HOUSE BILL NO. 2159 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE HURLBERT.
5193H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To amend chapter 324, RSMo, by adding thereto fifteen new sections relating to naturopathic medicine.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 324, RSMo, is amended by adding thereto fifteen new sections, to 2 be known as sections 324.1900, 324.1905, 324.1910, 324.1915, 324.1920, 324.1925, 3 324.1930, 324.1935, 324.1940, 324.1945, 324.1950, 324.1955, 324.1960, 324.1965, and 4 324.1970, to read as follows: 324.1900. Sections 324.1900 to 324.1970 shall be known and may be cited as the 2 "Naturopathic Practice Act". 324.1905. As used in sections 324.1900 to 324.1970, the following terms mean: 2 (1) "Approved naturopathic medical education program", an education 3 program that the board has approved as meeting the requirements of section 4 324.1930 and that prepares naturopathic doctors for the practice of naturopathic 5 medicine; 6 (2) "Board", the board of naturopathic medicine; 7 (3) "Common diagnostic procedure", any diagnostic procedure commonly 8 performed by health care professionals including, but not limited to, the following 9 diagnostic procedures: 10 (a) Taking and recording a patient's health history; 11 (b) Performing a physical examination; 12 (c) Performing venipuncture; 13 (d) Ordering, but not interpreting, radiography examinations;
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 2159 2
14 (e) Performing laboratory medicine; and 15 (f) Obtaining samples of human tissues, except surgical excision beyond surgical 16 excision that is authorized as a minor office procedure; 17 (4) "Controlled substance", a drug, substance, or immediate precursor 18 enumerated in Schedules I through V of section 195.017; 19 (5) "Division", the division of professional registration of the department of 20 commerce and insurance; 21 (6) "Drug", the same meaning given to the term in section 195.010; 22 (7) "Laboratory medicine", the collection and analysis of body fluids to provide 23 information to help aid the diagnosis and treatment of patients; 24 (8) "Legend drug", the same meaning given to the term in section 338.330; 25 (9) "License", a license issued by the board to an individual in accordance with 26 sections 324.1900 to 324.1970 and rules of the board authorizing that individual to 27 practice naturopathic medicine in this state; 28 (10) "Licensee", an individual who holds a license to practice naturopathic 29 medicine; 30 (11) "Minor office procedure", any minor office procedure including, but not 31 limited to, the following: 32 (a) Care and procedures incident thereto of superficial lacerations, lesions, or 33 abrasions and the removal of foreign bodies located in superficial structures, not to 34 include the eye; 35 (b) The use of antiseptics and topical or local anesthetics in connection with the 36 procedures described in paragraph (a) of this subdivision; 37 (c) Intramuscular, intravenous, subcutaneous, and intradermal injections of 38 substances consistent with the practice of naturopathic medicine; 39 (d) Trigger point therapy; 40 (e) The use of noninvasive and minimally invasive aesthetic lasers that cannot be 41 used for major surgeries or cutting; 42 (f) Dermal stimulation; and 43 (g) Allergy testing. 44 45 The definition of "minor office procedures" does not include general anesthetics or 46 surgery; 47 (12) "Naturopathic doctor", an individual licensed in this state to practice 48 naturopathic medicine as a naturopathic doctor in accordance with sections 324.1900 to 49 324.1970; HB 2159 3
50 (13) "Naturopathic medicine", a system of health care for the prevention, 51diagnosis, and treatment of human health conditions, injury, and disease; the promotion 52or restoration of health; and the support and stimulation of a patient's inherent self- 53healing processes through patient education and the use of naturopathic therapies; 54 (14) "Naturopathic physical medicine", the use of one or more of the following 55physical agents or treatments in a manner consistent with naturopathic medical practice 56on a part or the whole of the body, by hand or by mechanical means, in the resolution of 57a human ailment or condition: air, water, heat, cold, sound, light, electromagnetism, 58nondiagnostic ultrasound, cold laser, colon hydrotherapy, soft tissue therapy, joint 59mobilization, therapeutic exercise, and treatments taught in any approved naturopathic 60medical education program that are not otherwise prohibited by sections 324.1900 to 61324.1970; 62 (15) "Naturopathic therapies", any of the following exemplified in a standard 63naturopathic medical text, journal, or pharmacopeia: food; extracts of food; vitamins; 64minerals; nutraceuticals; oxygen; botanicals; enzymes; amino acids; homeopathics; 65hormones; hormonal or pharmaceutical contraceptives; all dietary supplements and 66nonprescription drugs as defined by the Federal Food, Drug, and Cosmetic Act, 21 67U.S.C. Section 301 et seq.; human cellular and tissue-based products that are not 68regulated as drugs; such legend drugs and controlled substances that are consistent with 69naturopathic medical practice; and any other physiologic substances; 70 (16) "Nutritional counseling", the prevention and treatment of disease or other 71human conditions through the use of food, water, herbs, roots, bark, or natural food 72elements; 73 (17) "Prescription", the same meaning given to the term in section 338.095; 74 (18) "Professional examination", a competency-based national licensing 75examination administered by the North American Board of Naturopathic Examiners 76or its successor agency, which board has been nationally recognized to administer a 77naturopathic examination that represents federal standards of education and training; 78 (19) "Radiography", radiographic diagnostic and other imaging studies 79including, but not limited to, x-ray, diagnostic ultrasound, mammogram, bone 80densitometry, computed tomography, positron emission tomography, and magnetic 81resonance imaging; 82 (20) "Therapeutic device", an instrument or an apparatus intended for use in 83diagnosis or treatment and in the prevention of disease or maintenance or restoration of 84health. 324.1910. 1. There is hereby created within the division a board to be known as 2 the "Board of Naturopathic Medicine". HB 2159 4
