1630-S AMH CODY H4407.3
SHB 1630 - H AMD 1050
By Representative Cody
Strike everything after the enacting clause and insert the following:
"NEW SECTION.  Sec. 1. The legislature finds that:
(1) Washington has a shortage of primary care services that poses a significant risk to public health resulting in increased human suffering and increased costs.
(2) Naturopaths, licensed under chapter 18.36A RCW since 1987 and chapter 18.36 RCW since 1919, are recognized as primary care providers in both statute and rule, and have served in this role for many years through private health plans, in apple health (medicaid), and with the Indian health service systems.
(3) In some areas, naturopaths are the only available health care providers. As such, they need authority for all appropriate primary care services consistent with their education and patient populations. This act supports better patient care, prevents duplication of services, reduces emergency department visits, and is more cost-effective for patients, health plans, and state agencies.
(4) The legislature first granted naturopaths limited prescriptive authority in 1987 and expanded this in 2005 to include all legend drugs and limited controlled substances in Schedules III through V of the uniform controlled substances act. This act is consistent with the findings of the 2014 sunrise review in which the department of health agreed with the health care authority arguments in support of a limited expansion of naturopathic prescriptive authority for controlled substances.
(5) This act recognizes the board of naturopathy, established by the legislature in 2011, and its role in rule making for determination of specific clinical parameters and educational requirements in the same manner as other boards and commissions with primary care authority.
NEW SECTION.  Sec. 2. A new section is added to chapter 18.36A RCW to read as follows:
A naturopath may sign and attest to any certificates, cards, forms, or other required documentation that a physician may sign, so long as it is within the naturopath's scope of practice. This includes, but is not limited to, death certificates, guardianships, powers of attorney, disability determinations, and similar legal documents.
Sec. 3. RCW 18.36A.020 and 2011 c 41 s 3 and 2011 c 40 s 1 are each reenacted and amended to read as follows:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Board" means the board of naturopathy created in RCW 18.36A.150.
(2) "Common diagnostic procedures" means the use of venipuncture consistent with the practice of naturopathic medicine, commonly used diagnostic modalities consistent with naturopathic practice, health history taking, physical examination, radiography, examination of body orifices excluding endoscopy and colonoscopy, laboratory medicine, and obtaining samples of human tissues, but excluding incision or excision beyond that which is authorized as a minor office procedure.
(3) "Department" means the department of health.
(4) "Educational program" means an accredited program preparing persons for the practice of naturopathic medicine.
(5) "Homeopathy" means a system of medicine based on the use of infinitesimal doses of medicines capable of producing symptoms similar to those of the disease treated, as listed in the homeopathic pharmacopeia of the United States.
(6) "Hygiene and immunization" means the use of such preventative techniques as personal hygiene, asepsis, public health, and immunizations, to the extent allowed by rule.
(7) "Manual manipulation" or "mechanotherapy" means manipulation of a part or the whole of the body by hand or by mechanical means.
(8) "Minor office procedures" means primary care ((and))services and procedures that pose minimal risk to the patient and can be safely performed in an office setting; procedures incident thereto of superficial lacerations, lesions, ((and abrasions))minor injuries, and the removal of foreign bodies located in superficial structures, not to include the eye; and the use of antiseptics and topical or local anesthetics in connection therewith. "Minor office procedures" also includes intramuscular, intravenous, subcutaneous, ((and)) intradermal ((injections)), topical, and other routes of administration of substances consistent with the practice of naturopathic medicine and in accordance with rules established by the ((secretary))board.
(9) "Naturopath" means an individual licensed under this chapter.
(10) "Naturopathic medicines" means vitamins; minerals; botanical medicines; homeopathic medicines; hormones; ((and)) those legend drugs and controlled substances consistent with naturopathic medical practice in accordance with rules established by the board; and other nutrients, compounds, and natural substances consistent with naturopathic medical practice. Controlled substances are limited to codeine and testosterone products that are contained in Schedules III, IV, and V in chapter 69.50 RCW.
(11) "Nutrition and food science" means the prevention and treatment of disease or other human conditions through the use of foods, water, herbs, roots, bark, or natural food elements.
(12) "Physical modalities" means use of physical, chemical, electrical, and other modalities ((that do not exceed those used as of July 22, 2011, in minor office procedures or common diagnostic procedures,)) including, but not limited to, heat, cold, air, light, water in any of its forms, sound, massage, durable medical equipment, and therapeutic exercise.
(13) "Radiography" means the ordering, but not the interpretation, of radiographic diagnostic and other imaging studies and the taking and interpretation of standard radiographs.
(14) "Secretary" means the secretary of health or the secretary's designee.
(15) "Suggestion" means techniques including but not limited to counseling, biofeedback, and hypnosis.
Sec. 4. RCW 18.36A.040 and 2011 c 40 s 2 are each amended to read as follows:
Naturopathic medicine is the practice by naturopaths of the art and science of the diagnosis, prevention, and treatment of disorders of the body by stimulation or support, or both, of the natural processes of the human body. A naturopath is responsible and accountable to the consumer for the quality of naturopathic care rendered and may only provide services that he or she is competent to perform based on his or her education, training, and experience.
The practice of naturopathic medicine includes manual manipulation (mechanotherapy), the prescription, administration, dispensing, and use, except for the treatment of malignancies, of nutrition and food science, physical modalities, minor office procedures, homeopathy, naturopathic medicines, hygiene and immunization, contraceptive devices, common diagnostic procedures, and suggestion; however, nothing in this chapter shall prohibit consultation and treatment of a patient in concert with a practitioner licensed under chapter 18.57 or 18.71 RCW. No person licensed under this chapter may employ the term "chiropractic" to describe any services provided by a naturopath under this chapter.
NEW SECTION.  Sec. 5. (1) The board of naturopathy, in consultation with the pharmacy quality assurance commission and the Washington medical commission, shall adopt rules specifying the educational requirements for licensed naturopaths to prescribe and administer controlled substances and other requirements necessary for the responsible utilization of the additional prescriptive authority for controlled substances by licensed naturopaths.
(2) The board of naturopathy shall prepare request legislation granting licensed naturopaths prescriptive authority consistent with the board's rules for consideration in the legislative session following the completion of the rule-making process.
(3) Nothing in this section grants licensed naturopaths the authority to prescribe legend drugs or controlled substances outside of what is authorized under chapter 18.36A RCW."
Correct the title.
EFFECT: Removes provisions expanding the authority of naturopaths to prescribe legend drugs and controlled substances and restores current law regarding naturopathic prescribing. Requires the board of naturopathy to adopt rules specifying: (1) The educational requirements for naturopaths to prescribe and administer controlled substances; and (2) other requirements necessary for the responsible utilization of the additional prescriptive authority for controlled substances. Requires the board of naturopathy to prepare request legislation granting licensed naturopaths prescriptive authority consistent with the rules. Specifies that the rule-making authority does not expand licensed naturopaths' authority to prescribe legend drugs or controlled substances.
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