The Legislative Archive reports the results of the 2013-2014 state legislative sessions on all CAM provider bills followed on SFSBM. For currently pending bills, please see Legislative Updates. (Note: Only New Jersey and Virginia carry over bills introduced in 2014 to 2015.)
ALASKA: Did not pass; Legislature adjourned. House Bill 7 expands scope of naturopathic practice.
ARIZONA: Passed Legislature; signed by Governor. Senate Bill 1050. Expands scope of practice. Permits naturopaths to practice telemedicine, which means they would be able to diagnose and recommend treatments via audio and video.
COLORADO Did not pass; Legislature adjourned. Senate Bill 14-128 amends the Naturopathic Doctor Act, which was passed just last year to allow naturopathic doctors to practice in Colorado. The bill has good features in that it narrows the scope of naturopathic practice. It is also a sop to the traditional naturopaths who were excluded from last year's law because they didn't graduate from accredited naturopathic "medical" schools and would allow them to practice if they met certain requirements. The bill also the eliminates the ability of NDs to prescribe medicines in the naturopathic formulary and to perform minor office procedures.
COLORADO Did not pass; Legislature adjourned. Senate Bill 14-032 also amends the Naturopathic Doctor Act byeliminating restrictions on naturopathic doctors treating children. As it stands, NDs cannot treat children under 2 years old, and if the child is under 8, requires the ND to provide a schedule of recommended vaccinations, tell parents that the Department of Health and Human Services recommends they be followed, disclose that the ND is not a physician, and recommend that the child have a relationship with a licensed pediatric health care provider. It also required NDs to have 3 hours of continuing education per year in pediatrics. This bill eliminates these important protections for children whose are naive enough to allow NDs to treat their children. It also eliminates important consumer protections for children who see unlicensed alternative health care providers. (See below, under "Other CAM Practitioners.")
CONNECTICUT: Passed in Legislature; signed by Governor. House Bill 5537. Expanded naturopathic scope of practice to include diagnosis, treatment and prevention of disease; ordering diagnostic tests; venipuncture for blood testing; ordering medical devices; administration of vaccines; minor wound repair and suturing. Naturopaths wanted, but did not get, prescription privileges.
HAWAII: Passed House and Senate; signed by Governor on 7/8/14. Senate Bill 2577. Under current law, naturopaths can prescribe, administer and dispense certain drugs and, with approval of the naturopathic board, administer these drugs IV or IM. The board sets the naturopathic formulary. The original bill, which sought to substantially increase naturopathic education and training before they could prescribe drugs, has been considerably weakened as it moved through the legislative process. Now the bill simply requires more continuing education, some of it directed at pharmacology. As originally drafted, this bill would have required naturopaths to fullfill the same requirements as MDs and DOs before they could prescribe, administer or dispense drugs. Licenses to prescribe would be issued by the Department of Commerce and Consumer Affairs, not the naturopathic board. Unfortunately, these requirements were elminated from the bill. It was amended to add some physician oversight and reporting requirements for naturopaths, as well as limit the ability of the board to add drugs to the formulary, although the limitation is weak. Even those restricitons are no longer in the bill.
ILLINOIS: Did not pass. Legislature adjourned. Senate Bill 1168, House Bill 3645. Naturopathic licensing. Both bills amend the Medical Practice Act of 1987 to provide for the licensure of naturopathic physicians and both are vague on details. For example, no scope of practice is specified but apparently it would be the same as an M.D. or D.O. primary care physician.
IDAHO: Did not pass. Legislature adjourned. House Bill 566. Idaho passed a law licensing naturopaths in 2005 but the law was never implemented. This bill would create a new licensing statute, apparently to resolve ambiguities in the current law. It permits a broad scope of practice, similar to an M.D. or D.O. primary care physician, defining naturopathy as "comprehensive system of primary health care" including the authority to order lab work, imaging and diagnostic testing "consistent with naturopathic medical education and training," the limits of which a Board of Naturopathic Medicine would decide. this provision would allow NDs to use such discredited treatments as chelation therapy and IV vitamin "cocktails" if listed on the formulary. The Board would consist of 3 NDs, as well as one MD, and one pharmacist, both of whom would be chosen by the Board. NDs could prescribe, administer and dispense drugs and medical devices, again "consistent with" their education and training, as determined by the Board. The bill would allow persons without an ND license to diagnose and treat patients as long as they don't use legend drugs, use only "natural elements," and viatmins, dietary supplements and homeopathy. Presumably this provision is to placate the traditional naturopaths whose practice might be forbidden by licensure of those with a "doctor of naturopathic medicine" degree, even though both groups buy into the same psuedoscience, such as the use of homeopathy and the elimination of never-identified "toxins" via enemas and fasting.