3 2. The board of naturopathic medicine shall consist of five members appointed 4 by the governor, all of whom shall be residents of this state. Three members shall be 5 naturopathic doctors as described in subsection 5 of this section, one member shall be a 6 physician licensed under chapter 334, and one member shall be a public member as 7 described in subsection 6 of this section. 8 3. The initial members of the board shall be appointed for staggered terms, the 9 longest of which shall not exceed four years. Following the initial appointments, all 10 terms shall be for three years, and no member of the board shall serve more than three 11 terms. 12 4. The initial physician member licensed under chapter 334 shall have at least 13 four years of experience in the practice of medicine or osteopathic medicine. 14 5. (1) The initial three naturopathic doctor members shall each have at least 15 four years of experience in the practice of naturopathic medicine and shall each be 16 eligible to become licensed under sections 324.1900 to 324.1970. 17 (2) Any naturopathic doctor member appointed following the initial 18 appointments to the board shall be licensed under sections 324.1900 to 324.1970 and 19 shall actively practice naturopathic medicine in this state for the duration of his or her 20 appointment. 21 6. The public member shall be, at the time of the member's appointment, a 22 citizen of the United States, a resident of this state for a period of at least one year, and a 23 registered voter. The public member shall not have been a member of any profession 24 licensed or regulated under sections 324.1900 to 324.1970 or an immediate family 25 member of such a person. The public member shall not have had a material financial 26 interest in the provision of naturopathic medicine or in an activity or organization 27 directly related to any profession licensed or regulated under sections 324.1900 to 28 324.1970. The duties of the public member shall not include any determination of the 29 technical requirements to be met for licensure or whether any candidate for licensure 30 meets such technical requirements or any determination of the technical competence or 31 technical judgment of a licensee or candidate for licensure. 32 7. In the event of death, resignation, or removal of any member of the board 33 before the expiration of the term to which he or she was appointed, the vacancy shall be 34 filled for the unexpired portion of the term in the same manner as the original 35 appointment. 36 8. The board shall, within thirty days after the appointment of all members, and 37 at least annually thereafter, hold a meeting and elect from its membership a chair, a vice 38 chair, and a secretary. The board may hold additional meetings as may be required in 39 the performance of its duties at the call of the chair or upon the written request of any HB 2159 5
40 two members of the board. Notice of every meeting shall be given to each member at 41 least three days before the date of the meeting. 42 9. The board may appoint such committees as it considers necessary to carry out 43 its duties. 44 10. A quorum of the board shall consist of a majority of its voting members. The 45 affirmative vote of a majority of a quorum of the board shall be required to carry a 46 motion or resolution, to adopt a rule, or to pass a measure. 47 11. The governor may remove a board member for misconduct, incompetence, 48 or neglect of official duties after giving the board member written notice of the charges 49 and an opportunity to be heard. 50 12. Notwithstanding any other provision of law, any appointed member of the 51 board shall receive as compensation an amount established by the director of the 52 division, not to exceed seventy-five dollars per member per day for commission business 53 plus actual and necessary expenses including, but not limited to, travel expenses. The 54 director of the division shall establish by rule guidelines for payment. All staff for the 55 board shall be provided by the division. 324.1915. 1. The board shall adopt rules that are necessary or proper for the 2 administration of sections 324.1900 to 324.1970 including, but not limited to, rules on: 3 (1) Regulating the licensure of naturopathic doctors and determining the hours 4 of continuing education units required for maintaining licensure as a naturopathic 5 doctor; 6 (2) Establishing the manner in which records of examinations and treatments 7 shall be kept and maintained; 8 (3) Establishing standards for professional responsibility and conduct; 9 (4) Identifying disciplinary actions and circumstances that require disciplinary 10 action; 11 (5) Developing a means to provide information to all licensees in the state; 12 (6) Providing for the investigation of complaints against licensees or persons 13 holding themselves out as naturopathic doctors in this state; 14 (7) Providing for the publication of information for the public about licensees 15 and the practice of naturopathic medicine in this state; 16 (8) Providing for an orderly process for reinstatement of a license; 17 (9) Establishing criteria for advertising or promotional materials; 18 (10) Establishing continuing education requirements related to hours and 19 acceptable content; 20 (11) Establishing standards for the state jurisprudence examination; HB 2159 6
