CSSB 38(HSS): "An Act relating to the practice of naturopathy; establishing the Naturopathy Advisory Board; relating to the licensure of naturopaths; relating to disciplinary sanctions for naturopaths; relating to the Department of Commerce, Community, and Economic Development; and providing for an effective date."

00 CS FOR SENATE BILL NO. 38(HSS) 01 "An Act relating to the practice of naturopathy; establishing the Naturopathy Advisory 02 Board; relating to the licensure of naturopaths; relating to disciplinary sanctions for 03 naturopaths; relating to the Department of Commerce, Community, and Economic 04 Development; and providing for an effective date." 05 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 06 * Section 1. AS 08.02.010(a) is amended to read: 07 (a) An acupuncturist licensed under AS 08.06, an audiologist or speech- 08 language pathologist licensed under AS 08.11, a behavior analyst licensed under 09 AS 08.15, a person licensed in the state as a chiropractor under AS 08.20, a 10 professional counselor licensed under AS 08.29, a dentist under AS 08.36, a dietitian 11 or nutritionist licensed under AS 08.38, a naturopath licensed under AS 08.45, a 12 massage therapist licensed under AS 08.61, a marital and family therapist licensed 13 under AS 08.63, a medical practitioner or osteopath under AS 08.64, a direct-entry 14 midwife certified under AS 08.65, a registered or advanced practice registered nurse

01 under AS 08.68, an optometrist under AS 08.72, a licensed pharmacist under 02 AS 08.80, a physical therapist or occupational therapist licensed under AS 08.84, a 03 psychologist under AS 08.86, or a clinical social worker licensed under AS 08.95, 04 shall use as professional identification appropriate letters or a title after that person's 05 name that represents the person's specific field of practice. The letters or title shall 06 appear on all signs, stationery, or other advertising in which the person offers or 07 displays personal professional services to the public. In addition, a person engaged in 08 the practice of medicine or osteopathy as defined in AS 08.64.380, or a person 09 engaged in any manner in the healing arts who diagnoses, treats, tests, or counsels 10 other persons in relation to human health or disease and uses the letters "M.D." or the 11 title "doctor" or "physician" or another title that tends to show that the person is 12 willing or qualified to diagnose, treat, test, or counsel another person, shall clarify the 13 letters or title by adding the appropriate specialist designation, if any, such as 14 "dermatologist," "radiologist," "audiologist," "naturopath," or the like. 15 * Sec. 2. AS 08.45 is amended by adding a new section to read: 16 Sec. 08.45.015. Naturopathy Advisory Board. (a) The Naturopathy Advisory 17 Board is established in the department. 18 (b) The board shall meet at least once each year as requested by the 19 commissioner and provide recommendations to the commissioner on public policy, the 20 adoption of regulations, and other matters related to the exercise of the functions of the 21 department under this chapter. 22 (c) The board consists of five members, who are appointed by and serve at the 23 pleasure of the commissioner, and shall include two public members and three 24 naturopaths licensed under this chapter. The board shall elect a chair from among its 25 membership. 26 (d) Members of the board are appointed for three-year terms and serve until a 27 successor is appointed. A member of the board serves without compensation or 28 reimbursement of expenses. 29 (e) In this section, "commissioner" means the commissioner of commerce, 30 community, and economic development. 31 * Sec. 3. AS 08.45.020 is amended to read:

