89R6387 AND-D     By: Cain H.B. No. 3979       A BILL TO BE ENTITLED   AN ACT   relating to the licensing and regulation of naturopathic   physicians; requiring an occupational license; authorizing fees;   providing penalties; creating a criminal offense.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle C, Title 3, Occupations Code, is   amended by adding Chapter 207 to read as follows:   CHAPTER 207. NATUROPATHIC PHYSICIANS   SUBCHAPTER A. GENERAL PROVISIONS          Sec. 207.001.  SHORT TITLE. This chapter may be cited as the   Naturopathic Physicians Licensing Act.          Sec. 207.002.  DEFINITIONS. In this chapter:                (1)  "Executive director" means the executive director   of the Texas Medical Board.                (2)  "Medical board" means the Texas Medical Board.                (3)  "Naturopathic board" means the Naturopathic   Medical Board.                (4)  "Naturopathic childbirth attendance" means the   specialty practice of natural childbirth by a naturopathic   physician that includes the management of normal pregnancy, normal   labor and delivery, and the normal postpartum period, including   normal newborn care.                (5)  "Naturopathic clinical elective" means a   specialty clinical practice consistent with naturopathic education   and training.                (6)  "Naturopathic medicine" means a system of primary   health care for the prevention, diagnosis, and treatment of human   health conditions, injury, and disease through the promotion or   restoration of health and the support and stimulation of a   patient's inherent self-healing processes through patient   education and the use of naturopathic therapies and therapeutic   substances.                (7)  "Naturopathic physician" means a person licensed   to practice naturopathic medicine under this chapter.                (8)  "Physician" means a person licensed to practice   medicine by the medical board.                (9)  "Prescription drug" has the meaning assigned by   Section 551.003.          Sec. 207.003.  SCOPE OF PRACTICE. (a) For purposes of this   chapter, a person practices naturopathic medicine if the person:                (1)  performs examination, diagnosis, and treatment of   disease consistent with naturopathic education and training;                (2)  performs physical examinations, including   orificial examinations;                (3)  orders or performs diagnostic laboratory tests or   physiological function tests;                (4)  orders diagnostic imaging studies;                (5)  orders or performs therapies, treatments, or   modalities, including hot or cold hydrotherapy, naturopathic   physical medicine, electromagnetic energy, colon hydrotherapy, and   therapeutic exercise;                (6)  repairs or provides care incidental to superficial   lacerations or abrasions;                (7)  removes foreign bodies located in the superficial   tissue;                (8)  performs musculoskeletal manipulation;                (9)  dispenses, administers, or prescribes:                      (A)  food, extracts of food, nutraceuticals,   vitamins, amino acids, minerals, enzymes, botanicals and their   extracts, botanical medicines, homeopathic medicines, or dietary   supplements and nonprescription drugs as defined by the Federal   Food, Drug, and Cosmetic Act (21 U.S.C. Section 301 et seq.);                      (B)  prescription drugs as approved by the   naturopathic board; or                      (C)  devices, including therapeutic devices,   barrier contraception, and durable medical equipment; or                (10)  provides counseling, behavioral medicine, or   health education.          (b)  A naturopathic physician may administer treatment using   various routes of administration, including oral, nasal,   auricular, ocular, rectal, vaginal, transdermal, intradermal,   subcutaneous, intravenous, and intramuscular routes.          (c)  A naturopathic physician may practice naturopathic   childbirth attendance if the naturopathic physician is authorized   by the naturopathic board under Section 207.301.          (d)  A naturopathic physician may use novel technologies,   modalities, and therapies approved by the naturopathic board.          (e)  The naturopathic board may adopt rules related to the   scope of practice of a naturopathic physician that are consistent   with this section.          Sec. 207.004.  APPLICABILITY.  This chapter does not apply   to:                (1)  a health care professional licensed under this   title acting within the scope of the person's practice;                (2)  a person employed in the service of the federal   government while performing duties related to that employment;                (3)  a student enrolled in an approved naturopathic   medical college who performs naturopathic medical acts under the   supervision of an instructor who is a licensed naturopathic   physician or a health care professional licensed in the area of   instruction in which the student is engaged;                (4)  a person providing self-care or care to a family   member;                (5)  a person who sells natural products, including   foods, dietary supplements, cosmetics, or homeopathic   preparations, and provides information to consumers about the   products, except that a person may not represent or assume the   character or appearance of a person practicing naturopathic   medicine or imply or indicate that the person is licensed to   practice naturopathic medicine; or                (6)  a person who is a licensed practitioner of   naturopathic medicine in another state and who, in this state,   consults with a naturopathic physician licensed in this state,   provided that the consultation is limited to providing an   examination, recommendation, instruction, or testimony.   