Annex A 1 TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS PART I. DEPARTMENT OF STATE Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS CHAPTER 16. STATE BOARD OF MEDICINE GENERAL PROVISIONS 16.1. Definitions. Subchapter A. BASIC DEFINITIONS AND INFORMATION The following words and terms, when used in this chapter and Chapters 17 and 18 (relating to State Board of Medicine medical doctors; and State Board of Medicine practitioners other than medical doctors), have the following meanings, unless the context clearly indicates otherwise: Board-regulated practitioner A medical doctor, midwife, physician assistant, [drugless therapist,] athletic trainer, acupuncturist, [practitioner of Oriental medicine,] perfusionist, respiratory therapist, genetic counselor, prosthetist, orthotist, pedorthist, orthotic fitter, naturopathic doctor, or an applicant for a license, registration, or certificate that the Board may issue. Subchapter B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION PROVISIONS 16.11. Licenses, certificates, and registrations.
(b) The following nonmedical doctor licenses and certificates are issued by the Board: (5) [Practitioner of Oriental medicine license. (6)] Behavior specialist license. [(7)] (6) Athletic trainer license. [(8)] (7) Perfusionist license. [(9)] (8) Respiratory therapist license. [(10)] (9) Genetic counselor license. [(11)] (10) Prosthetist license. [(12)] (11) Orthotist license. [(13)] (12) Pedorthist license. [(14)] (13) Orthotic fitter license. [(15)] (14) Graduate prosthetist license. [(16)] (15) Provisional prosthetist license. [(17)] (16) Graduate orthotists license. [(18)] (17) Provisional orthotist license. [(19)] (18) Temporary practice permit pedorthist. [(20)] (19) Temporary practice permit orthotic fitter. (c) The following registrations are issued by the Board: (2) Registration as a practitioner of East Asian herbology 2
(3) Registration as a naturopathic doctor [(2)] (4) Biennial registration of a license without restriction. [(3)] (5) Biennial registration of an extraterritorial license. [(4)] (6) Biennial registration of a midwife license. [(5)] (7) Biennial registration of a physician assistant license. [(6) Biennial registration of a drugless therapist license. (7)] (8) Biennial registration of a limited license-permanent. [(8)] (9) Biennial registration of an acupuncturist license. [(9) Biennial registration of a practitioner of Oriental medicine license.] (10) Biennial registration of a behavior specialist license. (11) Biennial registration of athletic trainer license. (12) Biennial registration of a perfusionist license. (13) Biennial registration of a respiratory therapy license. (14) Biennial registration of a genetic counselor license. (15) Biennial registration of a prosthetist license. (16) Biennial registration of an orthotist license. (17) Biennial registration of a pedorthist license. (18) Biennial registration of an orthotic fitter license. (19) Biennial renewal of registration as a naturopathic doctor 16.13. Licensure, certification, examination and registration fees. 3
(d) [Acupuncturist licenses: (1)] Acupuncturist license: Application..$30 Biennial renewal..$40 [(2) Practitioner of Oriental medicine license: Application.$30 Biennial renewal $40 (e) Drugless therapist license: Biennial renewal... $40] (e) Practitioner of East Asian herbology registration Application..$30 (f) Radiology Technician: (g) Respiratory Therapist License: (h) Athletic Trainer License: (i) Behavior Specialist License: (j) Verification or Certification: 4
(k) Examination Fees: (l) Perfusionist License: (m) Genetic Counselor License: (n) Prosthetists: (o) Orthotists: (p) Pedorthists: (q) Orthotic Fitters: Subchapter G. MINIMUM STANDARDS OF PRACTICE --- CHILD ABUSE REPORTING 16.101. Definitions. The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise: 5
Board-regulated practitioner A medical doctor, physician assistant, nurse midwife, [certified registered nurse practitioner,] respiratory care practitioner, [drugless therapist,] perfusionist, respiratory therapist, genetic counselor, prosthetist, orthotist, pedorthist, orthotic fitter, acupuncturist, [practitioner of Oriental medicine] naturopathic doctor or auxiliary personnel performing radiologic procedures on the premises of a medical doctor. CHAPTER 18. STATE BOARD OF MEDICINE PRACTITIONERS OTHER THAN MEDICAL DOCTORS Subchapter B. REGISTRATION AND PRACTICE OF ACUPUNCTURISTS AND PRACTITIONERS OF [ORIENTAL MEDICINE] EAST ASIAN HERBOLOGY 18.11. Definitions. The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise: Acupuncture examination An examination [offered or] recognized by the Board to test whether an individual has accumulated sufficient academic knowledge with respect to the practice of acupuncture [and herbal therapy] to qualify for the privilege of practicing as an acupuncturist [or as a practitioner of Oriental medicine] in the Commonwealth of Pennsylvania. The Board recognizes the NCCAOM component examinations in acupuncture and sterilization procedures as the examination for registration as an acupuncturist. [and the NCCAOM examination 6