IOWA: Did not pass. Legislature adjourned. House Study Bill 577, Senate Study Bill 3139. In Iowa, study bills are used to determine reception to an issue by the General Assembly and are developed under the auspices of a legislative committee. If a study bill is approved by the committee it can then be considered by the General Assembly. These study bills would give NDs an extremely broad scope of practice comparable to an MD or DO PCP. NDs could diagnose and treat any patient with any disease or condition, order lab tests and diagnostic imaging, and prescribe drugs unless the drug is excluded by the naturopathic exclusionary formulary. NDs would be governed by the Medical Board acting on the advice of a naturopathic advisory committee, consisting of 4 NDs, one MD or DO, one pharmacist and one public member, giving the NDs an automatic majority. This advisory committee would recommend which prescription drugs would be excluded from naturopathic practice. In other words, drugs are presumed included unless excluded.m No malpractice insurance is required.
MARYLAND: Passed; signed into law by Governor. Senate Bill 314, House Bill 402. Naturopathic licensing bills. Original bills gave naturopaths a broad scope of practice similar to that of MD or DO physician: could diagnose and treat any patient of any age with any disease or condition; could use of colon hydrotherapy, homeopathy, dietary supplements, electromagnetic energy, among many other treatments and administer IV; order lab tests and order and interpret diagnostic imaging. NDs would be self-governed by naturopathic board. No prescription privileges but establishes workshop to make recommmendations regarding establishment of naturopathic formulary. Amendments reduced the means NDs could employ but they could still diagnose and treat any patient with any disease or condition, order lab tests and order and interpret reports of diagnositc imaging. Cannot use colon hydrotherapy but can use many other dubious treatments, such as homeopathy.
MASSACHUSETTS: Did not pass; formal legislative sessions ended. House Bill 4304 (amends House Bill 3674 by substitution of a new draft; HB 3674 itself amended House Bill 2003 & Senate Bill 1091 by substitution of a new draft). Naturopathic licensing bill. Would permit naturopathic doctor to evaluate and treat any patient of any age with any disease or condition; allow use of disproven treatments such as homeopathy and colonic irrigation; allow naturopathic doctors to prescribe and sell unproven dietary supplements and other substances to patients; allow them to order lab work and other diagnostic tests; self-governance by a naturopathic board; no malpractice insurance required.
MICHIGAN: Did not pass; Legislature adjourned. House Bill 4252. Naturopathic licensing bill. Gives naturopaths extremely broad scope of practice similar to that of M.D. or D.O. primary care physician; can diagnose and treat, without limitation, any disease or condition in any patient regardless of age; allows naturopaths or prescribe prescription drugs and order and interpret lab tests and x-rays; permits all routes of administration of dietary supplements, “natural” products, homeopathic remedies, vitamins and minerals, including intravenous – this allows naturopaths to employ unproven and dangerous remedies like IV administration of vitamins and minerals for “flu prevention”; allows naturopaths to diagnose non-existent diseases and conditions they believe in such as “adrenal fatigue” and near universal “food sensitivities”; permits use of bizarre naturopathic diagnostic methods such as iridology, applied kinesiology, and “live blood analysis."
NEW YORK: Passed Senate; failed in Assembly. Legislature adjourned. Naturopathic licensing bill, Senate Bill 4878, passed the Senate on 6/17/13. Assembly Bill 7860, with same provisions, still under consideration in Assembly. Provides for the licensure of “Naturopathic Doctors.” Establishes self-regulation through a State Board of Naturopathy. Broad scope of practice permitted, similar to that of M.D. or D.O. primary care physician, no limitation on patient age or condition. Allows use of bizarre naturopathic diagnostic methods such as applied kinesiology and iridology and treatments such as homeopathy, colonic irrigation, severely restricted diets, and dietary supplements of unknown safety or effectiveness. Allows naturopaths to draw blood, order lab tests and order x-rays. Falsely assumes that naturopaths are experts in drug-supplement interaction. No liability insurance required.
