose a civil penalty under the NDRA and also impose a civil penalty under 63 Pa.C.S. § 3108(b) for the same violation, as prohibited by 63 Pa.C.S. § 3108(c)(2).
(9) Impose the costs of investigation underlying the disciplinary action.
[Pa.B. Doc. No. 21-2112. Filed for public inspection December 17, 2021, 9:00 a.m.]
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