CAMLAW: Complementary and Alternative Medicine Law Blog

Legal Rules Restrict Scope of Practice Boundaries in Acupuncture

Every state has legal rules that restrict practice boundaries (scope of practice) for non-medical health care professionals, such as acupuncturists, chiropractors, nurses and psychologists.

 

Practitioners and health care entities have to ensure they do not run afoul of these scope of practice legal rules.

Below are scope of practice rules from New York governing the acupuncture profession.

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New York State's Education Department, Office of the Professions (“OP”) maintains a list of laws, rules and regulations applicable to all the NYS health professions, including acupuncture. NYS defines the scope of practice for acupuncture in NY Education law Section 8211 (below). The NYS website for Laws and Regulations pertaining to acupuncture includes:

Education Law

·         Title VIII - links to all Articles

·         Article 160 - Acupuncture

Rules of the Board of Regents

·         Part 29 - Unprofessional Conduct

Commissioner's Regulations

·         Part 52.16 - Acupuncture

·         Subpart 79-2 - Acupuncture

·         Part 60 - Medicine, Physician Assistant, Specialist Assistant and Acupuncture

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§8211. Definitions.

As used in this article the following terms shall have the following meanings:

1.       

a.       "Profession of acupuncture" is the treating, by means of mechanical, thermal or electrical stimulation effected by the insertion of needles or by the application of heat, pressure or electrical stimulation at a point or combination of points on the surface of the body predetermined on the basis of the theory of the physiological interrelationship of body organs with an associated point or combination of points for diseases, disorders and dysfunctions of the body for the purpose of achieving a therapeutic or prophylactic effect.

b.      Each acupuncturist licensed pursuant to this article, shall advise each patient as to the importance of consulting with a licensed physician regarding the patient's condition and shall keep on file with the patient's records, a form attesting to the patient's notice of such advice. Such form shall be in duplicate, one copy to be retained by the patient, signed and dated by both the acupuncturist and the patient and shall be prescribed in the following manner:

WE, THE UNDERSIGNED, DO AFFIRM THAT (THE PATIENT) HAS BEEN ADVISED BY, (A LICENSED ACUPUNCTURIST), TO CONSULT A PHYSICIAN REGARDING THE CONDITION OR CONDITIONS FOR WHICH SUCH PATIENT SEEKS ACUPUNCTURE TREATMENT.

___________________________
(Signature)

________________________
Date

 

___________________________
(Signature)

________________________
Date

2.      "Board" is the state board for acupuncture as created by section eighty-two hundred thirteen of this article.


§8212. Practice of acupuncture and use of title "licensed acupuncturist" or "certified acupuncturist".

Only a person licensed or authorized pursuant to section eighty-two hundred fourteen of this article or certified pursuant to section eighty-two hundred sixteen of this article shall practice acupuncture. Only a person licensed pursuant to section eighty-two hundred fourteen of this article shall use the title "licensed acupuncturist" and only a person certified pursuant to section eighty-two hundred sixteen of this article shall use the title "certified acupuncturist".


§8213. State board for acupuncture.

1.      There is hereby established within the department a state board for acupuncture. The board shall consist of not less than eleven members to be appointed by the board of regents on the recommendation of the commissioner for the purpose of assisting the board of regents and the department on matters of professional licensing and professional conduct in accordance with section sixty-five hundred eight of this chapter, four of whom shall be licensed acupuncturists, four of whom shall be licensed physicians certified to use acupuncture and three of whom shall be public members representing the consumer and community. Of the acupuncturists first appointed to the board, one may be a registered specialist's assistant-acupuncture provided that the term of such registered specialist's assistant-acupuncture shall not be more than four years. Of the members first appointed, three shall be appointed for a one year term, three shall be appointed for a two year term and three shall be appointed for a three year term, and two shall be appointed for a four year term. Thereafter all members shall serve for five year terms. In the event that more than eleven members are appointed, a majority of the additional members shall be licensed acupuncturists. The members of the board shall select one of themselves as chairman to serve for a one year term.