PENNSYLVANIA: Passed House but not Sentate; Legislature adjourned. Naturopathic licensing bill (House Bill 612) passed in House and is now in Senate. Grants NDs what is essentially MD primary care physician scope of practice. Many of their unproven, and sometimes dangerous, therapies would be allowed, such as colon cleansing and other forms of hydrotherapy, visceral manipulation, cranial sacral therapy, radical fasting diets, homeopathy, including totally ineffective homeopathic “flu vaccines,” and green tea suppositories for prevention of cervical diseases. Irresponsible and unproven diagnostic techniques would be allowed, such as live blood analysis, applied kinesiology, hair mineral analysis, thermography and bogus food sensitivity testing; could order diagnostic tests and provide treatments for which they are not properly trained, such as “examination of body orifices” (which would allow vaginal and proctologic exams) and cognitive therapy.
RHODE ISLAND: Did not pass. Legislature adjourned. Senate Bill 2874. Naturopathic licensing bill. Gives naturopaths a broad scope of practice almost identical to MD/DO primary care physicians. Could diagnose any patient of any age with any disease or condition using all diagnostic methods "commonly used" by PCPs, a term that is undefined. Although these are not listed, would include the ability to order and interpret, for example, EKGs, MRIs, CAT scans, PET scans, EEGs. Although the scope of prescription privildges is not clearly defined, the bill would permit them to prescribe and administer high dose vitamins and minerals, homeopathic remedies, and dietary supplements by any means, including injection and IV. Also permits prescription of "natural medicines" by any means, including IV and injection, without any clear defintion of what "natural" means other than it is "present in, produced by, or derived from nature," which could mean practically any substance. Would be overseen by Department of Health with two naturopaths as its sole advisors;.
UTAH: Passed; signed into law by Governor. Senate Bill 193. Utah naturopaths can currently prescribe certain drugs in accordance with a naturopathic formulary, including the usual questionable naturopathic remedies such as glandulars, bio-identical hormones, and chelating agents, which they use for "detoxification." This bill would expand their scope of practice to include, minor office procedures, "percutaneous injection[s] into skin, tendons, ligaments, muscles and joints with local anesthetics and nonscheduled prescription medications . . . and natural substances." The bill as originally drafted added tramadol to the list of drugs they can prescribe but if only under the supervision of an M.D. or D.O., but this provision didn't pass. Under current law, the naturopathy board decides what is on the formulary, in collaberation with a naturopathic advisory committee, The only good feature of this bill is that it would remove one of the naturopaths from the committee and replace him or her with an M.D. or D.O.
CALIFORNIA: Did not pass; Legislature adjourned. Senate Bill 381. Prevents physical therapists from performing joint manipulations and makes doing so the unlawful practice of chiropractic. There is no evidence that chiropractors are superior to physical therapists in performing manipulation. This is turf protection.
HAWAII: Did not pass; Legislature adjourned. Senate Bill 2478, House Bill 1831. Substantially expands chiropractic scope of practice. Current law limits chiropractors to diagnosis and treatment of neuromusculoskeletal conditions related to spinal column. Bills would permit chiropractors to diagnose and treat anyone with any disease or condition by any physical, chemical, electrical or thermal method (including dietary supplements), use diagnostic imaging, order lab tests, or use any other method of diagnosis taught by chiropractic schools and approved by state chiropractic board. Permits chiropractors to call themselves "chiropractic physicians."
MINNESOTA: Passed; signed by Governor. Senate Bill 1665, House Bill 1850. Clarifies and expands scope of chiropractic practice to include detection (including by CAT and PET scans and MRI) and correction of the non-existent chiropractic “subluxation.” Permits the use of acupuncture with certain training.