SUBCHAPTER B. NATUROPATHIC MEDICAL BOARD          Sec. 207.051.  NATUROPATHIC BOARD MEMBERSHIP. (a) The   Naturopathic Medical Board is composed of seven members appointed   by the governor with the advice and consent of the senate as   follows:                (1)  four naturopathic physician members;                (2)  one physician member who is licensed to practice   medicine in this state and who has experience working with   naturopathic doctors;                (3)  one pharmacist; and                (4)  one member who represents the public and who is not   licensed or trained in a health care profession.          (b)  A member of the naturopathic board must be a United   States citizen and a resident of this state.          (c)  Appointments to the naturopathic board shall be made   without regard to the race, color, disability, sex, gender,   religion, age, or national origin of the appointee.          Sec. 207.052.  ELIGIBILITY OF PUBLIC MEMBER. A person is not   eligible for appointment as a public member of the naturopathic   board if the person or the person's spouse:                (1)  is registered, certified, or licensed by an   occupational regulatory agency in the field of health care;                (2)  is employed by or participates in the management   of a business entity or other organization regulated by or   receiving money from the medical board or naturopathic board;                (3)  owns or controls, directly or indirectly, more   than a 10 percent interest in a business entity or other   organization regulated by or receiving money from the medical board   or naturopathic board; or                (4)  uses or receives a substantial amount of tangible   goods, services, or money from the medical board or naturopathic   board, other than compensation or reimbursement authorized by law   for naturopathic board membership, attendance, or expenses.          Sec. 207.053.  MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a)   In this section, "Texas trade association" means a cooperative and   voluntarily joined statewide association of business or   professional competitors in this state designed to assist its   members and its industry or profession in dealing with mutual   business or professional problems and in promoting their common   interest.          (b)  A person may not be a member of the naturopathic board   and may not be a naturopathic board employee employed in a "bona   fide executive, administrative, or professional capacity," as that   phrase is used for purposes of establishing an exemption to the   overtime provisions of the federal Fair Labor Standards Act of 1938   (29 U.S.C. Section 201 et seq.) if:                (1)  the person is an officer, employee, or paid   consultant of a Texas trade association in the field of health care;   or                (2)  the person's spouse is an officer, manager, or paid   consultant of a Texas trade association in the field of health care.          (c)  A person may not be a member of the naturopathic board or   act as the general counsel to the naturopathic board if the person   is required to register as a lobbyist under Chapter 305, Government   Code, because of the person's activities for compensation on behalf   of a profession related to the operation of the medical board or   naturopathic board.          Sec. 207.054.  GROUNDS FOR REMOVAL. (a) It is a ground for   removal from the naturopathic board that a member:                (1)  does not have at the time of taking office the   qualifications required by Section 207.051;                (2)  does not maintain during service on the   naturopathic board the qualifications required by Section 207.051;                (3)  is ineligible for membership under Section 207.052   or 207.053;                (4)  cannot, because of illness or disability,   discharge the member's duties for a substantial part of the member's   term; or                (5)  is absent from more than half of the regularly   scheduled naturopathic board meetings that the member is eligible   to attend during a calendar year without an excuse approved by a   majority vote of the naturopathic board.          (b)  The validity of an action of the naturopathic board is   not affected by the fact that it is taken when a ground for removal   of a naturopathic board member exists.          (c)  If the executive director has knowledge that a potential   ground for removal exists, the executive director shall notify the   presiding officer of the naturopathic board of the potential   ground. The presiding officer shall then notify the governor and   the attorney general that a potential ground for removal exists. If   the potential ground for removal involves the presiding officer,   the executive director shall notify the next highest ranking   officer of the naturopathic board, who shall then notify the   governor and the attorney general that a potential ground for   removal exists.          Sec. 207.055.  PRESIDING OFFICER OF NATUROPATHIC BOARD. The   governor shall appoint a naturopathic board member who is a   naturopathic physician to serve as presiding officer of the   naturopathic board at the pleasure of the governor. The presiding   officer may vote on any matter before the naturopathic board.          Sec. 207.056.  TERMS; VACANCIES. (a) Members of the   naturopathic board serve staggered six-year terms. The terms of   two or three members expire on January 31 of each odd-numbered year.          (b)  A member of the naturopathic board may not serve more   than two consecutive terms.          (c)  A vacancy on the naturopathic board shall be filled by   appointment of the governor.          Sec. 207.057.  REIMBURSEMENT. A member of the naturopathic   board may receive reimbursement for travel expenses as provided by   the General Appropriations Act.          