Legislative Updates displays bills pending in the 2017 state legislative sessions.  It is updated weekly.  To view bills from the 2013-2014 and 2015-2016 sessions and their results, see Legislative Archive.  

Bills are listed by state and subject, with a brief explanation of what's in the bill. Unless indicated otherwise, we believe the listed bills should not pass. Unfortunately, most CAM bills filed in the state legislatures are pro-CAM.  Bills added to the list this week, or with updated information, are marked NEW! 

To voice your opinion on these bills (and we hope you will) you need to find out where they are in the legislative process and how to contact state legislators in the states where they are pending. See FAQS for more information on how to do this. Each year there are many bills forcing public and private health insurance providers to cover CAM services (especially chiropractic). Because of the sheer volume of these bills we are unable to include them in our legislative updates at this time.

Naturopathy

For more information on naturopathy and why naturopaths should not be licensed see former ND Britt Hermes's blog, Naturopathic Diaries, and her posts on Science-Based Medicine (type "Hermes" in search box.)  She details the disturbing lack of education and training of naturopaths, as well as their appalling practices. For information on how naturopathic licensing efforts are funded by dietary supplement companies, see "Naturopaths, often derided as quacks, push to go mainstream -- with help from vitamin companies."

ALASKA: Senate Bill 120To Senate Comms. on Labor & Commerce and Finance. Major practice expansion. Alaska naturopaths currently have a fairly narrow scope of practice. This bill would allow naturopaths to diagnose or treat any patient of any age with any disease or condition via "support and stimulation of an individual's inherent self-healing processes," i.e, vitalism, a long-discredited prescientific notion that a supernatural force guides human bodily functioning. Nevertheless, naturopaths would be able to prescribe drugs (except controlled substances and chemotherapy), perform minor office surgery, perform and order diagnostic testing, which would permit them to employ the sort of quack tests typical of naturopathic practice and diagnose fake diseases like "adrenal fatigue" and "chronic candidiasis." Naturopathic education and training are insufficient to allow them to safely practice primary care, which is essentially what this bill allows, especially prescription privileges

CALIFORNIA:  Senate Bill 746. To Senate Comms. on Education and Business, Professions & Economic Development. Practice expansion. Would allow chiropractors, naturopaths and nurse practitioners to perform school physicals required for interscholastic athletic play. 

CALIFORNIA: NEW! Senate Bill 796. Bill went through a whopping 8 versions before finally passing Senate and House; signed into law by Governor.  The naturopathic practice act is repealed and the Naturopathic Medicine Committee of the Osteopathic Medical Board is subject to review on Jan. 1, 2018. This bill moves the date for repeal and review to Jan. 1, 2022, thereby legalizing naturopathic practice and delaying further review for 5 more years.  Naturopathic doctors used this bill to try to make traditional naturopathic practice illegal but failed. They then tried to add restrictions on use of term "naturopath" but those failed also. Latest version protects traditional naturopaths as long as they comply with California's "health freedom" law, which permits unlicensed practice. Amendments also require continuing education courses to "provide balance, independence, objectively and scientific rigor" watered down by a provision requiring that patient care recommendations in CE courses "be based on evidence accepted by naturopathic doctors," an extremely low bar. Provisions also added to prevent conflicts of interest in CE course presentations, similar to those required of medical doctors. Gives state the authority to audit naturopaths' continuing education records. Requires naturopathic schools to provide credit to students for education and training obtained in armed services. 

COLORADO:   Senate Bill 106. Signed into law by Governor. History: Passed Senate; passed House with several amendments expanding scope of practice; Senate refused to concur in House amendments; Conference Comm. could not resolve differences; after much legislative wrangling and some memorable name calling by the former president of the Colorado Association of Naturopathic Doctors, the House receded from its amendments, Senate version was restored and passed in the Senate. Colorado's naturopathic registration bill sunset date moved to 2020; to avoid public confusion, naturopaths must use the title "Registered Naturopathic Doctor," or "R.N.D." so the public won't think they are licensed health care professionals; requires reporting of malpractice settlements and judgments to the Department of Regulatory Agencies and makes naturopaths mandatory reporters of elder and child abuse; clarifies substances on naturopathic formulary. A House Comm. substantially expanded scope of of practice by adding prescription privileges, to include administration of, among other substances, chelating agents, non-prescription drugs, and some hormones; administration includes injections and IVs. House committee further amended bill to require collaboration between naturopath and physician or nurse practitioner regarding prescribing hormones. The Senate refused to concur in these scope-of-practice-expanding amendments. SB 106 has been through at least 7 iterations during its passage through the legislature, indicating the contentiousness of regulating naturopathy and the appropriate scope of practice. 

