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F I S C A L I M P A C T R E P O R T

SPONSOR Beam

DATE TYPED 3/01/05

HB 890/HBICS/aHBIC

SHORT TITLE Naturopathic Medicine Practice Act

SB

ANALYST McSherry

REVENUE

Estimated Revenue

Subsequent

Years Impact

Recurring

or Non-Rec

Fund

Affected

FY05

FY06

NFI

$13-$50

$13-$50 Recurring Naturopathic Medi-

cine Practice Fund

(Parenthesis ( ) Indicate Revenue Decreases)

House Bill 890 relates to and conflicts with House Bill 921.

SOURCES OF INFORMATION

LFC Files

Responses Received From

Regulations and Licensing Department (RLD)

New Mexico Health Policy Commission (NMHPC)

Corrections Department (CD)

SUMMARY

Synopsis of Amendment

The House Business and Industry Committee amendment to HBBICS for House Bill 396 re-

moves the “making an appropriation” portion of the bill’s title and removes the “legislative pur-

pose” section from the proposed substitute bill.

Synopsis of Substitute Bill

House Bill 890 proposes to create a new state professional licensing board, the “Naturopathic

Medicine Practice Board which would regulate naturopathic medicine and traditional naturo-

pathic medicine.

“Naturopathic medicine” is defined in HB 890 as: “a system of health care practiced by doctors

of naturopathic medicine for the prevention, diagnosis and treatment of human health conditions,

injuries and diseases that uses education, natural medicine, homeopathy and therapies to support

and stimulate a person’s intrinsic self-healing process including for diagnostic purposes, physical

House Bill 890/HBICS/aHBIC -- Page 2

and orifical examinations, phlebotomy, diagnostic imaging, electrocardiograms, ultrasound,

clinical laboratory tests, examinations and physiological function tests.”

Traditional naturopathic medicine is defined as “a system of health care practiced by doctors of

traditional naturopathy for the prevention, assessment and evaluation and treatment of human

health conditions, injuries, and diseases that uses education, natural medicines, homeopathy and

therapies to support and stimulate a person’s intrinsic self-healing processes, including naturo-

pathic physical medicine.”

The bill also defines: doctor of naturopathic medicine; doctor of traditional naturopathy, home-

opathy; hygiene and immunizations; medicines of mineral, animal and botanical origin; naturo-

pathic medicine, traditional naturopathy school, naturopathic medicine school and naturopathic

physical medicine.

The bill provides that doctors of traditional naturopathy medicine may use for preventive and

therapeutic purposes the following medicine and therapies: food, food extracts, certain medicine

of mineral, animal and botanical origins, vitamins, minerals, enzymes, digestive aids, whole

gland thyroid, plant homeopathic preparations, , topical natural medicines, counseling, biofeed-

back, dietary therapy, hygiene and physical medicine, nutritional and lifestyle counseling, and

traditional naturopathic physical examinations.

Doctors of naturopathy would have the same capabilities as doctors of traditional naturopathy

and the additional permitted activities: prescribing and dispensing of hormones, therapeutic de-

vices (except those assigned exclusively to other professionals), and barriers for contraception,

using physical and orificial examinations, imaging, electrocardiograms, ultrasound, clinical labo-

ratory test, phlebotomy, examinations, and physiological function tests for diagnostic tests. The

bill also proposes to require unlicensed providers of healthcare services to provide a disclosure

statement and to collect a signed statement from any clients with acknowledgement of the pro-

viders lack of licensure.

HB 890 creates a 5 member board, 2 of whom are to be doctors of naturopathic medicine 2 of

whom would be doctors of traditional naturopathic medicine, and 1 member of which would rep-

resent the public. The 5 member board would be made responsible for adopting the rules and

regulations necessary and appropriate to “regulate” this group of professional licensees, includ-

ing examination requirements, education and experience requirements, and a code of ethics. At a

minimum, the bill provides that an applicant for licensure would have to have graduated from a

naturopathic college accrediting agency recognized by the United States Department of Educa-

tion.

The bill proposes the requirement of holding a license in order to practice naturopathy and tradi-

tional naturopathy; exemptions to the required licensure are specified as follows: natural health

care providers as long as the provider does not perform surgery or puncture the skin, use or pre-

scribe x-rays, prescribe or recommend discontinuance of legend drugs or controlled substances,

claim certification, or cause harm while willfully treating.

This bill sets forth a fee schedule for licensure, renewal, late renewals, and registration as a con-

tinuing education provider. Requirements are proposed for licensure, examination, temporary

licensure and reciprocal licensure as are grounds for grandfathering within in the first year of the

act’s effective date, and disciplinary action against a licensee. Disciplinary proceedings are

House Bill 890/HBICS/aHBIC -- Page 3

specified to be held, in accordance with the Uniform Licensing Act.

The Board of Naturopathic Medicine fund would be created in the State Treasury with all funds

credited to the Board.

Penalties for violations of the proposed act are provided and the provisions of the Criminal Of-

fender Employment act shall apply to the Naturopathic Medicine Practice Act.

The bill proposes Board termination on July 1, 2009 pursuant to the Sunset Act.

Significant Issues

The creation of this board has not been reviewed through the Sunrise Review Process for crea-

tion of new boards and commissions as is provided for in the Sunrise Act. The Sunrise Act pro-

vides a process for all new professional regulatory boards to follow prior to creation.

The Board of Medical Examiners estimates that the number of potential licensees is likely rela-

tively small. Currently it is estimated that there are as few as 80 Naturopaths eligible for licen-

sure (as per the original bill’s drafting, w/o the provisions currently provided for “traditional na-

turopathy”).