component in Chinese herbology as the examination for registration as a practitioner of Oriental medicine.] [Chinese herbology The study of the use of herbs in the Oriental medicine tradition.] East Asian herbology The study of the use of herbs, minerals, herbal materials, herbal preparations and finished herbal products that contain as active ingredients parts of plants, other plant materials, or combinations prepared for each individual patient according to East Asian medicine tradition to re-harmonize imbalances in the body. East Asian herbology examination Examinations recognized by the Board to test whether an individual has accumulated sufficient academic knowledge with respect to the practice of herbal therapy to qualify for registration as a practitioner of East Asian herbology in the Commonwealth of Pennsylvania. The Board recognizes the NCCAOM examination component in Chinese herbology and the NCCAOM examination for Oriental Medicine as the examinations for registration as a practitioner of East Asian herbology. Herbal therapy The application of [Chinese] East Asian herbology to the treatment of acupuncture patients. 7
NCCAOM The National Certification Commission for Acupuncture and Oriental Medicine or its successor organization. Practitioner of [Oriental medicine] East Asian herbology An acupuncturist who is [licensed] registered by the Board to use herbal therapy. Supplemental techniques The use of traditional and modern [Oriental] East Asian therapeutics, heat therapy, moxibustion, electrical and low level laser stimulation, acupressure and other forms of massage, and counseling that includes the therapeutic use of foods and supplements and lifestyle modifications. TOEFL The Test of English as a Foreign Language offered by Educational Testing Service. 18.13. Requirements for licensure as an acupuncturist. (a) The Board will license as an acupuncturist a person who satisfies the following requirements: (1) Has successfully completed an acupuncture educational program which includes a course in needle sterilization techniques. (2) Has obtained a passing grade on an acupuncture examination or has been certified by NCCAOM. If the examination was not taken in English, but is otherwise acceptable and a passing score was secured, the Board will accept the examination result if the 8
applicant has also secured [a score of 550 on the test of English as a Foreign Language (TOEFL). ] at least the indicated score on one of the offered TOEFL examinations: (i) TOEFL PBT examination (paper-based) a total scaled score of at least 550; (ii) TOEFL cbt (computer-based) a total scaled score of at least 213; (iii) (iv) TOEFL ibt (internet-based) a total scaled score of at least 79; or TOEFL paper-delivered (revised paper test first offered in 2017) a scaled score of: (1) 19 on the Reading portion, (2) 19 on the Listening portion, (3) 21 on the Writing portion. (b) The Board will license as an acupuncturist a medical doctor who satisfies the following requirements: [(c) Prior to January 1, 1988, the Board will register as an acupuncturist a medical doctor who satisfies the requirements of subsection (a), (b) or the following: (1) Has at least 3 years of acupuncture practice a minimum of 500 patient visits per year documented to the satisfaction of the Board. (2) Submits an application to register as an acupuncturist accompanied by the required fee. For the fee amount, see 16.13.] 9