CONNECTICUT:  Senate Bill 125; Senate Bill 314; House Bill 6250Failed; did not meet deadline for further consideration. Bills are vague on specifics. SB 125 says that naturopathic "physicians" who "meet certain [unspecified] requirements" should be allowed to prescribe medication from a specific formulary. SB 314 simply states that the law should be amended to allow naturopaths to prescribe medication "to keep costs down;" although there is no evidence that naturopathic prescribing achieves this goal. HB 6250 would allow naturopaths to prescribe medication, but only through a collaboration with a physician or advanced practice nurse. Consistent with the American Association of Naturopathic Physicians push for full primary care scope of practice in all 50 states, Connecticut naturopaths lobbied for prescription privileges in 2014, when the state "modernized" their scope of practice, but didn't get them. They've failed in subsequent years as well. A 2014 report by the Department of Public Health found their education and training, plus passing the NPLEX exam, insufficient for prescribing privilege, a fact that has since been admitted by the Board of Naturopathic Examiners

HAWAII:  Senate Bill 223. Passed Senate; to House; House Comm. on Health, Licensing and Technology amended; to House Judiciary Comm. Practice expansion bill. Would allow naturopaths to prescribe testosterone. Original bill would have allowed naturopaths to prescribe Schedule I-V controlled substances "consistent with naturopathic medical practice" but not narcotic drugs. (Hawaii naturopaths can already prescribe legend, i.e, prescription drugs, but not controlled substances.) Bill stated that "naturopathic physicians are known for their expertise in bio-identical hormone replacement therapy" and that their prescription, as well as prescription of codeine (which can have serious side effects) are "consistent with the practice of naturopathic medicine." Actually, the North American Board of Naturopathic Examiners has admitted that naturopathic education and training are not sufficient to allow naturopaths prescription privileges. "Bio-identical hormone" is a marketing, not a medical, term, and medical experts warn against their use. 

ILLINOIS:  Senate Bill 708; House Bill 2530SB 708 postponed Senate Comms. on Assignments and Licensed Activities & Pensions, rereferred to Assignments Comm. HB 2530 referred House Comm. on Health Care Licenses, rereferred to House Comm. on Rules. Licensing bill. Similar to failed bills introduced in past legislative sessions, SB 708 and HB 2530 do not define the scope of practice for naturopathic "doctors," who must have graduated from a naturopathic "medical" school and passed the NPLEX. Would be regulated by state board of medicine, to which one naturopathic member would be added. Would be allowed to call themselves naturopathic "physicians." 

INDIANA: Senate Bill 508; House Bill 1595. Failed; Legislature adjourned. SB 508 Referred to Senate Comm. on Commerce & Technology; HB 1595 referred to House Comm. on Public Health. Licensing bill. Would give naturopathic "physicians" an extremely broad scope of practice, allowing them to diagnose and treat any patient of any age with any disease or condition using naturopathic therapies and substances "recognized by the Council on Naturopathic Medical Education" (even though the CNME doesn't officially "recognize" anything) and approved by a naturopathic board. The board, which would regulate all aspects of naturopathic practice, consists solely of naturopaths and two public members who must not be licensed health care professionals, virtually guaranteeing they are unlikely to be able to recognize naturopathic quackery for what it is or effectively protect the public. Would be able to prescribe certain medications, including controlled substances, approved by board; no formulary council or medical or pharmacist oversight of formulary required. Naturopaths would be able to order and perform physical and lab exams, including phlebotomy and electrocardiograms, giving them the authority to order quack tests to diagnose fake diseases (also here) and order and interpret the reports of diagnostic imaging studies. Could prescribe and sell to patients worthless and potentially dangerous herbs, other dietary supplements and homeopathic remedies, which they will be able to administer by all typical routes, including IV, as well as use the quack treatment colon hydrotherapy and perform minor office surgery. 

MAINE:  House Bill 393. Failed; Comm. on Health & Human Services voted "ought not to pass."  Practice expansion. No specific bill language was ever drafted, but bill proposes to expand the authority of naturopathic doctors to prescribe certain "naturally occurring medications."

MINNESOTA:  Senate Bill 1514 House Bill 1138. SB 1514 referred to Health & Human Services Finance & Policy; HB 1138 referred to House Health & Human Services Reform Comm. Major practice expansion. Changes naturopathy from a registered to a licensed health care profession. Adds authority to prescribe drugs, do minor office surgery, perform biopsies, and do speculum & orificial exams and phlebotomy. Can use the term "naturopathic physician." 