2.      An executive secretary to the board shall be appointed by the board of regents on recommendation of the commissioner.

3.      The board of regents and the commissioner shall promulgate such rules and regulations as they deem necessary and appropriate to effectuate the provisions of this article.


§8214. Requirements for a professional license.

To qualify for a license as a licensed acupuncturist an applicant shall fulfill the following requirements.

1.      Application: file an application with the department;

2.      Education: provide evidence of satisfactory completion of a course of formal study or its substantial equivalent in accordance with the commissioner's regulations;

3.      Experience: have experience in accordance with the commissioner's regulations;

4.      Examination: pass an examination satisfactory to the board and in accordance with the commissioner's regulations. Such examination shall be given at least once within twelve months of the effective date of this article, and at least once annually thereafter, and shall consist of both written and practical parts. Either part may be given at the discretion of the department in English and/or Chinese or other language. Nothing in this subdivision is to be construed to require the department to issue an exam in a language other than English. The practical part of the exam must be directly administered by an acupuncturist acceptable to the department, who may also be a member of the board. The cost of the initial examination or reexamination shall be borne by the applicant in accordance with a schedule established by the department and approved by the director of the budget;

5.      Age: be at least twenty-one years of age;

6.      Character: be of good moral character as determined by the department;

7.      Fees: pay a fee of five hundred dollars to the department for initial licensure, and a fee of two hundred fifty dollars for each triennial registration;

8.      Registration: if a license is granted, register triennially with the department, including present home and business address and such other pertinent information as the department requires.


§8215. Limited permits.

1.      The department shall issue a limited permit to an applicant who meets all requirements for admission to the licensing examination;

2.      All practice under a limited permit shall be under the supervision of a licensed or certified acupuncturist in a public hospital, an incorporated hospital or clinic, a licensed proprietary hospital, a licensed nursing home, a public health agency, the office of a licensed or certified acupuncturist or in the civil service of the federal or state government;

3.      Limited permits shall be for one year and may be renewed at the discretion of the department for one additional year;

4.      Supervision of a permittee by a licensed or certified acupuncturist shall be on-site supervision and not necessarily direct personal supervision;

5.      No practitioner shall supervise more than one permittee;

6.      The fee for each limited permit and for each renewal shall be determined by the department.


§8216. Exemptions; waiver.

1.      A person who is validly registered as a "specialist's assistant-acupuncture" in accordance with section sixty-five hundred forty-one of this chapter and the commissioner's regulations shall not be subject to the provisions of this article;

2.      Any person who is validly licensed under the provisions of the former chapter nine hundred fifty-nine of the laws of nineteen hundred seventy-four is deemed to be licensed pursuant to this article;

3.      Any person who is validly certified under the provisions of the former chapter nine hundred fifty-nine of the laws of nineteen hundred seventy-four shall continue to be certified to practice acupuncture and may continue to use the title certified acupuncturist. The department may establish rules and regulations providing for the certification of physicians and dentists as acupuncturists, provided that such certified acupuncturists do not represent themselves as licensed acupuncturists. Certified acupuncturists seeking to become licensed acupuncturists shall be subject to all provisions of this article;

