This filing was published in the 01/15/2008, issue, Vol. 2008, No. 2, of the Utah State Bulletin.
Commerce, Occupational and Professional Licensing
Naturopathic Physician Practice Act Rules
NOTICE OF PROPOSED RULE
DAR File No.: 30854
Filed: 12/18/2007, 08:53
Received by: NL
Purpose of the rule or reason for the change:
The division and the Naturopathic Physicians Licensing Board are proposing amendments to the rule to recodify and expand the naturopathic formulary using the American Hospital Formulary Service as a medical reference for prescription medications used by naturopathic physicians. The Naturopathic Physician Licensing Examination (NPLEX) has changed the format for its national examination, so the rule should be modified to reflect the updated examinations. The number of required continuing education hours will be increased and additional continuing education requirements added.
Summary of the rule or change:
Throughout the rule the term "rules" has been replaced with "rule" where applicable. In Section R156-71-102, new definitions for "distance learning" and "primary health care" have been added. The definition for "primary health care" is based on the definition of "primary care" from Taber's Cyclopedic Medical Dictionary, 15th edition, published by F.A. Davis. In Section R156-71-202, the proposed amendments recodify the naturopathic formulary. The old formulary listed legend drugs that were being used locally by naturopaths at the time. The Naturopathic Formulary Peer Committee researched and developed the new proposed formulary amendments. The amended formulary is based on primary health care and uses the reference numbers identified in the American Hospital Formulary Service (AHFS) published by the American Society of Health System Pharmacists, 2006 edition. This will become the standard reference for all legend drugs prescribed by naturopathic physicians. The Utah Medical Association (UMA) reviewed the proposed formulary modifications and indicated it has no concerns with naturopathic physicians prescribing medications from the proposed formulary. In Section R156-71-302, the Council of Naturopathic Medical Education has changed its examination format and has combined parts of the qualifying examinations. The NPLEX has combined the homeopathic portion with the Clinical Series examination, thus eliminating the requirement for the homeopathic examination. In Section R156-71-304, the proposed amendments increase the required number of continuing education hours in a 2-year period from 24 hours to 48 hours. The proposed amendments will require all licensed naturopathic physicians to attend at least 20 hours of pharmacology or pharmacy training in each 2-year period. The proposed amendments also limit distance learning to a maximum of 20 hours during each 2-year period. It is the Naturopathic Formulary Peer Committee's belief that the increase in required continuing education hours, required pharmacology training and the new legend drug references will ultimately create substantial improvements in public safety. As a result of proposed amendments with respect to continuing education, several new organizations may sponsor continuing education for naturopathic physicians. These include a professional health care licensing agency, hospital or institution accredited by the Accreditation Council of Continuing Medical Education (ACCME), the American Council on Pharmaceutical Education (ACPE), any accredited college or university, or any professional association or organization representing a licensed profession whose program objectives are related to naturopathic practice. The Utah Naturopathic Physicians Licensing Board may also approve continuing education courses if the course meets the required standards.
State statutory or constitutional authorization for this rule:
Section 58-71-101 and Subsections 58-1-106(1)(a) and 58-1-202(1)(a)
Anticipated cost or savings to:
the state budget:
The division will incur minimal costs of approximately $100 to reprint the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the division's current budget. The division's investigators will not require any additional training as a result of the proposed amendments. A possible increase in compliance costs to the Division may occur if complaints regarding the prescribing practices of naturopathic physicians are reported to the Division. Any potential cost increase is impossible to determine at this time. There are fewer than 30 licensed naturopathic physicians in Utah so any potential fiscal impact to the division would be minimal.
The proposed amendments do not apply to local governments. The proposed amendments only apply to licensed naturopathic physicians and applicants for licensure as a naturopathic physician.
small businesses and persons other than businesses:
The proposed amendments to the naturopathic physician formulary will create a possible savings for the public and insurance carriers. Patients who presently see a naturopathic physician requesting specific types of medications may not be able to receive the required prescription. The patient currently has to schedule another visit with a prescribing practitioner. Each office visit to a prescribing practitioner is about $100 for each patient. If the naturopathic physician can prescribe the medication needed at the initial office visit, the result would be a reduction in duplication of services, thus reducing costs for the patients and insurance carriers. There is no way for the division to determine how many patients are seen by naturopathic physicians versus other types of prescribing practitioners. As a result of increasing the number of required continuing education hours for licensed naturopathic physicians from 24 hours to 48 hours with a mandatory 20 hours component every 2 years, licensed naturopathic physicians will see an increase in costs to obtain the required additional continuing education hours. The Utah Association of Naturopathic Physicians has reported that current continuing education costs are estimated at $25 per hour. The increase in cost for each licensed naturopathic physician could be approximately $600 for each 2-year period. There are approximately 30 licensed naturopathic physicians in Utah for an aggregate increase cost of $18,000 for each 2-year period. However, the increase in continuing education hours, required pharmacology training and the new formulary legend drug references are expected to create substantial improvements in public safety and potentially a reduction in malpractice insurance premiums for licensees. It should be noted that a licensed naturopathic physician office may qualify as a small business if such a naturopathic physician owns or works in a small clinic.