MISSISSIPPI:   Senate Bill 2511. Failed; "died on calendar."  Licensing bill amended in committee to add some medical physician oversight, but bill would give naturopathic "physicians" an extremely broad scope of practice. Naturopathy defined as "primary care for prevention, diagnosis, and treatment" of any disease or condition in any patient of any age via "stimulation of patient's inherent self-healing processes," i.e., vitalism. In addition, would permit "naturopathic childbirth attendance," prescribing drugs from a naturopathic formulary, and minor office surgery. Could also prescribe and sell to patients worthless and potentially dangerous dietary supplements, herbs, and homeopathic remedies using virtually all routes of administration, including IVs. They use colon hydrotherapy and order diagnostic imaging as well as, under the supervision of a medical doctor, order and perform other lab tests, giving them the ability to use unvalidated testing to diagnose fabricated diseases (also here). Would be regulated by the state medical board, assisted by a naturopathic advisory committee. 

NEW YORK:  Senate Bill 4297, Assembly Bill 5913SB 4297 referred to Senate Comm. on Higher Education; AB 5913 referred to Assembly Comm. on Higher Education. This will be the ninth consecutive legislative session a licensing bill has been introduced. Gives naturopaths a broad scope of practice "to address the shortage of primary care physicians." Is based on the fiction that naturopaths can stimulate the "inherent property in a living organism to heal itself," i.e., vitalism. Would allow naturopaths to diagnose and treat any patient of any age with any disease or condition. Allows the use of bogus "CLIA-waived" tests, including diagnostic tests that have never been validated, which they use to diagnose fake diseases. Naturopaths would be able to prescribe worthless homeopathic remedies, dietary supplements, herbs, thyroid hormones, estrogen, progesterone and DHEA, which they would be able to administer by all the usual routes (vaginal, rectal, oral) and, if registered with the state, by injection, including IV administration. This would permit them to concoct dubious remedies like Myers cocktails, high dose vitamin C and other substances and administer them intravenously. Could order diagnostic imaging, including MRIs and thermography, and perform cryotherapy, ligation, fulguration, other minor office procedures and colonics. Would be regulated by a naturopathic board consisting of six naturopaths, two public members and one MD or DO. If bill passes, after two years naturopaths would have to have completed a one-year "residency" to become licensed. 

NEW JERSEY:  Assembly Bill 1937; Senate Bill 1311. No action on either bill in 2016; bills carried over to 2017 session. Naturopathic licensing bill. This is the same bill that never got out of committee during the last N.J. legislative session, reintroduced with a new bill number for the new session. Bill defines naturopathic doctors as practitioners of primary health care and gives them the authority to independently diagnose and treat any patient with any condition, injury or disease. Naturopaths could order diagnostic tests, including x-rays; use typical naturopathic remedies such as homeopathy, dietary supplements, colonic irrigation, and "neutraceuticals;" and prescribe durable medical equipment. They would be self-governed by a naturopathic board.  Establishes an advisory committee to look into "naturopathic childbirth attendance." 

NORTH CAROLINA:  Senate Bill 258; House Bill 692. SB 258 to Senate Comm. on Rules; HB 692 to House Comm. on Finance. This will be the 8th consecutive legislative session in which a naturopathic regulatory bill has been introduced. The latest attempt creates "certification" for naturopaths but otherwise gives them the scope of practice they generally want to start with before coming back to the state legislatures year after year to expand their scope, as the current and archived Legislative Updates demonstrate they regularly do. Naturopaths who've graduated from an accredited naturopathic school and passed the NPLEX would be allowed to diagnose and treat any patient of any age with any condition or disease, no matter how complex. They could order and dispense (read: sell) "natural" remedies, including food, "nutraceuticals," dietary supplements and homeopathic remedies. They could employ their quack diagnostic tests and order diagnostic imaging (fortunately, interpretation of imaging would be left to professionals). They would be able to use oral, nasal, rectal and vaginal routes of administration; injections and IVs are neither excluded or included. Would be regulated by a Naturopathic Doctors Certification Board, with a majority of the board being naturopaths. No malpractice insurance is required and no prohibition against substandard care (only "gross negligence") or false advertising is contained in the bill. 

NORTH CAROLINA: House Bill 277. Original bill dealt with prescription drug abuse committee and passed House as such; Senate Health Care Comm. substituted totally different language and passed; now before Comm. on Rules & Operations of the Senate. Would establish a "work group" to study "the appropriate oversight and regulation" of naturopathic practice in North Carolina, although the game seems rigged in favor of licensing by commanding the work group to "identify an approved study of naturopathic medicine" but which defines same so that only one outcome can be reached, that being the current system of self-regulated naturopathic schools which teach homeopathy, "detoxification," anti-vaccination ideology and other pseudoscience. The work group would consist of two naturopaths appointed by the North Carolina Association of Naturopathic "Physicians," two MDs (one of whom must have experience working with naturopathic doctors) and a designee of the state Secretary of Health. 