4.      A person who does not otherwise possess the credentials or qualifications required for the practice of acupuncture prescribed by this article or the regulations promulgated hereunder or any other law but who is authorized by the division of alcoholism and alcohol abuse, the division of substance abuse services, or the department of health to provide treatment for alcoholism, substance dependence, or chemical dependency in a hospital or clinical program which has been approved for such treatment by the division of alcoholism and alcohol abuse, the division of substance abuse services, or the department of health and who has been trained to practice acupuncture for the treatment of alcoholism, substance dependence, or chemical dependency through an educational program acceptable to the education department may nevertheless practice acupuncture provided such practice is limited to the treatment of alcoholism, substance dependence, or chemical dependency in such clinical or hospital programs, or in a program that if statutorily exempt from such approval meets standards approved by the division of alcoholism and alcohol abuse, the division of substance abuse services, or the department of health, and further provided that such practice is done in accordance with regulations promulgated by the division of alcoholism and alcohol abuse, the division of substance abuse services, or the department of health. Such person shall work only under the general supervision of a physician or dentist certified to practice acupuncture or an individual licensed to practice acupuncture in the state of New York pursuant to this article. Notwithstanding any other law, rule or regulation to the contrary, persons authorized on or before the effective date of this article to practice acupuncture for the treatment of alcoholism, substance dependence, or chemical dependency within a hospital or clinical program which has been approved for such treatment by the division of alcoholism and alcohol abuse, the division of substance abuse services, or the department of health may nevertheless continue to practice acupuncture under the provisions of this subdivision;

5.      Any person who is pursuing qualification for licensure through a course of formal study pursuant to this article may practice acupuncture without a license, provided such practice is limited to such study;

6.      Any person who has completed a formal course of study or a tutorial apprenticeship acceptable to the department and in accordance with the commissioner's regulations, prior to the effective date of this article, and presents satisfactory proof of such completion, shall be exempt from the education requirements set forth in subdivision two of section eighty-two hundred fourteen of this article provided an application pursuant to subdivision one of section eighty-two hundred fourteen of this article is filed with the department not later than one year from the effective date of this article, and in no event shall participation in such tutorial apprenticeship or formal course of study constitute a violation of this chapter.

7.      Any person who is pursuing qualification for certification through a formal course of study in a registered program and any person appointed to the faculty of such program may practice acupuncture without a license, provided that such practice is limited to such research, study and training.

            The Commissioner’s Regulations provide:

Part 52.16, Acupuncture

§52.16

Programs needed for a certificate to practice acupuncture as set forth in subparagraph (b)(1)(i) of section 60.9 of this Title or for a license to practice acupuncture as set forth in Subpart 79-2 of this Title may be registered only upon compliance with the requirements set forth in this section. No program may be offered in New York State unless duly registered or approved pursuant to this Part.

Programs may be offered within New York State only by an institution which is either chartered by the Board of Regents or otherwise approved to offer professional training pursuant to section 6506(3) of the Education Law.