Sec. 207.058.  MEETINGS.  The naturopathic board shall meet   at least annually and at the call of the presiding officer or   executive director. The naturopathic board may also meet at the   written request of any two members.          Sec. 207.059.  TRAINING. (a) A person who is appointed to   and qualifies for office as a member of the naturopathic board may   not vote, deliberate, or be counted as a member in attendance at a   meeting of the naturopathic board until the person completes a   training program that complies with this section.          (b)  The training program must provide the person with   information regarding:                (1)  the law governing naturopathic board operations;                (2)  the programs, functions, rules, and budget of the   naturopathic board;                (3)  the scope of and limitations on the rulemaking   authority of the naturopathic board;                (4)  the results of the most recent formal audit of the   naturopathic board;                (5)  the requirements of:                      (A)  laws relating to open meetings, public   information, administrative procedure, and disclosing conflicts of   interest; and                      (B)  other laws applicable to members of the   naturopathic board in performing their duties; and                (6)  any applicable ethics policies adopted by the   medical board, naturopathic board, or the Texas Ethics Commission.          (c)  A person appointed to the naturopathic board is entitled   to reimbursement, as provided by the General Appropriations Act,   for the travel expenses incurred in attending the training program   regardless of whether the attendance at the program occurs before   or after the person qualifies for office.          (d)  The executive director shall create a training manual   that includes the information required by Subsection (b). The   executive director shall distribute a copy of the training manual   annually to each naturopathic board member. On receipt of the   training manual, each naturopathic board member shall sign and   submit to the executive director a statement acknowledging receipt   of the training manual.   SUBCHAPTER C. POWERS AND DUTIES          Sec. 207.101.  POWERS AND DUTIES. (a) The naturopathic   board shall:                (1)  administer and enforce this chapter;                (2)  establish qualifications for obtaining a license;                (3)  evaluate and approve clinical, practical, or   naturopathic medicine residency requirements;                (4)  approve a national naturopathic medicine   licensing examination;                (5)  establish procedures for applying for or renewing   a license;                (6)  evaluate the qualifications of license   applicants;                (7)  establish minimum continuing education   requirements and approve continuing education courses;                (8)  establish qualifications for naturopathic   clinical electives;                (9)  establish qualifications and standards relating   to prescribing authority;                (10)  establish requirements relating to malpractice   insurance;                (11)  investigate credible complaints made against a   license holder; and                (12)  deny, revoke, or suspend a license or otherwise   discipline a license holder.          (b)  In addition to the advisory committee required under   this subchapter, the naturopathic board may appoint advisory   committees to perform advisory functions as determined necessary by   the naturopathic board. An advisory committee appointed under this   subsection is subject to Chapter 2110, Government Code.          Sec. 207.102.  GENERAL RULEMAKING AUTHORITY. The   naturopathic board shall adopt rules as necessary to perform the   naturopathic board's duties and implement this chapter.          Sec. 207.103.  ASSISTANCE BY MEDICAL BOARD. (a) The medical   board shall provide administrative and clerical employees as   necessary to enable the naturopathic board to administer this   chapter.          (b)  Subject to the advice and approval of the medical board,   the naturopathic board shall develop and implement policies that   clearly separate the policy-making responsibilities of the   naturopathic board and the management responsibilities of the   executive director and the staff of the medical board.          Sec. 207.104.  FEES. The naturopathic board by rule shall   set fees in amounts reasonable and necessary to cover the costs of   administering this chapter.          Sec. 207.105.  NATUROPATHIC CHILDBIRTH ATTENDANCE ADVISORY   COMMITTEE. (a) The naturopathic board shall establish a   naturopathic childbirth attendance advisory committee to provide   specific recommendations to the naturopathic board about   requirements for a naturopathic physician to receive authorization   from the naturopathic board to practice naturopathic childbirth   attendance.          (b)  The naturopathic childbirth attendance advisory   committee shall be composed of five members appointed by the   naturopathic board as follows:                (1)  three naturopathic physician members who are   qualified to practice naturopathic childbirth attendance;                (2)  one physician member who specializes or is   board-certified in obstetrics; and                (3)  one licensed midwife or nurse midwife member.          (c)  The naturopathic board must consult with the   naturopathic childbirth attendance advisory committee and consider   the committee's recommendations before adopting rules establishing   the requirements to receive authorization from the naturopathic   board to practice naturopathic childbirth attendance.          (d)  At least once each year or on the request of the   naturopathic board, the naturopathic childbirth attendance   advisory committee shall review the rules for naturopathic   childbirth attendance and recommend changes to the requirements to   receive authorization from the naturopathic board to practice   naturopathic childbirth attendance.   SUBCHAPTER D. PUBLIC INTEREST INFORMATION AND COMPLAINT   PROCEDURES          Sec. 207.151.  PUBLIC INTEREST INFORMATION. (a) The   naturopathic board shall prepare information of public interest   describing the functions of the naturopathic board and the   procedures by which complaints are filed with and resolved by the   naturopathic board.          (b)  The naturopathic board shall make the information   available to the public and appropriate state agencies.          Sec. 207.152.  COMPLAINTS. (a) The naturopathic board by   rule shall establish methods by which consumers and service   recipients are notified of the name, mailing address, and telephone   number of the naturopathic board for the purpose of directing   complaints to the naturopathic board. The naturopathic board may   provide for that notice:                (1)  on each registration form, application, or written   contract for services of a person regulated by the naturopathic   board;                (2)  on a sign prominently displayed in the place of   business of a person regulated by the naturopathic board; or                (3)  in a bill for services provided by a person   regulated by the naturopathic board.          (b)  The naturopathic board shall list with its regular   telephone number any toll-free telephone number that may be called   to present a complaint about a person regulated by the naturopathic   board.          Sec. 207.153.  INFORMATION ABOUT COMPLAINT ACTIONS. (a)   The naturopathic board shall maintain a system to promptly and   efficiently act on complaints filed with the naturopathic board.   The naturopathic board shall maintain information about parties to   the complaint, the subject matter of the complaint, a summary of the   results of the review or investigation of the complaint, and its   disposition.          (b)  The naturopathic board shall make information available   describing its procedures for complaint investigation and   resolution.          (c)  The naturopathic board shall periodically notify the   parties to a complaint of the status of the complaint until final   disposition of the complaint.          Sec. 207.154.  GENERAL RULES REGARDING COMPLAINT   INVESTIGATION. (a) The naturopathic board shall adopt rules   concerning the investigation of a complaint filed with the   naturopathic board. The rules adopted under this section must:                (1)  distinguish between categories of complaints;                (2)  ensure that a complaint is not dismissed without   appropriate consideration;                (3)  require that the naturopathic board be advised of   a complaint that is dismissed and that a letter be sent to the   person who filed the complaint explaining the action taken on the   complaint;                (4)  ensure that the person who files a complaint has an   opportunity to explain the allegations made in the complaint; and                (5)  prescribe guidelines concerning the categories of   complaints that require the use of a private investigator and   prescribe the procedures for the naturopathic board to obtain the   services of a private investigator.          (b)  The naturopathic board shall:                (1)  dispose of a complaint in a timely manner; and                (2)  establish a schedule for conducting each phase of   the disposition of a complaint that is under the control of the   naturopathic board not later than the 30th day after the date the   naturopathic board receives the complaint.          (c)  The naturopathic board shall notify the parties to a   complaint of the projected time requirements for pursuing the   complaint.          (d)  The naturopathic board shall notify the parties to a   complaint of any change in the schedule not later than the seventh   day after the date the change is made.          (e)  The executive director shall notify the naturopathic   board of a complaint that is unresolved after the time prescribed by   the naturopathic board for resolving the complaint so that the   naturopathic board may take necessary action on the complaint.          (f)  The naturopathic board shall assign priorities and   investigate complaints based on:                (1)  the severity of the conduct alleged in the   complaint; and                (2)  the degree of harm to public health and safety.          Sec. 207.155.  CONFIDENTIALITY OF COMPLAINT INFORMATION.   (a) Except as provided by Subsection (b), a complaint and   investigation and all information and materials compiled by the   naturopathic board in connection with the complaint and   investigation are not subject to:                (1)  disclosure under Chapter 552, Government Code; or                (2)  disclosure, discovery, subpoena, or other means of   legal compulsion for release of information to any person.          (b)  A complaint or investigation subject to Subsection (a)   and all information and materials compiled by the naturopathic   board in connection with the complaint may be disclosed to:                (1)  the naturopathic board, the naturopathic board's   employees or agents, or the medical board's employees or agents   involved in license holder discipline;                (2)  a party to a disciplinary action against the   license holder or that party's designated representative;                (3)  a law enforcement agency;                (4)  a governmental agency, if:                      (A)  the disclosure is required or permitted by   law; and                      (B)  the agency obtaining the disclosure protects   the identity of any patient whose records are examined; or                (5)  a person engaged in bona fide research, if all   information identifying a specific individual has been deleted.          (c)  Unless good cause for delay is shown to the presiding   officer at the hearing, the naturopathic board shall provide the   license holder with access to all information that the naturopathic   board intends to offer into evidence at the hearing not later than   the 30th day after the date the naturopathic board receives a   written request from a license holder who is entitled to a hearing   under this chapter or from the license holder's attorney of record.          (d)  The naturopathic board shall protect the identity of any   patient whose records are examined in connection with a   disciplinary investigation or proceeding against a license holder,   except a patient who:                (1)  initiates the disciplinary action; or                (2)  has submitted a written consent to release the   records.          Sec. 207.156.  SUBPOENAS. (a) In the investigation of a   complaint filed with the naturopathic board, the executive director   or the presiding officer of the naturopathic board may issue a   subpoena to compel the attendance of a relevant witness or the   production, for inspection or copying, of relevant evidence that is   in this state.          (b)  A subpoena may be served personally or by certified   mail.          (c)  If a person fails to comply with a subpoena, the   naturopathic board, acting through the attorney general, may file   suit to enforce the subpoena in a district court in Travis County or   in the county in which a hearing conducted by the naturopathic board   may be held.          (d)  On finding that good cause exists for issuing the   subpoena, the court shall order the person to comply with the   subpoena. The court may punish a person who fails to obey the court   order.          (e)  The naturopathic board shall pay a reasonable fee for   photocopies subpoenaed under this section in an amount not to   exceed the amount the naturopathic board may charge for copies of   its records.          (f)  The reimbursement of the expenses of a witness whose   attendance is compelled under this section is governed by Section   2001.103, Government Code.          (g)  Information and materials subpoenaed or compiled by the   naturopathic board in connection with the investigation of a   complaint may be disclosed only as provided by Section 207.155.          Sec. 207.157.  PUBLIC PARTICIPATION. The naturopathic board   shall develop and implement policies that provide the public with a   reasonable opportunity to appear before the naturopathic board and   to speak on any issue under the jurisdiction of the naturopathic   board.   SUBCHAPTER E. LICENSE REQUIREMENTS          Sec. 207.201.  LICENSE REQUIRED. (a) A person may not   practice as a naturopathic physician unless the person holds a   license under this chapter.          (b)  A person may not use the title "naturopath,"   "naturopathic physician," "physician of naturopathic medicine,"   "naturopathic doctor," "doctor of naturopathic medicine," or   "doctor of naturopathy" or the abbreviation "N.D." or "N.M.D."   unless the person is licensed under this chapter.          Sec. 207.202.  LICENSE APPLICATION.  Each applicant for a   license under this chapter must submit to the naturopathic board an   application on a form required by the naturopathic board and the   required application fee.          Sec. 207.203.  REQUIREMENTS FOR LICENSE.  An applicant for a   license to practice naturopathic medicine must present to the   naturopathic board sufficient evidence that the applicant:                (1)  graduated from a naturopathic medical program that   meets the requirements of Section 207.205;                (2)  passed the licensing examination required by   Section 207.206;                (3)  has not been denied a license to practice   naturopathic medicine or another health care profession in this   state or another state or had the license suspended or revoked based   on the license holder's ability to safely practice the health care   profession; and                (4)  is physically and mentally capable of safely   practicing naturopathic medicine with or without reasonable   accommodation.          Sec. 207.204.  ISSUANCE OF LICENSE.  The naturopathic board   shall issue a license as a naturopathic physician to an applicant   who:                (1)  complies with the requirements of this chapter;                (2)  meets any additional requirements the   naturopathic board establishes by rule; and                (3)  pays the license fee required by the naturopathic   board.          Sec. 207.205.  NATUROPATHIC MEDICAL PROGRAM.  A naturopathic   medical program may be approved by the naturopathic board if the   program is:                (1)  an institution or part of an institution of higher   education that is accredited or is a candidate for accreditation by   a regional or national institutional accrediting agency recognized   by the United States secretary of education that:                      (A)  offers a degree of doctor of naturopathy or   doctor of naturopathic medicine that includes graduate-level   full-time didactic and supervised clinical training; and                      (B)  is accredited or has candidacy status for   accreditation by the Council on Naturopathic Medical Education or   an equivalent federally recognized accrediting agency for   naturopathic medical programs approved by the naturopathic board;                (2)  a degree-granting college or university that:                      (A)  before the existence of the Council on   Naturopathic Medical Education, offered doctoral-level   