21 (12) Establishing procedures and standards for reviewing licensing examination 22 scores; 23 (13) Establishing procedures for reviewing transcripts demonstrating 24 completion of the approved naturopathic medical education program; 25 (14) Establishing the requirements for issuance and renewal of licenses; and 26 (15) Regulating any other matter necessary to implement sections 324.1900 to 27 324.1970. 28 2. The board shall establish and maintain a list of naturopathic medical 29 education programs that meet the requirements of section 324.1930. 30 3. The board shall administer and enforce all provisions of sections 324.1900 to 31 324.1970 and all rules adopted by the board under the authority granted in sections 32 324.1900 to 324.1970. 33 4. The board shall set the amount of the fees that sections 324.1900 to 324.1970 34 authorize and require by rules and regulations promulgated under section 536.021. The 35 fees shall be set at a level to produce revenue that shall not substantially exceed the cost 36 and expense of administering sections 324.1900 to 324.1970. 37 5. All fees payable under sections 324.1900 to 324.1970 shall be collected by the 38 division and transmitted to the department of revenue for deposit in the state treasury 39 to the credit of the board of naturopathic medicine fund established under section 40 324.1920. 41 6. The board shall employ permanent or temporary personnel it deems 42 necessary to carry out the purposes of sections 324.1900 to 324.1970 and designate their 43 duties. 44 7. Any rule or portion of a rule, as that term is defined in section 536.010, that is 45 created under the authority delegated in this section shall become effective only if it 46 complies with and is subject to all of the provisions of chapter 536 and, if applicable, 47 section 536.028. This section and chapter 536 are nonseverable and if any of the powers 48 vested with the general assembly pursuant to chapter 536 to review, to delay the 49 effective date, or to disapprove and annul a rule are subsequently held unconstitutional, 50 then the grant of rulemaking authority and any rule proposed or adopted after August 51 28, 2026, shall be invalid and void. 324.1920. 1. There is hereby created in the state treasury the "Board of 2 Naturopathic Medicine Fund". All fees authorized to be charged by the board shall be 3 collected by the director of the division and shall be transmitted to the department of 4 revenue for deposit in the state treasury for credit to this fund. The state treasurer shall 5 be custodian of the fund. In accordance with sections 30.170 and 30.180, the state 6 treasurer may approve disbursements. The fund shall be a dedicated fund and, upon HB 2159 7
7 appropriation, moneys in this fund shall be used solely in payment of expenses of 8 maintaining the board and for the enforcement of the provisions of law concerning the 9 practice of naturopathic medicine. 10 2. Notwithstanding the provisions of section 33.080 to the contrary, moneys in 11 this fund shall not be transferred and placed to the credit of general revenue until the 12 amount in the fund at the end of the biennium exceeds three times the amount of the 13 appropriation from the fund for the preceding fiscal year. The amount, if any, in the 14 fund that shall lapse is that amount in the fund that exceeds the appropriate multiple of 15 the appropriations from the fund for the preceding fiscal year. 16 3. The state treasurer shall invest moneys in the fund in the same manner as 17 other funds are invested. Any interest and moneys earned on such investments shall be 18 credited to the fund. 324.1925. The board shall issue a license to an applicant who: 2 (1) Is of good moral character, in accordance with standards established by rules 3 of the board; 4 (2) Submits, in accordance with rules of the board, the following items to the 5 board: 6 (a) An application for licensure designed and approved by the board and 7 submitted in accordance with rules of the board; 8 (b) An application fee submitted in an amount and manner established by rules 9 of the board; 10 (c) Evidence that the applicant has graduated from an approved naturopathic 11 medical education program; 12 (d) Evidence that the applicant has successfully completed a professional 13 examination or, for graduates of approved naturopathic medical education programs in 14 the United States prior to the existence of the Council on Naturopathic Medical 15 Education, a competency-based state naturopathic medicine licensing examination or 16 equivalent Canadian provincial licensing examination for the practice of naturopathic 17 medicine approved by the board; 18 (e) Evidence that the applicant has passed a pharmacy examination authorized 19 by rules of the board and administered by the North American Board of Naturopathic 20 Examiners; 21 (f) Evidence that the applicant has passed a state jurisprudence examination 22 that meets standards established in rules of the board; and 23 (g) Evidence of professional liability insurance; 24 (3) Is determined by the board to be physically and mentally capable of safely 25 practicing naturopathic medicine with or without reasonable accommodation; and HB 2159 8
26 (4) Has not had a license to practice naturopathic medicine or other health care 27 license, registration, or certificate refused, revoked, or suspended by any other 28 jurisdiction for reasons that relate to the applicant's ability to skillfully and safely 29 practice naturopathic medicine unless that license, registration, or certification has been 30 restored to good standing by that jurisdiction. 324.1930. 1. The board shall establish by rule guidelines for the licensure 2 requirements described in section 324.1925 relating to graduation from an approved 3 naturopathic medical education program. The guidelines shall meet the requirements of 4 this section and the board's specifications for the education of naturopathic doctors. 5 2. The requirement for graduation from an approved naturopathic medical 6 education program shall be interpreted in the guidelines as requiring, at a minimum, 7 graduation from: 8 (1) A naturopathic medical education program in the United States providing 9 t