  1. Certificate Programs. In addition to meeting all applicable provisions of this Part, a certificate program to be registered shall meet the following requirements:
    1. Admissions. Admission shall be limited to licensed physicians and dentists eligible for authorization to practice acupuncture as provided in section 60.9(b)(1)(i) of this Title.
    2. Instruction. A program shall provide:
      1. at least 100 hours of instruction and clinical demonstrations in general and basic aspects of acupuncture;
      2. at least 100 hours of sequential specialized instruction in specific uses and techniques of acupuncture; and
      3. at least 100 hours of supervised experience acceptable to the department and under the supervision of a licensed physician or dentist certified in acupuncture.
    3. Records. Programs shall maintain adequate individual student records, including all evidence of prior experience submitted by applicants and of the performance of students in both the academic and clinical portions of the program.
  2. Licensure Programs. In addition to meeting all applicable provisions of this Part, a licensure program to be registered shall meet the following requirements:
    1. Admissions. Admission shall be limited to persons who have successfully completed at least 60 semester hours of study, including at least nine semester hours in the biosciences, creditable as part of one or more college or university programs which are:
      1. registered by the department pursuant to this Part; or
      2. offered by a college or university accredited by at least one accrediting agency accepted by the department as a reliable authority for the purpose of accreditation at the postsecondary level, which applies its criteria for granting accreditation in a fair, consistent, and nondiscriminatory manner, such as an agency recognized for these purposes by the United States Department of Education; or
      3. determined by the department to be the equivalent of a program approved pursuant to subparagraphs (i) or (ii) of this paragraph.
    2. Curriculum. A program shall provide a minimum of 4,050 hours, of at least 50 minutes each in length, of classroom instruction, supervised clinical experience, and out of classroom or out of clinic study assignments. For each hour of classroom instruction there shall be two hours of out of classroom study assignments. For each hour of supervised clinical experience there shall be one-half hour of clinic study assignments. To be registered a program must provide:
      1. at least 200 classroom instructional hours in the biosciences including anatomy, physiology and pathology; and
      2. at least 600 classroom instructional hours in acupuncture including acupuncture principles; acupuncture channel and point theory; acupuncture physiology; acupuncture pathology; acupuncture clinical examination and diagnosis; acupuncture techniques; acupuncture treatment principles; and sterilization and precautions; and
      3. at least 650 hours of supervised clinical acupuncture experience in general health problems to include acupuncture diagnosis; therapeutic treatment planning; acupuncture needling technique; moxibustion; electroacupuncture; pre- and post- treatment instruction; contraindications and precautions; treatment of emergencies; when to refer to appropriate health professionals; and acupuncture hygiene.
  3. Educational programs for the training of persons to practice acupuncture for the treatment of alcoholism, substance dependence, or chemical dependency in hospital or clinical programs approved by the Division of Alcoholism and Alcohol Abuse, the Division of Substance Abuse Services or the Department of Health as provided in section 8216(4) of the Education Law, may be approved upon meeting the following conditions:
    1. Sponsorship. An acceptable program for training in the use of acupuncture for detoxification may be offered by a hospital or a medical or dental school satisfactory to the department and shall have adequate equipment and resources.
    2. Instruction. Such programs shall include didactic and clinical instruction in the use of acupuncture for detoxification purposes.
    3. Faculty. Such programs shall provide a sufficient number of qualified instructors and a director with satisfactory professional training for both the clinical and the didactic portions of the program.
    4. Records. Such programs shall maintain adequate individual student records, including evidence of the performance of students in both the didactic and clinical portions of the program.

Subpart 79-2, Acupuncture

§79-2.1. Professional study of acupuncture | §79-2.2. Licensing examinations | §79-2.3. Limited permits in acupuncture | §79-2.4. Exemption requirements

§79-2.1. Professional study of acupuncture.

To meet the professional education requirement for admission to the licensing examination, the applicant shall present evidence of successful completion of the following requirements:

  1. Pre-professional education requirement. The applicant shall have completed at least 60 semester hours of study, including at least nine semester hours in the biosciences, creditable as part of one or more college or university programs which are:
    1. registered by the department pursuant to Part 52 of this Title; or
    2. offered by a college or university accredited by at least one accrediting agency accepted by the department as a reliable authority for the purpose of accreditation at the post-secondary level, which applies its criteria for granting accreditation in a fair, consistent, and non-discriminatory manner, such as an agency recognized for these purposes by the United States Department of Education; or
    3. determined by the department to be the equivalent of a program approved pursuant to paragraphs (1) or (2) of this subdivision.
  2. Professional education requirement. The applicant shall have successfully completed a course of study in acupuncture registered by the department pursuant to section 52.16 of this Title or determined by the department to be the equivalent of such a registered program.

§79-2.2. Licensing examinations.

An applicant may fulfill the examination requirement by submitting evidence of having successfully completed the examination of the National Commission for the Certification of Acupuncturists, or any other examination which the department determines to be the equivalent in terms of content, scoring, administration, security and other comparable factors which affect the validity or integrity of the examination.


§79-2.3. Limited permits in acupuncture.

  1. As provided in section 8215 of the Education Law, limited permits may be issued to candidates who have satisfactorily completed the educational requirements set forth in sections 79-2.1 or 79-2.4 (a) or (b) of this Subpart.
  2. Limited permits shall expire one year from the date granted except that such permits may be renewed for one additional year.
  3. Supervision by a licensed or certified acupuncturist as used in Section 8216 of the Education Law shall mean that a supervising acupuncturist shall be on site at all times when professional services are being rendered by the holder of a limited permit and shall exercise that degree of supervision appropriate to the circumstances.
  4. No practitioner shall supervise more than one permittee at any time.
  5. An application for a limited permit or renewal in acupuncture shall be submitted on a form provided by the Department and shall be accompanied by a fee of $70.