Compliance costs for affected persons:
The proposed amendments to the naturopathic physician formulary will create a possible savings for the public and insurance carriers. Patients who presently see a naturopathic physician requesting specific types of medications may not be able to receive the required prescription. The patient currently has to schedule another visit with a prescribing practitioner. Each office visit to a prescribing practitioner is about $100 for each patient. If the naturopathic physician can prescribe the medication needed at the initial office visit, the result would be a reduction in duplication of services, thus reducing costs for the patients and insurance carriers. There is no way for the division to determine how many patients are seen by naturopathic physicians versus other types of prescribing practitioners. As a result of increasing the number of required continuing education hours for licensed naturopathic physicians from 24 hours to 48 hours with a mandatory 20 hours component every 2 years, licensed naturopathic physicians will see an increase in costs to obtain the required additional continuing education hours. The Utah Association of Naturopathic Physicians has reported that current continuing education costs are estimated at $25 per hour. The increase in cost for each licensed naturopathic physician could be approximately $600 for each 2-year period. However, the increase in continuing education hours, required pharmacology training and the new formulary legend drug references are expected to create substantial improvements in public safety and potentially a reduction in malpractice insurance premiums for licensees.
Comments by the department head on the fiscal impact the rule may have on businesses:
This rule filing amends the naturopathic formulary, which is expected to be a cost savings to patients and presumably also a benefit to licensees, who will no longer need to refer their clients to medical doctors. Although the increased continuing education requirement will cost licensees approximately $600 each 2-year licensing period, public safety is expected to improve while malpractice insurance premiums are expected to decrease. It is thus difficult to estimate the actual costs to licensees. No other fiscal impact to businesses is anticipated. Francine A. Giani, Executive Director
The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316
Direct questions regarding this rule to:
Daniel T. Jones at the above address, by phone at 801-530-6767, by FAX at 801-530-6511, or by Internet E-mail at firstname.lastname@example.org
Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:
Interested persons may attend a public hearing regarding this rule:
1/17/2008 at 9:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 210 (second floor), Salt Lake CIty, UT
This rule may become effective on:
F. David Stanley, Director
R156. Commerce, Occupational and Professional Licensing.
R156-71. Naturopathic Physician Practice Act Rule[
ese] rule[ s are]
known as the "Naturopathic Physician Practice Act Rule[ s]."
In addition to the definitions in Title 58, Chapters
1 and 71, as used in Title 58, Chapters 1 and 71, or th[
(1) "Approved clinical experience program" or "residency program" as used in Subsections 58-71-302(1)(e) and 58-71-304.2(1)(b), means a minimum 12 month program associated with a naturopathic medical school or college accredited by the Council of Naturopathic Medical Education.
(2) "Direct supervision" as used in Subsection 58-71-304.2(1)(b), means the supervising naturopathic physician, physician and surgeon, or osteopathic physician is responsible for the naturopathic activities and services performed by the naturopathic physician intern and is normally present in the facility and when not present in the facility is available by voice communication to direct and control the naturopathic activities and services performed by the naturopathic physician intern.
(3) "Direct and immediate supervision" of a medical naturopathic assistant ("assistant") as used in Subsections 58-71-102(6) and 58-71-305(7), means that the licensed naturopathic physician is responsible for the activities and services performed by the assistant and will be in the facility and immediately available for advice, direction and consultation.
"Naturopathic physician intern" or "intern" means an
individual who qualifies for a temporary license under Section 58-71-304.2 to
engage in a naturopathic physician residency program recognized by the division
under the direct supervision of an approved naturopathic physician, physician
and surgeon, or osteopathic physician.
"NPLEX" means the Naturopathic Physicians Licensing
"Qualified continuing education," as used in th[ ese]
rule[ s], means continuing education that meets the standards set forth
in Subsection R156-71-304.
"Unprofessional conduct," as defined in Title 58, Chapters 1
and 71, is further defined, in accordance with Subsection 58-1-203(5), in
R156-71-103. Authority - Purpose.
ese] rule[ s are]
adopted by the division under the authority of Subsection 58-1-106(1)(a) to
enable the division to administer Title 58, Chapter 71.
R156-71-202. Naturopathic Physician Formulary.