NORTH DAKOTA:  Senate Bill 2256. Failed; Legislature adjourned; no carryover to 2018. Practice expansion bill. Would allow naturopaths to prescribe, dispense or administer prescription drugs listed on a naturopathic formulary established by a committee consisting of a physician, naturopath, pharmacists and advanced practice nurse. Formulary cannot include Schedule I - IV drugs except endogenous anabolic androgenic steroids. Would also permit naturopaths to perform minor office surgery and if "certified" practice "naturopathic childbirth attendance." 

OREGON:  Senate Bill 217; House Bill 2390Failed; Legislature adjourned; no carryover to 2018.  Allows chiropractic "physicians" and naturopathic "physicians" to return student athletes who've suffered a concussion to play. In a move that seems tailored to make science-based healthcare professionals (like MDs, DOs, and PAs) pay the price for the lack of education and training of DCs and NDs, the bill has been amended so that all healthcare providers will be required to obtain a certificate to return school athletes to play post-concussion after taking a Oregon Health Authority-approved course. Similar bills failed last year. Oregonian Mark Crislip, MD, explains how inadequate chiropractic and naturopathic education and training, plus their pseudoscience-filled practices, makes them ill-qualified to the task and puts patients at risk.

OREGON:  Senate Bill 23.Failed; Legislature adjourned; no carryover to 2018. Practice expansion bill. Current law allows naturopaths to surgically repair and care for superficial lacerations and abrasions and benign superficial lesions and to remove foreign bodies located in superficial structures. Bill would allow any surgery "that poses little risk to the life of the patient and can be safely performed in an office setting, as further defined by rule." Whether these vague criteria are met would be determined by the Oregon Board of Naturopathic Medicine, which requested the bill. 

OREGON:  Senate Bill 22Failed; Legislature adjourned; no carryover to 2018. Repeals provision establishing peer review committee for purpose of evaluating complaints against naturopathic "physicians" and making recommendations to Oregon Board of Naturopathic Medicine about those complaints. The reason for this is unclear, but the bill was introduced at the request of Governor Kate Brown on behalf of the Board, indicating that concern for public safety, as opposed to protection of naturopaths, is not a rationale. 

OREGON:  Senate Bill 856. Passed Senate and House; signed into law by Governor. [Senate Comm. on Health Care voted "do pass" with amendment leaving most of bill intact but removing authority to return concussed athletes to play, which is the subject of  Senate Bill 217; House Bill 2390 (see above)]. Amends a variety of state laws to add "naturopathic physicians" to various protections afforded to, and privileges allowed, MD and DO physicians and other health care providers.  Appears to be an attempt to "mainstream" naturopaths in the health care system. Adds "naturopathic physicians" to protections from tort liability for health care providers employed by the state, providing emergency medical services, using defibrillators, and incorporating certain products into medical procedures. Allows "naturopathic physicians" to provide certain medical services (including birth control advice and mental health services) to minors without parental consent. Adds "naturopathic physicians" to health care practitioners who can provide information to or receive information from the state's POLST (Physician orders for life-sustaining treatment) registry. Senate Comm. amended to add naturopaths to list of health care professionals who can determine patient needs hospice care. 

OREGON: House Bill 3400.Failed; Legislature adjourned; no carryover to 2018. Even though naturopathic education and training are far inferior to that of medical and osteopathic primary care physicians, Oregon forces health insurers to credential naturopaths as primary care physicians. (For starters, naturopathic education is full of pseudoscience and their clinical training is some 15,000 hours short of what a physician gets in residency.) Some concerned insurers have responded to this mandate by imposing additional credentialing requirements on naturopaths. HB 3400 would prevent insurers from imposing these additional requirements before credentialing them as primary care providers. 

PENNSYLVANIA: Senate Bill 834Referred to Senate Consumer Protection & Professional Licensing Comm. Just last year, Pennsylvania passed a naturopathic registration act, allowing naturopathic "doctors" to register with the state, without defining a scope of practice and leaving the details up to the state medical board, under whose jurisdiction naturopaths would practice. As predicted, this was simply a "foot-in-the-door" strategy and naturopaths are already back before the General Assembly with a licensing bill that would allow them to diagnose and treat any patient with any disease or condition, although they would still operate under the jurisdiction of the medical board. As is typical, the licensing bill defines naturopathy as vitalism  ("to support and stimulate the individual's intrinsic self-healing processes," a long-discredited, pre-scientific notion of human bodily functioning. Naturopathic "doctors" with four-year degrees from naturopathic "medical schools" who pass the NPLEX could perform and order diagnostic testing, order diagnostic imaging studies, and prescribe dietary supplements, homeopathic remedies, herbs, and other nostrums of dubious efficacy and safety, like colonic irrigation. They would be required to have $1 million in malpractice insurance and must refer a patient "presenting a contradiction to naturopathic medicine" to a physician. They could not prescribe drugs or perform surgery and cannot call themselves "physicians." 

