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; 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.
Authority The provisions of this Subchapter M added under sections 202(6), 203(b) and (c) and 207 of the Naturopathic Doctor Registration Act (63 P.S. § § 272.202(6), 272.203(b) and (c) and 272.207), unless otherwise noted.
Source The provisions of this Subchapter M added May 17, 2024, effective May 18, 2024, 54 Pa.B. 2780, unless otherwise noted.
§ 18.901. Purpose.
This subchapter implements the NDRA 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 state or Federal 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 grants candidacy and accreditation to programs of naturopathic medicine for the education of naturopathic doctors.
Marketing activity—A communication about a service or merchandise that encourages recipients of the communication to purchase or use the merchandise or service. For purposes of this chapter, the term does not include a service from or referral to another health care practitioner.
Merchandise—Items that can be sold including vitamins, supplements, food, food extracts, homeopathic remedies, botanical medicines and herbs.
NABNE—North American Board of Naturopathic Examiners—The organization which administers the NPLEX.
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.
Natural therapies—Treatment of an individual through the use of substances in which the active ingredient is derived from plant, mineral or fungal sources, or any substance found in nature, and which may also contain common pharmaceutical excipients, and nonprescription drugs as defined by the Federal Food, Drug, and Cosmetic Act (52 Stat. 1040, 21 U.S.C. § § 301—399g).
Naturopathic doctor—An individual who holds an active registration issued by the Board under the NDRA.
Naturopathic medicine—Naturopathic physical medicine, natural therapies, naturopathic counseling or a combination thereof, to support and stimulate the individual’s self-healing processes.
Naturopathic physical medicine—The use of the physical agents of air, water, heat, cold, sound and light, and the physical modalities of electrotherapy, biofeedback, diathermy, ultraviolet light, ultrasound, hydrotherapy and exercise, including naturopathic manipulation and mobilization therapy.
Naturopathic service—Providing or performing naturopathic physical medicine, natural therapies, naturopathic counseling or a combination thereof, to support and stimulate an individual’s self-healing processes.
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) 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, including information required by § 16.16 (relating to reporting of disciplinary actions, criminal dispositions and other licenses, certificates or authorizations to practice) 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 as a naturopathic doctor 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 an institutionally accredited or pre-accredited college or university offering a naturopathic doctor program which has been granted programmatic candidacy or accreditation 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) and in § 16.108(a) (relating to child abuse recognition and reporting—mandatory training requirement).
(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 grounds for discipline).
§ 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,’’ ‘‘registered naturopathic doctor’’ 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) and in § 16.108(b) (relating to child abuse recognition and reporting—mandatory training requirement).
§ 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,’’ ‘‘registered naturopathic doctor’’ 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,’’ ‘‘registered naturopathic doctor’’ or any other term implying that the individual was currently registered as a naturopathic doctor in the 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) and in § 16.108(b) (relating to child abuse recognition and reporting—mandatory training requirement).
(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 Part II—Core Clinical Science 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 does not preclude the Board from taking disciplinary action for utilizing the title of ‘‘naturopathic doctor,’’ ‘‘doctor of naturopathic medicine,’’ ‘‘registered naturopathic doctor’’ 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; 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) A naturopathic doctor who uses the designation ‘‘Dr.’’ shall further identify himself 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 any marketing activity relating to merchandise.
§ 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) An 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,’’ ‘‘doctor of naturopathic medicine,’’ or ‘‘registered naturopathic doctor.’’
(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) 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 merchandise or naturopathic 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 or to provide naturopathic services with reasonable skill and safety to patients 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) Safeguard patient protected health 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 naturopathic service regimen.
(ii) Alternatives to naturopathic care.
(iii) Side effects and benefits of a proposed naturopathic service regimen.
(iv) The estimated cost of naturopathic services.
(v) The right of the patient to withdraw from naturopathic services.
(5) Maintain professional boundaries, even when the patient initiates crossing the boundaries of the professional relationship.
(6) Decline to administer a naturopathic service if the naturopathic doctor believes that the service is contraindicated or unjustified.
(7) Make referrals only to registered naturopathic doctors or other qualified and duly licensed health care providers.
(8) Inform the patient, other health care professionals and the public of the limitations of naturopathic medicine.
(9) 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:
(i) Furnishing information requested as directed by the Board.
(ii) Complying with a subpoena.
(iii) Responding to a complaint at the request of the Board.
(iv) Providing access to relevant patient records.
(12) Report to the Board misconduct committed by a naturopathic doctor in the practice of naturopathic medicine or in the provision of naturopathic services.
(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 marketing activity which conflicts with subsection (c).
(4) Perform naturopathic medicine on or provide a naturopathic service to 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 a naturopathic 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 the naturopathic doctor’s practice, particular naturopathic service or the anticipated results of care.
(10) Exploit the professional relationship by either of the following:
(i) Continuing naturopathic service unnecessarily.
(ii) Charging for a naturopathic 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.
(13) Provide or perform a naturopathic service at a level beneath the accepted standard of care for a naturopathic doctor which would be normally exercised by the average professional of the same kind in this Commonwealth under the circumstances, including locality and whether the naturopathic doctor is or purports to be a specialist in the area.
(e) A naturopathic doctor may not perform or provide naturopathic service that the naturopathic doctor is not qualified to perform, or which is beyond the naturopathic doctor’s education and training.
(f) A naturopathic doctor may not assert as a defense to a disciplinary action under section 204 of the NDRA (63 P.S. § 272.204) or § 18.913 (relating to grounds for discipline), the absence of a specific ethical, legal or professional duty in this subsection when the duty is normally exercised by the average professional of the same kind in this Commonwealth under the circumstances, including locality and whether the naturopathic doctor is or purports to be a specialist in the area.
§ 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 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) Failing to disclose the contents of merchandise or the nature and description of naturopathic services recommended, provided or offered to a patient.
(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.
Cross References This section cited in 49 Pa. Code § 18.903 (relating to application for naturopathic doctor registration); and 49 Pa. Code § 18.911 (relating to Code of Ethics).
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