(1) In accordance with Subsections 58-71-102(8) and 58-71-202, the naturopathic physician formulary which consists of noncontrolled substance legend medications deemed appropriate for the scope of practice of naturopathic physicians, the prescription of which is approved by the Division in collaboration with the Naturopathic Formulary Advisory Peer Committee, consists of the following legend drugs, listed by category:
Adrenergic Stimulators, limited to: Albuterol,
Epinephrine, and Metaproteranol; Ace Inhibitors; Amino Acids; Anesthetics (local); Antiemetics; Antifungals, limited to:
Nystatin and Fluconazole; Antigout; Antihistamines; Anti-inflammatories, except
DMARDS; Antimicrobials (oral), limited
to: Pencillins, 1st and 2nd generation Cephalosporins, Tetracyclines,
Macrolides, Azalides, Lincosamines, Metronidazole, Hydantoins, and Sulfas; Antimicrobials (ophthamologic),
limited to: Sulfas and Macrolides; Antimicrobials (topical); Antivirals, limited to
Acyclovir; Biologics, limited to: Skin
Testing, CDC recommended Immunizations, Toxoids, and Immunoglobulin; Calcium Channel Blockers (2nd
Generation Dihydropyridine); Contraceptives, except implants
and injections; Corticosteroids (oral or
topical), except Opthamologic Preparations; Diabetic Agents, limited to:
Insulin, and oral Hypoglycemics, except Thiazolidinediones; Diuretics, limited to: Thiazide
or Loop; Dyslipidemia Modulators; Electrolyte and Fluid
Replacements; Enzymes, limited to: Digestive
and Proteolytic; H2 Blockers; Hormones; Leukotrine modulators; Migraine Preparations, limited
to: Ergotamines and Sumatriptin; Minerals: Macro and Micro; Osteoporosis agents, limited to:
Calcitonin and Raloxifene; Oxygen; Pentoxiflylline; Proton-Pump Inhibitors; Urinary Antispasmodics; Vitamins; Other: Methergine and Pitocin, limited to use only after the uterus has
been emptied; Silver Nitrate.]
[ New categories or classes of drugs will need to be approved as part
of the formulary prior to prescribing/administering.]
The licensed naturopathic physician has the responsibility to be
knowledgeable about the medication being prescribed or administered.
R156-71-302. Qualifications for Licensure - Examination Requirements.
In accordance with Subsections 58-71-302(1)(f) and 58-71-302(2)(c), the licensing examination sequence required for licensure is as follows:
(1) NPLEX Basic Science Series, the State of Washington Basic Science Series or the State of Oregon Basic Science Series;
(2) NPLEX Clinical Series;
Homeopathy; and (4) ]NPLEX Minor Surgery.
R156-71-304. Qualified Continuing Education.
1]) In accordance with S[ ubs]ection
58-71-304[ (1)(a)], qualified continuing education shall consist of [ 24]
hours of qualified continuing professional education in each preceding two year
period of licensure.
If a licensee allows his license to expire and the application for
reinstatement is received by the division within two years after the expiration
date the applicant shall:
documentation of having completed [
24] hours of qualified
continuing professional education required for the previous renewal period; and
(b) submit documentation of having completed a pro rata amount of qualified continuing professional education based upon one hour of qualified continuing professional education for each month the license was expired for the current renewal period.
If the application for reinstatement is received by the division more
than two years after the date the license expired, the applicant shall complete
a minimum of [ 24] hours of qualified continuing professional
education and additional hours as determined by the board to clearly demonstrate
the applicant is currently competent to engage in naturopathic medicine.
(4) The standards for qualified continuing education are as follows: (a) content must be relevant to naturopathic practice and consistent
with the laws and rules of this state; (b) under sponsorship of: (i) an approved college or university; or (ii) a professional association or organization representing a
licensed profession whose program objectives are related to naturopathic
practice; (c) learning objectives must be reasonably and clearly stated; (d) teaching methods must be clearly stated and appropriate; (e) faculty must be qualified, both in experience and in teaching
expertise; (f) there must be a written post course or program evaluation; and (g) documentation of attendance must be provided. (5) Qualified continuing education shall consist of at least 10 hours
of seminars, conferences or workshops addressing case management and
prescribing of legend drugs.
Audits of a licensee's continuing education hours may be done on a
random basis by the division in collaboration with the board.
A licensee shall be responsible for maintaining competent records of
completed qualified professional education for a period of two years after
close of the two year period to which the records pertain. It is the responsibility of the licensee to
maintain this information with respect to qualified professional education to
demonstrate it meets the requirements under this section.
The division in collaboration with the board may grant a waiver of
continuing education requirements to a waiver applicant who documents he is
engaged in full time activities or is subjected to circumstances which prevent
the licensee from meeting the continuing professional education requirements
established under this section. A
waiver may be granted for a period of up to four years. However, it is the responsibility of the
licensee to document the reasons and justify why the requirement could not be
KEY: licensing, naturopaths, naturopathic physician
Date of Enactment or
Last Substantive Amendment: [
Notice of Continuation: January 8, 2007
Authorizing, and Implemented or Interpreted Law: 58-71-101; 58-1-106(1)(a); 58-1-202(1)(a)
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For questions regarding the content or application of this rule, please contact Daniel T. Jones at the above address, by phone at 801-530-6767, by FAX at 801-530-6511, or by Internet E-mail at email@example.com
For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.
Last modified: 01/14/2008 8:11 PM