NEW MEXICO: Postposed indefinately; Legislature adjourned. Senate Bill 239. Would considerably expand the already liberal scope of practice for chiropractors. DCs would be allowed to diagnose and treat any condition for which they have been "educated and trained," essentially defaulting to the chiropractor the authority to make the decision regarding what he can and cannot do. The state's existing "advanced practice" chiropractors are divided into two tiers, "Level One" and "Level Two." Both could administer certain substances, such as "nutritional medicine," bioidentical hormones, and glandulars, by injection. Both could prescribe any drugs approved by the chiropractic board. Level Ones currently have 90 additional hours of training after chiropractic school but that requirement has been changed to a "postgraduate degree in a clinical specialty" from a chiropractic school, but no minimum standards for such a course are set. They would be able to prescribe, inject and dispense dangerous drugs if the chiropractic board, in consultation with (but not necessarily the approval of) the pharmacy board, gives its ok. Level Twos must have, in addition, 650 hours in a supervised "clinical rotation." Level Twos could also prescribe, inject and dispense all dangerous drugs, except Schedule I and II controlled substances,that are used in standard primary care practice.
NEW YORK: Did not pass; Legislature adjourned. Assembly Bill 6998. Mandates that chiropractors perform scoliosis screening on all students in the third, sixth and ninth grade. The need for scoliosis screening for asymptomatic children is controversial and not all chiropractors adhere to evidence-based treatment of scoliosis.
OKLAHOMA: Passed in Senate but failed to pass in House; Legislature adjourned. Senate Bill 451. Originally the bill required chiropractors to obtain written consent from patients prior to any treatment of the cervical spine and to disclose the risks and possible side effects, including risk of stroke. The bill, which is now making its way through the House, has been watered down to create a Task Force on Neck Manipulation. While chiropractors have the majority (3 positions) on the Task Force among health care providers, there is a provision for one M.D., one D.O, and one Physical Therapist. Other members are Senators and Representatives. The effectiveness of the Task Force will likely turn on which legislators are appointed.
VIRGINIA: House Joint Resolution 93. A vanity resolution with no legal effect but chock full of chiropractic buzzwords supporting the non-existent ìvertebral subluxationî (without ever mentioning it by name) and MD/DO bashing. Describes chiropractors as ìphysician level providersî and designates October, 2014, and thereafter, as Chiropractic Health Month in Virginia.
WASHINGTON: Did not pass; Legislature adjourned. House Bill 1573. Prohibits “discrimination” against chiropractors and allows them to perform sports physicals for school athletics and physicals for commercial drivers’ licenses.
WASHINGTON: Passed; signed into law by Governor. House Bill 2160. Allows physical therapists to perform spinal manipulation after being issued a spinal manipulation endorsement by the Secretary of the State Department of Health; prohibits a physical therapist from advertising that he or she performs chiropractic "adjustment, spinal adjustment, maintenance or wellness manipulation, or chiropractic care of any kind."
WISCONSIN: Passed; signed into law by Governor. Senate Bill 518 requires chiropractors (and dentists and optometrists) to inform patients of reasonable treatment alternatives and the risks and benefits of those alternatives, but employs the "reasonable chiropractor" standard, as opposed to the standard requiring disclosure of what a "reasonable patient" would want to know. The Wisconsin Supreme Court has already ruled that chiropractors have the same duty as physicians to provide informed consent, which was, at the time, the "reasonable patient" standard. (The legislature subsequently passed a law applying the "reasonable physician" standard.) The bill does not require the disclosure of "extremely remote possibilities that might detrimentally alarm the patient." If passed, it will be interesting to see how chiropractors apply this to cervical manipulation, as many of them deny that vertebral artery dissection and stroke are risks of manipulating the neck.
WISCONSIN: Did not pass; Legislature adjourned. Assembly Bill 765. Expands the scope of practice of chiropractic to include practice of acupuncture with 100 hours of training and 2 hours of continuing education annually.
Acupuncture, Traditional Chinese Medicine and Oriental Medicine
ALABAMA: Did not pass; Legislature adjourned. Senate Bills 384 and 452 and House Bill 541 would legalize the practice of acupunture in Alabama. Acupuncture is defined broadly as "a form of health care developed from traditional and modern Oriental medical concepts and modern research, that employs acupuncture diagnosis and treatment." The bill also permits, quite broadly, unspecified "adjunctive therapies and diagnostic techniques, for the promotion, maintenance and restoration of health and the prevention of disease." In addition to needle instertion, electroacupunture, electrodermal assessment, Qi Gong, moxibustion, herbs and dietary supplements would be permitted. Acunpuncturists could not make a medical diagnosis, only "pattern differentiation according to traditional Chinese medicine" and must refer to a physician under the loose standard that a patient is "not improving" or requires emergency medical treatment. The bill buys into the myth that education and training according to certain standards, created wholly by acupuncuturists, somehow improves the fact that acupuncture (in all its forms) is pseudoscience and there is no evidence that is effective for anything.