RHODE ISLAND: NEW! Senate Bill 327; House Bill 5474.  Both bills substantially amended and passed House and Senate; signed into law by Governor. As amended SB 327 passed Senate, on House consent calendar. Licensing bills. Similar to bills rejected by the state legislature in past sessions, these bills would license naturopathic "physicians," give them the authority to diagnose and treat any patient of any age with any disease or condition. Could prescribe and sell patients dietary supplements and homeopathic remedies, order and perform lab tests; order diagnostic imaging. Could prescribe drugs on a formulary established by a formulary council, although bill does not say who would be on the council or how formulary would be composed. Could use all usual routes of administration, including injections and IVs. Would be regulated by the state Department of Health with the assistance of naturopathic "advisors." State would default to the National Board of Naturopathic Examiners, which is completely controlled by naturopaths, to determine what therapies naturopaths could use. In other words, these bills would subject the citizens of Rhode Island the substantial, and growing, hodgepodge of quackery typically employed by naturopaths.  SB 327 and HB 5474 dramatically amended. Would still allow naturopaths to diagnose and treat any patient with herbs, dietary supplements and homeopathic remedies and perform and order lab tests, but bill now specifically says that naturopathic "doctors" are not primary care physicians and that they cannot advise patients regarding prescription drugs, except for herb-drug interactions; naturopathy is considered an adjunct to, not a substitute for, medical care. Would be regulated by a naturopathic board consisting of two physicians, two naturopaths and one public member. Must have collaboration and consultation agreement with physician. 

WASHINGTON: Senate Bill 5369Referred to Senate Comm. on Health Care. Practice expansion bill.  Would expand authority to prescribe controlled substances to include all Schedule III, IV, and V controlled substances with additional education requirements determined by the naturopathic board. Currently, the board permits limited controlled substances prescribing with only 4 hours of additional education. Board would also be given exclusive authority to determine what minor office surgery naturopaths could perform and what are cryptically described as "other nutrients, compounds, and natural substances" naturopaths could prescribe and sell to patients. Would allow naturopaths to sign "guardianships, powers of attorney, disability determinations, and similar legal documents." 

  

Chiropractic

CALIFORNIA:  Senate Bill 746. To Senate Comms. on Education and Business, Professions & Economic Development. Practice expansion. Would allow chiropractors, naturopaths and nurse practitioners to perform school physicals required for interscholastic athletic play. 

COLORADO:  Senate Bill 135. Passed Senate; from House Comm. on Agriculture, Livestock & Natural Resources, postponed indefinitely; died in committee. Colorado law permits the practice of animal chiropractic, defined as "diagnosing and treating animal vertebral subluxation," including the use of x-rays for diagnosis. Subluxations do not exist in humans or other mammals and obviously you cannot see them on an x-ray, although a favorite chiropractic scam is to point out the non-existent subluxation on an x-ray film. Chiropractors are required to get clearance from a DVM before "detecting" and "correcting" subluxations in animals. This bill removes the clearance requirement for chiropractors who are registered in animal chiropractic with the state. (For more on animal chiropractic and other forms of pseudoscience inflicted on animals, see the SkeptVet blog.) 

CONNECTICUT:  Senate Bill 323; House Bill 6249; House Bill 6029. Failed; did not meet deadline for further consideration. SB 323 and HB 6249 would allow chiropractors to clear student athletes to participate in an intramural, interscholastic or college athletic activity after showing signs of or being diagnosed with a concussion. HB 6029 goes even further by specifically allowing chiropractors to diagnose student athletes with a concussion in addition to returning them to play. Mark Crislip explained why chiropractors are not competent to diagnose and treat concussions

FLORIDA:  Senate Bill 240; House Bill 161. Failed; Legislature adjourned. Would permit chiropractors (along with MDs, DOs and nurses) to enter into "direct primary care agreements" with patients. “Primary care service” is defined in these bills as "the screening, assessment, diagnosis, and treatment of a patient for the purpose of promoting health or detecting and managing disease or injury within the competency and training of the primary care provider." Chiropractic scope of practice is defined by state law as essentially the detection and correction of (non-existent) subluxations. Chiropractors are not educated and trained in primary care and are incompetent to provide this level of care. It is misleading to the public to imply that they are by allowing chiropractors to enter into direct primary care agreements with patients. It is important to remember that these agreements are not bound by the usual limitations imposed by health insurers based on the lack of evidence of safety or effectiveness. (See, for example, Aetna’s discussion of coverage of chiropractic services.)