18.13a. Requirements for [licensure] registration as a practitioner of [Oriental medicine] East Asian herbology. (a) An acupuncturist who also intends to use herbal therapy is required to be [licensed] registered by the Board as a practitioner of [Oriental medicine] East Asian herbology. (b) The Board will [license] register an acupuncturist as a practitioner of [Oriental medicine] East Asian herbology if the licensee, in addition to meeting the requirements under 18.13 (relating to requirements for licensure as an acupuncturist) has fulfilled one of the following: (1) Successfully completed an acupuncture education program that includes the study of [Chinese] East Asian herbology and has passed the NCCAOM examination component on Chinese herbology. (2) Has obtained NCCAOM certification in Chinese herbology or Oriental medicine, which includes passing the NCCAOM examination in Chinese herbology. [(c) An acupuncturist registered with the Board prior to April 14, 2007, may obtain a license as a practitioner of Oriental medicine if the acupuncturist can demonstrate one of the following: (1) Successful completion of a Chinese herbology or Oriental medicine education program recognized by the licensing authority of another state or United States territory for the practice of herbal therapy or Oriental medicine and successful completion of an examination in Chinese herbology or Oriental medicine recognized by the licensing authority of another state or United States territory for the practice of herbal therapy or Oriental medicine. (2) NCCAOM certification in Chinese herbology or Oriental medicine. 10
(3) The achievement of cumulative qualifications that the Board determines to be equivalent to the standard requirements for registration as a practitioner of Oriental medicine. (d)] c. This subsection does not apply to a medical doctor licensed as an acupuncturist nor does it restrict the practice of medicine by a medical doctor. (d) This subsection does not limit the practice of a naturopathic doctor also licensed as an acupuncturist when recommending herbs, minerals, and other supplements based on modalities according to non-east Asian traditions. 18.14. Biennial registration requirements. (a) Acupuncturists [and practitioners of Oriental medicine] shall register biennially and submit the appropriate registration fee to engage in the practice of acupuncture for the biennial period. (b) Procedures for biennial registration of acupuncturists [and practitioners of Oriental medicine] are outlined in 16.15 (relating to biennial registration; inactive status and unregistered status). (c) The biennial registration fee is set forth in 16.13 (relating to licensure, certification, examination and registration fees). (d) A practitioner of East Asian herbology may not engaged in herbal therapy without possessing a current and active license to practice acupuncture. 18.15. Practice responsibilities of acupuncturist; [and] responsibilities of practitioner of [Oriental medicine acupuncturist] East Asian herbology providing herbal therapy who is not a medical doctor. 11
(a) Responsibilities to patient and public acupuncturist who is not a medical doctor. [In relation to the acupuncture patient, the acupuncturist and the practitioner of Oriental medicine] An acupuncturist who is not a medical doctor: (1) Shall perform an acupuncture [or Oriental medicine] evaluation and develop an acupuncture [or Oriental medicine] treatment plan. (2) May treat an individual presenting with no symptoms of a condition for an unlimited period of time. [(2)] (3) May treat the patient s symptoms without the condition being diagnosed by a physician, dentist or podiatrist for 60 calendar days from the date of the first treatment. [(3)] (4) May treat the patient s symptoms beyond 60 calendar days from the date of first treatment if the patient has obtained an examination and diagnosis from a physician, dentist or podiatrist. [(4)] (5) Shall promptly refer the patient to a physician, dentist or podiatrist, as appropriate to the patient s condition, if the acupuncturist [or practitioner of Oriental medicine] determines that further acupuncture [or Oriental medicine] treatment is contraindicated for the patient or determines that the patient s symptoms have worsened. [(5)] (6) Shall consult with the patient s physician, dentist, podiatrist or other health care practitioner upon request of the patient. [(6)] (7) Shall cooperate with the patient s physician, dentist or podiatrist in regard to the coordination of the patient s care, and comply with restrictions or conditions as directed by the physician, dentist or podiatrist. 12