ARIZONA Did not pass; Legislature adjourned. House Bill 2548 expands the scope of practice of "auricular acupuncture" to include post-traumatic stress disorder. It limits the number of needles per ear, per treatment, to five. Given the fact that auricular acupuncture has no plausible basis and is not effective for anything, the necessity of this limitation is puzzling, as the number of needles per ear cannot possibly matter.
CALIFORNIA: Passed Senate but not House; Legislture adjourned. Senate Bill 218. Creates Traditional Chinese Medicine Traumatologist certification. TCM traumatology is defined as a system of treatment of musculoskeletal conditions by stimulation “acupressure points” to “open the body’s defensive chi and stimulate energy movement in the meridians.”
PENNSYLVANIA: Passed; signed into law by Governor. Senate Bill 990, House Bill 266. These bills contain both good and bad provisions. Current law requires an acupuncturist to refer to a physician if he treats a “condition” beyond 60 days. The bad: These bills would not require the referral if the patient doesn’t present with a “condition.” In such a case the acupuncturist should not be treating the patient at all, not continue to treat the patient, as this bill would allow. In any event, no acupuncturist should be allowed to treat any patient beyond 60 days no matter what the patient’s “condition” so the law should not be amended in this respect. The good: The bills require acupuncturists to carry at least $1 million in liability insurance.
PENNSYLVANIA: The Pennsylvania House passed a resolution making October 24, 2014 "Acupuncture and Oriental Medicine Day." The resolution says that these have been "used for thousands of years to diagnose and treat illness, prevent disease and improve well-being." It fails to reveal that, while it may have been "used" for these purposes, it is not "effective."
LOUISIANA: Did not pass; Legislature adjourned. Senate Concurrent Resoultion 22 directs the Department of Health and Hospitals to create the "Practice and Regulation of Acupuncture and Oriental Medicine Review Committee." The Committee would study whether acupuncture and oriental medicine should be regulated and licensed by an independent state board and what the requirements for practice should be. Currently, only physicians and trained "assistants" can perform acupuncture. The resolution makes a number of incorrect statements about acupuncture: that it provides important health benefits; that it is a "proactive avenue towards health when neither symptoms nor severity of disease warrants other forms of of treatment," and that it is a "valuable way to to identify those in need of a referral to a western medical provider." In other words, a trifecta of evidence-free assumptions.
MASSACHUSETTS: Did not pass; Legislature adjourned. House Bill 3972 is a new draft for Senate Bill 1107 and House Bill 2051. The bill create a commission on “acupuncture and wellness” consisting of acupuncturists, state health officials and representatives of the insurance industry. The commission would study how to best integrate acupuncture services into state health care “to expand access, reduce health care costs, and provide improved quality of care to Massachusetts residents.” The underlying premise of the bills is flawed in that it assumes acupuncture has anything to offer which would achieve these goals. It is a transparent attempt to force a conclusion that the expansion of acupuncture services is warranted. The bill forces insurers to provide benefits for acupuncture and oriental medicine based diagnosis and treatment "in the areas of pain management, post-traumatic stress disorder, substance abuse treatment, and nausea."
MISSISSIPPI: Did not pass; Legislature adjourned. Senate Bill 2391. Expands scope of practice. Acupuncturists keep trying to get out from under the current state law requirement that they can see patients only on physician referral. This bill would exempt an acupuncturist from the referral requirement if he or she remains in good standing in the state for five consecutive years.
Other CAM Practitioners
COLORADO Did not pass; Legislature adjourned. Senate Bill 14-032 eliminates important protections for children whose parents take them to "alternative health care providers." Last year, Colorado passed a law allowing anyone who wanted to practice "alternative medicine" a safe harbor from prosecution for the unlicensed practice of medicine. It contained limitations on these uneducated and untrained practitioners treating children. This bill removes those limitations. It would permit any practitioner to treat any child and removes the requirements that the practitioner disclose that he is not a physician, recommend that the child have a relationship with a licensed pediatric health care practitioner, and attempt to maintain a collaborative relationship with the child's licensed health care provider.