According to the NMHPC, the U.S. Department of Education has had difficulty during the last

five years deciding which colleges to recognize and which accrediting agency to use and the

commission should leave either leave the issue of credentialing to the Board or wait until the pro-

fession agrees on clear standards and criteria.

FISCAL IMPLICATIONS

HB 890 does not include an appropriation for start-up costs although the bill does create the

Board of Naturopathic Medicine Fund and provides that the state treasurer shall invest the fund

as other state funds are invested, and income from the investment of the fund shall be credited to

the fund. All balances in the fund shall remain in the fund and shall not revert to the general

fund.

RLD predicts that the Act’s proposal of a naturopathy fees would be unlikely to cover the cost of

establishing and operating a regulatory board for naturopathy; since the time of the RLD estimate

the fees proposed in the bill (in the substitute) have decreased by approximately 50 percent.

It is estimated by RLD that the cost of setting up a naturopathy board, drafting regulations, con-

ducting hearings, and attending to the various tasks necessary to set up a viable regulation pro-

gram would cost $100.0 in the first year and possibly less on a recurring basis. The prediction

includes funding for a half-time Office Clerk and Administrative support, travel expenses for

four board meetings, travel for rule hearings statewide, and any overhead costs associated with

setting up a new program.

There are boards and commissions under the auspice of RLD with budgets in the range of $27

thousand to $50 thousand

House Bill 890/HBICS/aHBIC -- Page 4

Continuing Appropriations

This bill creates a new fund and provides for continuing appropriations. The LFC objects to in-

cluding continuing appropriation language in the statutory provisions for newly created funds.

Earmarking reduces the ability of the legislature to establish spending priorities.

ADMINISTRATIVE IMPLICATIONS

Substitute HB 890/HB921 proposes to attach the Naturopathic Medicine Board administratively

to the Regulation & Licensing Department; being administratively attached to the department

will permit the board to rely on RLD staff to assist with the development of the program frame-

work and the drafting and adopting of rules and regulations and would also increase the adminis-

trative workload for the Department.

CONFLICT, DUPLICATION, COMPANIONSHIP, RELATIONSHIP

House Bill 890 and 921 have been combined as they each related to creating a naturopathy

board.

TECHNICAL ISSUES

The bill makes references to “a reasonable amount of time” or “in a timely manner” in several

instances, particularly in the grandfathering section. It is not clear what a reasonable amount of

time would be.

The Regulation & Licensing Department cites the following concern:

•

1. The bill makes references to the naturopathic physician being able to administer im-

munizations. RLD asserts that if naturopathic physicians are given authority for immuni-

zations the NM Drug, Device and Cosmetic Act and the Controlled Substances Act will

conflict with this Act.

On Page 8, lines 23-25 it is specified that: “two members of the board shall be doctors of naturo-

pathic medicine and two members shall be doctors of traditional naturopathy, all of whom have

been residents of and practiced naturopathic medicine in New Mexico for at least three years

immediately preceding the date of their appointment.” Currently, there is no valid licensure

available for naturopathic physicians in New Mexico so it is not clear who would be eligible to

be appointed as a practicing naturopathic professional.

Because the proposed statute would become effective in July 2005 and the board would come

into existence (statutorily) at the same point, it is unclear how the board will be able to regulate

the industry upon creation as is provided. The board will need time to promulgate rules before it

can regulate the industry and the industry will be subject to board rules and fees before these

rules are promulgated.

OTHER SUBSTANTIVE ISSUES

NMHPC cites that:

“Naturopathic Medicine” is defined by the American Association of Naturopathic Physi-

cians as: a distinct system of primary health care - an art, science, philosophy and prac-

House Bill 890/HBICS/aHBIC -- Page 5

tice of diagnosis, treatment and prevention of illness.” The commission asserts that natu-

ropathic medicine is distinguished by the principles which underlie and determine its

practice and that these principles are based upon the objective observation of the nature

of health and disease, and are continually reexamined in the light of scientific advances.

Methods used are consistent with these principles and are chosen upon the basis of pa-

tient individuality. Naturopathic physicians are primary health care practitioners, whose

diverse techniques include modern and traditional, scientific and empirical methods.

A “Naturopathic Doctor” diagnoses, treats, and cares for patients, using (a) system of

practice that bases treatment of physiological functions and abnormal conditions on natu-

ral laws governing human body: Utilizes physiological, psychological, and mechanical

methods, such as air, water, light, heat, earth, phytotherapy, food and herb therapy, psy-

chotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechanotherapy,

naturopathic corrections and manipulation, and natural methods or modalities, together

with natural medicines natural processed foods, and herbs and nature's remedies. Ex-

cludes major surgery, therapeutic use of x-ray and radium, and use of drugs, except those

assimilable substances containing elements or compounds of body tissues and are physio-

logically compatible to body processes for maintenance of life.

NMHPC further points out that currently, 13 states, the District of Columbia, and the US

territories of Puerto Rico and Virgin Islands have licensing laws for Naturopathic Doc-

tors. These licensure laws specify that Naturopathic Doctors are required to graduate

from a 4 year residential naturopathic medical school and pass an extensive postdoctoral

board examination. Per the American Association of Naturopathic Physicians website,

there are only 7 accredited programs in the United States.

The New Mexico Medical Board supports licensure of Naturopathic Physicians, assuming educa-

tion guidelines are established, and that the Board of Naturopathic Medicine maintains over-site

of educational requirements.

ALTERNATIVES

The proposed board could follow the statutorily-prescribed process for creation established in the

Sunrise Act.

Provisions to allow a period of rule promulgation and board creation should be considered so

that the board members themselves can become licensed and organization established.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL.

Professional licensure will not be enacted in New Mexico for the Naturopathic profession

RLD asserts that New Mexicans will continue to be able to access alternative health care

EM/yr:lg