IDAHO:  House Bill 195. Passed House and Senate; signed into law by Governor. Practice expansion bill. Permits chiropractors (who can call themselves "physicians") who are "certified in clinical nutrition" to prescribe and administer certain vitamins, minerals and fluids, including by injection and IV. This will allow chiropractors to cash in on the booming business in useless vitamin and mineral infusion therapies. Certification takes on 77 classroom hours in clinical nutrition and 24 hours in clinical training on injections, lab tests and blood chemistry interpretation.  Classes can be taken at a chiropractic school. Except in the case of actual deficiency, which is rare, and a very limited number of medical uses, vitamin and mineral injections confer no proven health benefit

INDIANA:  Senate Bill 437Failed; Legislature adjourned; no carryover to 2018. Before Senate Comm. on Health and Provider Services. Although not obvious at first glance, this is a major practice expansion bill in the vein of the American Chiropractic Association's position that chiropractors are competent primary care physicians. (Actually, they aren't.) Allows chiropractors to call themselves "physicians" and to order, perform and interpret "laboratory, radiological, electrodiagnostic or any other diagnostic studies" if taught in a chiropractic college, "including ordering of advanced imaging of all parts of the human body." Allows chiropractors to "evaluate and examine individuals" for "diagnosis of physical or physiologic injuries, conditions, or disorders of the body" and treat "injuries, conditions and disorders" by "administering or dispensing of supportive procedure therapies" including "nutrition" and "risk factor screening." This means chiropractors could diagnose and treat virtually any disease or condition (with the exception of infectious diseases, endocrine disorders, or atypical or abnormal histology, which are specifically prohibited by the bill) and use virtually all forms of diagnostic testing, no matter what organ or body system it involves, including dubious tests like MTHFR genetic testing for unvalidated purposes ("risk factor screening") using dietary supplements ("nutrition"). The bill also buys into the pretension that DCs are PCPs by stating that chiropractors can "manage, coordinate or delegate patient care functions including initiating referrals to specialists," which are basic functions of a real primary care doctor

NEVADA:   Assembly Bill 456. Failed; Legislature adjourned; no carryover to 2018. To Assembly Comm. on Commerce & Labor. Practice expansion bill. Current law defines chiropractic as force applied to spinal vertebrae (known in chiropractic lingo as "adjustments") to "eliminate or decrease interference with neural transmission . . . to correct [the] subluxation complex." In other words, traditional straight chiropractic pseudoscience. This bill would expand the permitted use of adjustments "to improve health," an impossibility because the chiropractic subluxation is a fiction and no amount of force applied to the putative subluxation will "improve health." The bill's passing would, however, improve chiropractors' bottom line by increasing the breadth of bogus claims they could make. 

NEW MEXICO:  Senate Bill 150. Failed; Legislature adjourned; no carryover to 2018. New Mexico is unique in allowing "advance practice" chiropractors, who have 90 hours of education and training in pharmacology, to prescribe drugs. This bill would bifurcate the "advance practice" chiropractor into two levels. Level One, with the 90 hours of education, would have an expanded formulary, increasing the drugs they could inject and doing away with pharmacy and medical board approval. Level Twos could, with 650 hours of additional training at chiropractic schools, prescribe and administer all drugs used in primary care practice, except Schedule I controlled substances. The bill removes the statutory definition of chiropractic scope of practice, leaving it solely up to the chiropractic board to decide what chiropractors can and cannot do. 

NEW YORK:  Assembly Bill 8541To Assembly Comm. on Higher Ed. Practice expansion bill. This bill substitutes one pseudoscientific definition of chiropractic for another. Current law allows chiropractors to remove "nerve interference" via the detection and correction of "subluxations." The bill allows chiropractors to diagnose "the human body" for "any human disease, pain, injury, deformity or physical condition" by detecting and correcting "subluxations." Of course, the chiropractic "subluxation" does not exist and the entire premise of the bill is based on a fiction. Would permit chiropractors with vaguely described additional training to to engage in "wellness care methods" and give dietary and nutritional advice, including dispensing dietary supplements. Bill would also expand chiropractors right to use lab testing and electrodiagnostic testing, as well as perform manipulation under anesthesia. Would allow allow chiropractors to call themselves chiropractic "physicians."  These provisions are typical of the American Chiropractic Association's campaign to rebrand chiropractors as "primary care physicians" and "chiropractic internists."  

NORTH CAROLINA:  House Bill 818. To House Comm. on Health. Allows chiropractors to perform school physicals for students participating in interscholastic athletics. Harriet Hall, MD, explains why chiropractors are not competent to perform school physicals on Science-Based Medicine. 