§79-2.4. Exemption requirements.

As provided in section 8216(6) of the Education Law, an applicant may be exempt from the education requirements of this Part provided that the applicant submits an application for licensure by May 1, 1992 and either:

  1. presents evidence of satisfactory completion of a formal acupuncture education program of no less than 1,100 hours of classroom instruction and supervised clinical acupuncture experience recognized in the jurisdiction in which it was located and satisfactory to the department, or completion of equivalent training satisfactory to the department; and has completed at least 12 months of full-time acupuncture practice in general health problems; or
  2. has completed secondary education and a tutorial apprenticeship acceptable to the department which included anatomy, physiology, pathology; observation, history and physical examination; therapeutic treatment planning; preparation of the patient; sterilization; use and maintenance of equipment; moxibustion; electro-acupuncture; body and auricular acupuncture; treatment of emergencies; when to refer to appropriate health professionals; pre- and post-treatment instructions to the patient; contraindications and precautions; acupuncture channel and point theory; acupuncture physiology; acupuncture technique; clinical examination and diagnosis; and western medical terminology. Such tutorial apprenticeship shall have consisted of a minimum of 3,600 clock hours or the equivalent. Such apprenticeship shall have been under a licensed acupuncturist who can demonstrate at least 10 years full-time experience and who did not supervise more than three apprentices concurrently. In addition, the applicant shall have completed at least 24 months of full-time acupuncture practice in general health problems.

§ 60.9 Acupuncture.

  1. To practice acupuncture as a physician, dentist or specialist assistant-acupuncture in New York State, a person shall possess one of the following credentials:
    1. a license to practice medicine or dentistry and a certificate to practice acupuncture issued pursuant to paragraph (b)(1) of this section; or
    2. a registration as a specialist assistant-acupuncture, pursuant to Education Law, section 6541 and the requirements of paragraph (b)(2) of this section.
  2. Qualifications for practice.
    1. For a certificate to practice acupuncture, the applicant shall:
      1. possess a license to practice medicine or dentistry;
      2. have completed at least 200 hours of instruction in programs in acupuncture registered by the department, or in programs determined by the department to be the equivalent of registered programs, and at least 100 hours of supervised experience acceptable to the department. Instruction shall consist of:
        1. at least 100 hours of instruction and clinical demonstrations in general and basic aspects of acupuncture;
        2. at least 100 hours of sequential specialized instruction in specific uses and techniques of acupuncture. Topics of instruction shall include indications and contraindications for acupuncture administration, techniques for locating acupuncture points, needling and stimulating techniques, and trainee participation in administration of acupuncture in clinical demonstrations; and
        3. at least 100 hours of supervised experience acceptable to the department and under the supervision of a currently registered physician or dentist certified in acupuncture; and
      3. pay the fees specified in section 59.9(e) of this Title.
    2. For registration as a specialist assistant-acupuncture, the applicant shall:
      1. satisfy the education and training requirements set forth in subparagraph (1)(ii) of this subdivision;
      2. have graduated from a school of medicine or a school of traditional oriental medicine, herb medicine or acupuncture acceptable to the department;
      3. have at least five years of experience in the use of acupuncture;
      4. pay the fees specified in section 6541 of the Education Law.
    3. Examination requirement. The department, in its discretion, may require the passing of an examination in acupuncture as an additional qualification of any applicant for certification or registration who is unable to submit satisfactory evidence of the education and training requirements set forth in subparagraph (1)(ii) of this subdivision, but who meets all other requirements for an authorization to practice acupuncture.

 

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