[(7)] (8) May not diagnose a physical or mental ailment or condition or prescribe or dispense a drug. This provision does not prohibit the use of diagnostic billing codes for billing or reimbursement purposes. [(8)] (9) Shall comply strictly with sterilization standards relative to aseptic practices. [(9)] (10) Shall maintain patient records in a manner consistent with 16.95 (relating to medical records). (11) Shall wear a tag or badge with lettering clearly visible to the patient bearing the acupuncturist s name and the title acupuncturist. The use of the words doctor, physician or any title or abbreviation implying licensure as a physician on this tag or badge is prohibited. Provided, however, that an individual licensed as an acupuncturist who also possesses a current and active license as a naturopathic doctor may utilize the title Doctor of Naturopathic Medicine, Naturopathic Doctor, or the abbreviations N.D. or R.N.D. in addition to the title acupuncturist. (b) [Identification of acupuncturist or practitioner of Oriental medicine. An acupuncturist who is not a medical doctor shall wear a tag or badge with lettering clearly visible to the patient bearing the acupuncturist s name and the title acupuncturist or practitioner of Oriental medicine, as appropriate. The use of the word doctor on this tag or badge is prohibited.] Additional responsibilities to patient and public acupuncturist who is registered as a practitioner of East Asian herbology. In addition to the responsibilities in 18.15(a)(1-9), a practitioner of East Asian herbology providing, or contemplating providing, herbal therapy: 13
(1) Shall perform an East Asian herbology evaluation and, if appropriate, develop an appropriate treatment plan utilizing, in whole or in part, East Asian herbology. (2) Shall promptly refer the patient to a physician, dentist or podiatrist, as appropriate to the patient s condition, if the practitioner of East Asian herbology determines that further treatment of the patient by East Asian herbology is contraindicated for the patient, may interfere with known drugs prescribed to the patient, or determines that the patient s symptoms have worsened. (3) Shall wear a tag or badge with lettering clearly visible to the patient bearing the acupuncturist s name, as well as the title acupuncturist, Practitioner of East Asian herbology, or Practitioner of Oriental Medicine. The use of the words doctor, physician or any title or abbreviation implying licensure as a physician on this tag or badge is prohibited. Provided, however, that an individual licensed as an acupuncturist, registered as a practitioner of East Asian herbology, and who also possesses a current and active license as a naturopathic doctor may utilize the title Doctor of Naturopathic Medicine or Naturopathic Doctor in addition to the title acupuncturist, Practitioner of East Asian herbology, or Practitioner of Oriental Medicine. (c) Responsibilities to patient and public acupuncturist who is a medical doctor. A medical doctor who is also licensed as an acupuncturist: (1) Shall include in the patient s medical records evidence of having performed an acupuncture evaluation and development of an acupuncture treatment plan for patients considered for, or who receive, acupuncture services. 14
(2) Shall comply strictly with sterilization standards relative to aseptic practices when providing acupuncture services to patients. 18.15a. Scope of practice of acupuncturists and practitioners of [Oriental medicine] East Asian herbology. (a) An acupuncturist may practice acupuncture and use supplemental techniques but may not use herbal therapy unless registered with the Board as a practitioner of East Asian herbology. (b) A practitioner of [Oriental medicine] East Asian herbology may practice acupuncture and use supplemental techniques including herbal therapy. A practitioner of [Oriental medicine] East Asian herbology is not prohibited from dispensing or administering therapeutic herbs that contain ingredients that are similar or equivalent to active ingredients in drugs as classified by the Federal Food and Drug Administration. (c) This subsection does not limit the scope of practice of a medical doctor who is registered as an acupuncturist. (d) This subsection does not limit the scope of practice of a naturopathic doctor when recommending herbs, minerals, and other supplements based on modalities according to non-east Asian traditions. 18.18. Disciplinary and corrective measures. (a) The Board may [refuse, revoke, suspend, limit or attach conditions to the license of an acupuncturist or practitioner of Oriental medicine] impose any disciplinary sanctions authorized under section 42 of the act (63 P.S. 422.42), as amended, or section 5(b) of the Act of July 2, 1993, P.L. 345, No. 48, 63 P.S. 2201-2207, as amended for: 15