OREGON:  Senate Bill 217; House Bill 2390Failed; Legislature adjourned; no carryover to 2018. Allows chiropractic "physicians" and naturopathic "physicians" to return student athletes who've suffered a concussion to play. In a move that seems tailored to make science-based healthcare professionals (like MDs, DOs, and PAs) pay the price for the lack of education and training of DCs and NDs, the bill has been amended so that all healthcare providers will be required to obtain a certificate to return school athletes to play post-concussion after taking a Oregon Health Authority-approved course. Similar bills failed last year. Oregonian Mark Crislip, MD, explains how inadequate chiropractic and naturopathic education and training, plus their pseudoscience-filled practices, makes them ill-qualified to the task and puts patients at risk.

TENNESSEE:  Senate Bill 313; House Bill 387; Senate Bill 1280 (same language as SB 313). HB 387 passed HouseHB 387 substituted for SB 313 and passed Senate; signed by GovernorPractice expansion bills.  Chiropractic is currently defined under state law as "locating and removing nerve interference," i.e., traditional subluxation-based chiropractic, and diagnosing and treating "neuromuscular and musculoskeletal conditions." These bills expand chiropractic scope of practice to include performing a "differential diagnosis" for any physical condition to establish "an appropriate plan of care for the patient." In addition to x-rays and "other non-invasive procedures," chiropractors could perform "minimally invasive procedures" if approved by the chiropractic board in consultation with the medical board.  Treatment limited to neuromuscular, musculoskeletal, and "related conditions." However, chiropractors will also be able to provide "supportive care," including "nutrition," leaving patients open to a chiropractors pushing all sorts of dietary supplements to patients. Chiropractors could collect bodily fluids and hair for analysis (a "cardinal sign of quackery," according to Quackwatch), subjecting patients to unvalidated lab tests which are used to sell dietary supplements.   

TENNESSEE:  Senate Bill 224 and House Bill 334. SB 224, as amended, passed Senate and House; signed into law by GovernorUnder these bills, chiropractors could enter into direct primary care agreements with their patients. "Primary care" is defined under state law as "includes the screening, assessment, diagnosis, and treatment for the purpose of promotion of health or the detection and management of disease or injury within the competency and training of the direct primary care physician," but Senate and House committee amendments clarified that the state does not consider chiropractors PCPs by adding language "or, if applicable, within the scope of practice of a chiropractic physician." 

TEXAS: Senate Bill 304; House Bill 2011; House Bill 2203. (House bills are duplicates.) SB 304 passed Senate & House; signed into law by Governor. Current law allows chiropractors to "analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system." Bills add "diagnose," but discussion in Senate makes clear this is not a scope of practice expansion and chiropractors are limited to diagnosing a biomechanical condition of the spine or musculoskeletal system. 

VIRGINIA:  House Bill 1688Passed House & Senate; signed into law by Governor. Practice expansion bill. Would allow chiropractors to perform physicals for commercial driver's or learner's permits if chiropractor has received certification as medical examiner from federal government and registered with same. 

WISCONSIN:  Assembly Bill 260; Senate Bill 232.  AB 260 passed Assembly, to Senate; SB 232 & AB 260 referred to Senate Comm. on Health & Human Services. Practice expansion bill. Would allow chiropractors to perform physical exams for student athletes. Requires chiropractor to hold "certificate in health or physical examinations" but the education, training and any other requirements for these certificates would be solely up to the chiropractic board. Many groups oppose the bill, including the Wisconsin Medical Society, which rightly pointed out that chiropractors aren't qualified to examine students for cardiovascular problems, mental health, and substance abuse issues, among others. Also opposed by several medical specialty groups, the state nurses and athletic trainers associations, hospitals, insurance groups and "straight" chiropractors. Harriet Hall, MD, herself a retired family practice physician, explained why chiropractors aren't qualified to perform sports physicals on Science-Based Medicine. Bill would also allow the practice of something called "chiropractic acupuncture," which is opposed by acupuncturists. 

WYOMING: House Bill 107. Failed legislative deadline for further consideration. (Digest here.) Would allow chiropractors to call themselves chiropractic "physicians." A similar bill last session failed

 

Acupuncture, Traditional Chinese Medicine and Oriental Medicine

ILLINOIS:  House Bill 2630, House Bill 3860Senate Bill 1350HB 2360 amended and passed House and Senate; signed into law by Governor.  HB 3860 before House Comms. on Rules and Health Care Licenses. SB 1350 to Senate Comm. on Assignments. Adds the practice of "East Asian medicine" to acupuncture practice act, defined to include acupuncture, moxibustion, herbal medicine, dietary supplements, and diet, among others, to "normalize physiological functions, or for the treatment of diseases or dysfunctions of the body."  Both bills expand scope of practice of acupuncture to include far-infrared, electro and magnetic stimulation, cold laser, cupping, dry needling, and gua sha. Practitioners limited to determination of differential diagnosis via principles and techniques taught at acupuncture schools. Must refer patient to physician or dentist if patient's condition is beyond the scope of the practice of practitioner, although it's unclear what that would entail as no limitation put on the diseases or conditions an acupuncturist can diagnose or treat. Extends sunset of practice act from 2018 to 2028. HB 3860 simply extends the sunset date to 2028 and makes other minor changes, but does not expand scope of practice. 