naturopathic medical education that:                            (i)  provided a full-time structured   curriculum in basic sciences and supervised patient care; and                            (ii)  required the completion of not less   than 132 weeks of education within 35 months; and                      (B)  either:                            (i)  is found by the naturopathic board to   have been reputable and in good standing; or                            (ii)  if still in existence, has current   programmatic accreditation by the Council on Naturopathic Medical   Education or another federally recognized accrediting agency;                (3)  a diploma-granting, degree-equivalent college or   university in Canada that:                      (A)  offers graduate-level full-time didactic and   supervised clinical training;                      (B)  is accredited or has candidacy status for   accreditation by the Council on Naturopathic Medical Education or   an equivalent federally recognized naturopathic medical program   accrediting agency that is approved by the naturopathic board; and                      (C)  has provincial approval for participation in   government-funded student aid programs; or                (4)  a diploma-granting, degree-equivalent college or   university in Canada that:                      (A)  before the existence of the Council on   Naturopathic Medical Education, offered doctoral-level   naturopathic medical education that:                            (i)  provided a full-time structured   curriculum in basic sciences and supervised patient care; and                            (ii)  required the completion of not less   than 132 weeks of education within 35 months; and                      (B)  either:                            (i)  is found by the naturopathic board to   have been reputable and in good standing; or                            (ii)  if still in existence, has current   programmatic accreditation by the Council on Naturopathic Medical   Education or another federally recognized accrediting entity and   has provincial approval for participation in a government-funded   student aid program.          Sec. 207.206.  EXAMINATION. To receive a license, an   applicant must pass a competency-based national naturopathic   physician licensing examination and a naturopathic physician   pharmacology examination that are approved by the naturopathic   board and administered by the North American Board of Naturopathic   Examiners or its successor organization.          Sec. 207.207.  CRIMINAL HISTORY RECORD INFORMATION   REQUIREMENT FOR LICENSE ISSUANCE. (a) The naturopathic board   shall require that an applicant for a license submit a complete and   legible set of fingerprints, on a form prescribed by the   naturopathic board, to the naturopathic board or to the Department   of Public Safety for the purpose of obtaining criminal history   record information from the Department of Public Safety and the   Federal Bureau of Investigation.          (b)  The naturopathic board may not issue a license to a   person who does not comply with the requirement of Subsection (a).          (c)  The naturopathic board shall conduct a criminal history   record information check of each applicant for a license using   information:                (1)  provided by the individual under this section; and                (2)  made available to the naturopathic board by the   Department of Public Safety, the Federal Bureau of Investigation,   and any other criminal justice agency under Chapter 411, Government   Code.          (d)  The naturopathic board may:                (1)  enter into an agreement with the Department of   Public Safety to administer a criminal history record information   check required under this section; and                (2)  authorize the Department of Public Safety to   collect from each applicant the costs incurred by the Department of   Public Safety in conducting the criminal history record information   check.          Sec. 207.208.  RECIPROCITY. The naturopathic board shall   issue a license to a person who:                (1)  is licensed in good standing as a naturopathic   physician in another state that has licensing requirements   substantially equivalent to the requirements of this chapter;                (2)  has not been the subject of a final disciplinary   action and is not the subject of a pending disciplinary action in   any jurisdiction in which the naturopathic physician is or has been   licensed;                (3)  pays the fee set by the naturopathic board; and                (4)  meets any additional criteria established by   naturopathic board rule.   SUBCHAPTER F. LICENSE RENEWAL          Sec. 207.251.  LICENSE EXPIRATION. A license issued under   this chapter expires on the second anniversary of the date of   issuance.          Sec. 207.252.  LICENSE RENEWAL. Before the expiration of a   license, a license may be renewed by:                (1)  submitting an application for renewal;                (2)  paying the renewal fee set by the naturopathic   board; and                (3)  providing verification to the naturopathic board   that the applicant for renewal has met the continuing education   requirements established by the naturopathic board.          Sec. 207.253.  CRIMINAL HISTORY RECORD INFORMATION   REQUIREMENT FOR RENEWAL. (a) An applicant for renewal of a license   issued under this chapter shall submit a complete and legible set of   fingerprints for purposes of performing a criminal history record   information check of the applicant as provided by Section 207.207.          (b)  The naturopathic board may administratively suspend or   refuse to renew the license of a person who does not comply with the   requirement of Subsection (a).          (c)  A license holder is not required to submit fingerprints   under this section for the renewal of the license if the holder has   previously submitted fingerprints under:                (1)  Section 207.207 for the initial issuance of the   license; or                (2)  this section as part of a prior renewal of a   license.          Sec. 207.254.  CONTINUING EDUCATION. The naturopathic board   shall recognize, prepare, or administer continuing education   programs for license holders. A license holder must participate in   the programs to the extent required by the naturopathic board to   keep the person's license.   SUBCHAPTER G. PRACTICE BY LICENSE HOLDER          Sec. 207.301.  NATUROPATHIC CHILDBIRTH ATTENDANCE. (a) The   naturopathic board shall establish qualifications required for the   naturopathic board to authorize a naturopathic physician to   practice naturopathic childbirth attendance.          (b)  To obtain authorization from the naturopathic board to   practice naturopathic childbirth attendance, a naturopathic   physician must:                (1)  graduate from a naturopathic midwifery or   naturopathic obstetrics program that is approved by the   naturopathic board;                (2)  pass the North American Registry of Midwives   examination, American College of Naturopathic Obstetrics   examination, or another examination approved by the naturopathic   board; and                (3)  meet all other requirements established by the   naturopathic board in consultation with the naturopathic   childbirth attendance advisory committee established under Section   207.105.          Sec. 207.302.  COMPLIANCE WITH STATE LAW AND LOCAL   REGULATIONS: PUBLIC HEALTH; REPORTING BIRTHS AND DEATHS. A   naturopathic physician shall comply with state law and a political   subdivision's regulations concerning infectious diseases and   public health and reporting births and deaths to the same extent as   a physician.          Sec. 207.303.  NATUROPATHIC CLINICAL ELECTIVE. The   naturopathic board shall establish qualifications for authorizing   a naturopathic physician to practice a naturopathic clinical   elective. The qualifications must require that a naturopathic   physician:                (1)  meet the educational requirements for the   naturopathic clinical elective provided by the North American Board   of Naturopathic Examiners or another examining entity approved by   the naturopathic board;                 (2)  pass a competency-based national naturopathic   physician clinical elective examination approved by the   naturopathic board and administered by the North American Board of   Naturopathic Examiners or its successor agency; and                (3)  meet all other requirements established by the   naturopathic board.   SUBCHAPTER H. PROHIBITED PRACTICES          Sec. 207.351.  PROHIBITED PRACTICES. (a) A naturopathic   physician may not:                (1)  practice or claim to practice as a physician,   dentist, podiatrist, optometrist, psychologist, advanced practice   registered nurse, physician assistant, chiropractor, physical   therapist, acupuncturist, or any other health care professional   unless the naturopathic physician holds a license for the   profession issued by this state;                (2)  perform surgical procedures, including procedures   involving the eye, ear, tendons, nerves, veins, or arteries that   extend beyond superficial tissue;                (3)  administer general or spinal anesthetics; or                (4)  administer ionizing radioactive substances for   therapeutic purposes.          (b)  A naturopathic physician may not treat a lesion that is   suspected of being malignant or that requires surgical removal. If   a naturopathic physician suspects that a lesion may be malignant or   requires surgical removal, the naturopathic physician shall refer   the patient to a physician or other appropriate health care   provider.          (c)  Notwithstanding Subsection (b), a naturopathic   physician may provide adjunctive or concurrent treatment to a   person who is under the care of a physician for treatment of a   malignant lesion.   SUBCHAPTER I. LICENSE DENIAL AND DISCIPLINARY PROCEDURES          Sec. 207.401.  GROUNDS FOR LICENSE DENIAL AND DISCIPLINARY   ACTION. (a) After a hearing, the naturopathic board may deny a   license to an applicant, suspend or revoke a person's license, or   place on probation a license holder if the applicant or license   holder:                (1)  violates this chapter or a naturopathic board   order or rule;                (2)  obtains a license by means of fraud,   misrepresentation, or concealment of a material fact;                (3)  sells, barters, or offers to sell or barter a   license; or                (4)  engages in unprofessional conduct that endangers   or is likely to endanger public health, welfare, or safety as   defined by naturopathic board rule.          (b)  The naturopathic board may not issue or renew a person's   license if the person:                (1)  has an impairment related to drugs or alcohol that   would limit the person's ability to practice naturopathic medicine   in a manner consistent with public safety; or                (2)  is found mentally incompetent by a physician and   the mental incompetence impairs the person's ability to undertake   the practice of naturopathic medicine in a manner consistent with   public safety.          Sec. 207.402.  INFORMAL PROCEEDINGS. (a) The naturopathic   board by rule shall adopt procedures governing:                (1)  informal disposition of a contested case under   Section 2001.056, Government Code; and                (2)  an informal proceeding held in compliance with   Section 2001.054, Government Code.          (b)  Rules adopted under this section must:                (1)  provide the complainant and the license holder an   opportunity to be heard; and                (2)  require the presence of a member of the   naturopathic board's or medical board's legal staff to advise:                      (A)  the naturopathic board or the naturopathic   board's employees; or                      (B)  the medical board or the medical board's   employees.          Sec. 207.403.  HEARING. A license holder is entitled to a   hearing before the State Office of Administrative Hearings before a   sanction is imposed under this subchapter.          Sec. 207.404.  SCHEDULE OF SANCTIONS. (a) The naturopathic   board by rule shall adopt a broad schedule of sanctions for   violations under this chapter.          (b)  The State Office of Administrative Hearings shall use   the schedule for any sanction imposed under this chapter as the   result of a hearing conducted by that office.   SUBCHAPTER J.  PENALTIES AND ENFORCEMENT PROCEDURES          Sec. 207.451.  ADMINISTRATIVE PENALTY. (a) The   naturopathic board may impose an administrative penalty against a   person licensed under this chapter who violates this chapter or a   rule or order adopted under this chapter.          (b)  An administrative penalty may not exceed $200. Each day   a violation continues or occurs is a separate violation for the   purpose of imposing a penalty. The amount of the penalty shall be   based on:                (1)  the seriousness of the violation, including the   nature, circumstances, extent, and gravity of any prohibited acts,   and the hazard or potential hazard created to the health, safety, or   economic welfare of the public;                (2)  the history of previous violations;                (3)  the amount necessary to deter a future violation;                (4)  efforts to correct the violation; and                (5)  any other matter that justice requires.          (c)  The person may stay enforcement during the time the   order is under judicial review if the person pays the penalty to the   court clerk or files a supersedeas bond with the court in the amount   of the penalty. A person who cannot afford to pay the penalty or   file the bond may stay enforcement by filing an affidavit like that   required by the Texas Rules of Civil Procedure for a party who   cannot afford to file security for costs, except that the   naturopathic board may contest the affidavit as provided by those   rules.          (d)  A proceeding to impose an administrative penalty is   subject to Chapter 2001, Government Code.          Sec. 207.452.  CIVIL PENALTY. (a) A person found by a court   to have violated this chapter is liable to this state for a civil   penalty of $200 for each day the violation continues.          (b)  A civil penalty may be recovered in a suit brought by the   attorney general, a district attorney, or a county attorney.          Sec. 207.453.  CRIMINAL OFFENSE. (a) A person commits an   offense if the person knowingly violates this chapter.          (b)  Except as provided by Subsection (c), an offense under   this section is a Class A misdemeanor.          (c)  An offense under this section is a felony of the third   degree if the person:                (1)  obtains a license by means of fraud,   misrepresentation, or concealment of a material fact;                (2)  practices naturopathic medicine without a license   issued under this chapter; or                (3)  sells, barters, or offers to sell or barter a   license.          (d)  Each day a violation occurs constitutes a separate   offense.          SECTION 2.  As soon as practicable after the effective date   of this Act, the governor shall appoint seven members to the   Naturopathic Medical Board in accordance with Chapter 207,   Occupations Code, as added by this Act. In making the initial   appointments, the governor shall designate two members for terms   expiring January 31, 2027, two members for terms expiring January   31, 2029, and three members for terms expiring January 31, 2031.          SECTION 3.  Notwithstanding Chapter 207, Occupations Code,   as added by this Act, a person may be appointed to the Naturopathic   Medical Board as an initial naturopathic physician member if the   person does not hold a naturopathic physician license under that   chapter. A person appointed to the Naturopathic Medical Board as a   naturopathic physician member on or after June 1, 2026, must hold a   naturopathic physician license under Chapter 207, Occupations   Code, as added by this Act.          SECTION 4.  Notwithstanding Chapter 207, Occupations Code,   as added by this Act, a person may be appointed to serve as a   naturopathic physician member of the naturopathic childbirth   attendance advisory committee if the person does not hold a   naturopathic physician license under that chapter. A person   appointed to the naturopathic childbirth attendance advisory   committee as a naturopathic physician member of the committee on or   after June 1, 2028, must hold a naturopathic physician license   under Chapter 207, Occupations Code, as added by this Act.          SECTION 5.  Not later than January 1, 2026, the Naturopathic   Medical Board shall adopt the rules, procedures, and fees necessary   to administer Chapter 207, Occupations Code, as added by this Act.          SECTION 6.  Notwithstanding Chapter 207, Occupations Code,   as added by this Act, a naturopathic physician is not required to   hold a license under that chapter to practice as a naturopathic   physician in this state before June 1, 2026.          SECTION 7.  (a) Except as provided by Subsection (b) of this   section, this Act takes effect September 1, 2025.          (b)  Section 207.201, Occupations Code, and Subchapter J,   Chapter 207, Occupations Code, as added by this Act, take effect   June 1, 2026.