(1) failing to comply with the duties and requirements in 18.15 (relating to practice responsibilities of acupuncturist), (2) for practicing acupuncture or East Asian herbology without a current and valid license to practice acupuncture, (3) for practicing East Asian herbology without first being registered with the Board, (4) for practicing acupuncture or East Asian herbology without current professional liability insurance coverage as required under section 3.2 of the Acupuncture Licensure Act, 63 P.S. 1803.2(c), or (5) for engaging in conduct prohibited under section 41 of the act (63 P. S. 422.41) for Board-regulated practitioners. (b) The Board will order the emergency suspension of the license of an acupuncturist [or practitioner of Oriental medicine] who presents an immediate and clear danger to the public health and safety, as required under section 40 of the act (63 P. S. 422.40). (c) The license of an acupuncturist [or practitioner of Oriental medicine] shall automatically be suspended, as required under section 40 of the act. (d) The license of an acupuncturist shall automatically be suspended upon the failure to be covered by the required professional liability insurance, as required by section 3.2 of the Acupuncture Licensure Act, 63 P.S. 1803.2(c). 18.20. Professional liability insurance coverage for acupuncturists. 16
(a) A licensed acupuncturist shall maintain a level of professional liability insurance coverage in the minimum amount of $1,000,000 per occurrence or claims made, as required under section 3.2 of the Acupuncture Licensure Act (63 P. S. 1803.2). (b) Proof of professional liability insurance coverage may include: (1) A certificate of insurance or copy of the declaration page from a personally purchased professional liability insurance policy setting forth the effective date, expiration date and dollar amounts of coverage. (2) A certificate of insurance or copy of the declaration page from an employer purchased professional liability insurance policy setting describing the licensee by name as a covered party under the policy, the effective date, expiration date and dollar amounts of coverage. (3) Evidence of a plan of self-insurance approved by the Insurance Commissioner of the Commonwealth under regulations of the Insurance Department in 31 Pa. Code Chapter 243 (relating to medical malpractice and health-related self-insurance plans). (c) A licensee who does not have current professional liability insurance coverage as required under section 3.2 of the Acupuncture Licensure Act, 63 P.S. 1803.2(c) may not practice as an acupuncturist in this Commonwealth. 17
(d) The professional liability insurance coverage for a licensed acupuncturist also registered as a practitioner of East Asia herbology shall cover claims against related to acupuncture as well as claims related to the provision of herbal therapy. 18.21 Transition from licensure of practitioners of Oriental medicine to registration as practitioner of East Asian herbology. (a) Upon the effective date of this regulation: (1) In the case of individuals who obtained a license to practice Oriental medicine without first obtaining a license as an acupuncturist in this Commonwealth, the Board shall automatically, and without charge, issue the individual a license as an acupuncturist and a registration as a practitioner of East Asian herbology. The status of the new license as an acupuncturist shall be the same status as the most recent status of the practitioner of Oriental medicine license. All disciplinary actions and orders of the Board which affected the individual s license to practice Oriental medicine shall become effective against the acupuncture license and registration to practice East Asian herbology of the individual. (2) In the case of individuals who obtained a license to practice Oriental medicine after having first been licensed as an acupuncturist in this Commonwealth, the Board shall automatically, and without charge, issue the individual a registration as a practitioner of East Asian herbology. The status of the individual s license as an acupuncturist shall be automatically, and without charge or need for application, changed to the same status as the most 18
recent status of the practitioner of Oriental medicine license. All disciplinary actions and orders of the Board which affected the individual s license to practice Oriental medicine shall become effective against the acupuncture license of the individual and registration to practice East Asian herbology of the individual. (b) Upon the issuance of the registration as a practitioner of East Asian herbology and the issuance or change of status of the acupuncturist license, as the case may be, the license of the individual as a Practitioner of Oriental medicine shall become null and void. (c) This section shall expire 12 months after the effective dates of the regulations. 19