MAINE:  House Bill 141. Passed House and Senate; became law without Governor's signature.  Requires state Department of Health and Human Services to apply to for federal authorization to develop a pilot project to treat alcohol abuse disorders, substance abuse disorders using the National Acupuncture Detoxification Association ("NADA") auricular acupuncture protocol. NADA auricular acupuncture is highly implausible and has not been proven effective for substance abuse. As is typical of acupuncture studies in general, higher quality studies show that it is no more effective than placebo. 

MISSISSIPPI:  Senate Bill 2214; House Bill 495SB 2214, as amended, passed in Senate and House; signed into law by Governor. (HB 495 died in committee.) Current law requires that an acupuncturists have a written prescription or referral from a physician to perform acupuncture and that the physician perform a medical diagnostic examination prior to the referral or prescription and specifies certain elements in the referral or prescription. SB 2214, as amended and passed by Senate, repealed these requirements for acupuncturists and physicians who have been in practice for 5 years. As amended and passed by House, patient of acupuncturist must have been seen by physician for condition being treated within past 6 months, unless for weight loss, smoking or substance abuse. Acupuncturist must advise patient that acupuncture not a substitute for conventional medical treatment and must get informed consent for treatment. Acupuncturist cannot make a diagnosis and must consult with physician if patient not improving or requires emergency medical treatment. (HB 495 repealed this requirement altogether.) Original bill extended repealer on Acupuncture Practice Act to 2021, but House version eliminates repeal date. Similar bills have failed in recent sessions.

MINNESOTA: Senate Bill 1958; House Bill 2389. SB 1958 from Senate Comm. on Health & Human Services, voted "do pass;" read second time in Senate and re-referred to Health & Human Services. HB 2389 to House Comm. on Health & Human Services Reform. Appropriates $375,000 to do what is essentially a worthless study amounting to no more than a collection of anecdotes which will supposedly determine the effectiveness of acupuncture for pain and its potential to reduce opioid use. 

NEBRASKA:  L.B. 19  Passed Legislature; signed into law by Governor. Practice expansion bill.  Would remove requirement that patient have a referral from, or an evaluation and medical diagnosis by, a physician. Add requirement that acupuncturist refer patient to "appropriate practitioner" when patient's problem is beyond training, experience, or competence of the acupuncturist; how acupuncturist is supposed to make this call is not explained.  

NEW HAMPSHIRE:  House Bill 575. Passed House and Senate; signed into law by Governor. Creates "Certified Acupuncture Detoxification Specialist" who has been trained in the NADA protocol to practice. As amended in Senate auricular acupuncture could be used only in conjunction with other therapies, but Conference Committee rejected the amendment NADA auricular acupuncture is highly implausible and has not been proven effective for substance abuse. As is typical of acupuncture studies in general, higher quality studies show that it is no more effective than placebo. 

NEW MEXICO:  House Bill 232. Failed; Legislature adjourned; no carryover to 2018Would expand scope of practice of Doctors of Oriental Medicine, who are defined by state law as "primary care" practitioners, to include "substances used for detoxification and chelation," among other things. Adds certification in "holistic integrative medicine" to injection, intravenous and bioidentical hormone therapy certifications Board of Acupuncture and Oriental Medicine can issue. 

UTAH:  Senate Bill 73. Passed House and Senate; Signed into law by Governor. Acupuncture practice act sunsets on July 1, 2017; extends sunset date to 2022. 

WEST VIRGINIA: NEW!  House Bill 3032. To House Comm. on Prevention & Treatment of Substance Abuse; failed to meet deadline for further consideration. Would allow the practice of "auricular acupuncture" if practitioner certified by National Acupuncture Detoxification Association for chemical dependency even if person not a licensed acupuncturist. "Auricular acupuncture" is a fantasy treatment with no competent evidence of efficacy for any condition. 

WYOMING:  House Bill 165. Digest herePassed House & Senate; signed into law by Governor. As originally introduced, would license acupuncturists and practitioners of Oriental medicine, but Oriental medicine has been eliminated from the bill. Acupuncture is defined as insertion of needles, with or without electric current, for 'therapeutic purpose of promoting, maintaining and restoring health." Also permits practice of "auricular acupuncture" for "treating mental and emotional health, post and acute trauma, substance abuse and chemical dependency," even though it has not been proven effective for those conditions. Creates Board of Acupuncture, consisting of three acupuncturists, one public member and one licensed health care professional who is not an acupuncturist, to regulate acupuncture practice.