01 Sec. 08.45.020. Application for license. A person desiring to practice 02 naturopathy shall 03 (1) apply in writing to the department on a form provided by the 04 department; 05 (2) submit to the department the person's fingerprints and the fees 06 required by the Department of Public Safety under AS 12.62.160 for the 07 department to forward to the Department of Public Safety to obtain a report of 08 criminal justice information under AS 12.62.160 and a national criminal history 09 record check under AS 12.62.400; and 10 (3) pay the application fee established by the department. 11 * Sec. 4. AS 08.45.030 is amended to read: 12 Sec. 08.45.030. Issuance of license. The department shall issue a license to 13 practice naturopathy to an applicant who 14 (1) provides proof satisfactory to the department that the applicant 15 (A) has received a doctoral degree from an accredited 16 naturopathic medical school; 17 (B) has [ACCREDITED FOUR-YEAR COLLEGE OR 18 UNIVERSITY, AND 19 (1) ON OR BEFORE DECEMBER 31, 1987, HAS GRADUATED 20 FROM A SCHOOL OF NATUROPATHY THAT REQUIRED FOUR YEARS OF 21 ATTENDANCE AT THE SCHOOL AND AFTER GRADUATION HAS 22 RECEIVED A LICENSE IN ANOTHER STATE AFTER PASSING AN 23 EXAMINATION FOR LICENSURE IN THAT STATE AND IS LICENSED BY A 24 STATE AT THE TIME OF APPLICATION; OR 25 (2) AFTER DECEMBER 31, 1987, HAS 26 (A) GRADUATED FROM A SCHOOL OF NATUROPATHY 27 THAT REQUIRED FOUR YEARS OF ATTENDANCE AT THE SCHOOL 28 AND AT THE TIME OF GRADUATION THE SCHOOL WAS 29 ACCREDITED OR A CANDIDATE FOR ACCREDITATION BY THE 30 COUNCIL ON NATUROPATHIC MEDICAL EDUCATION OR A 31 SUCCESSOR ORGANIZATION RECOGNIZED BY THE UNITED

01 STATES DEPARTMENT OF EDUCATION; AND 02 (B)] passed the Naturopathic Physicians Licensing 03 Examination; 04 (2) has completed a two-year naturopathic externship program; 05 (3) has passed a pharmaceutical examination approved by the 06 department that is equivalent to any examination of pharmaceutical knowledge 07 required under AS 08.64.210 or 08.64.220; 08 (4) is not subject to an unresolved disciplinary action against a 09 license to practice naturopathy in this or another jurisdiction; 10 (5) complies with the requirements of AS 08.45.020; and 11 (6) has not been convicted of, or pled guilty or no contest to, a 12 crime that adversely reflects on the applicant's ability or competency to practice 13 as a naturopath or that jeopardizes the safety or well-being of a patient. 14 * Sec. 5. AS 08.45 is amended by adding a new section to read: 15 Sec. 08.45.032. Documentation of license refusals and revocations. If the 16 department refuses to issue or revokes a license, the department shall issue a concise 17 written statement describing the reasons for the department's decision. 18 * Sec. 6. AS 08.45.035(a) is amended to read: 19 (a) The department shall issue a temporary license to practice naturopathy to 20 an applicant who 21 (1) has applied for and is qualified to take the next Naturopathic 22 Physicians Licensing Examination offered after the date of application; and 23 (2) [AND PROVIDES PROOF SATISFACTORY TO THE 24 DEPARTMENT THAT THE APPLICANT (1)] meets the requirements of 25 AS 08.45.030(1)(A) and (2) - (6) [AS 08.45.030(2)(A); AND 26 (2) HAS NOT PREVIOUSLY FAILED THE NATUROPATHIC 27 PHYSICIANS LICENSING EXAMINATION]. 28 * Sec. 7. AS 08.45 is amended by adding new sections to read: 29 Sec. 08.45.037. Continuing education requirements. (a) The department 30 shall promote a high degree of competence in the practice of naturopathy in the state 31 by requiring every naturopath licensed under this chapter to fulfill continuing

01 education requirements. 02 (b) Before a license may be renewed, a naturopath licensed under this chapter 03 shall submit evidence to the department that continuing education requirements 04 prescribed by regulations adopted by the department have been met. Continuing 05 education requirements must be equivalent to the continuing education requirements 06 of a physician assistant under AS 08.64.107 and must also include a requirement that 07 not less than two hours of education in pain management and opioid use and addiction 08 be completed not more than two years before the application for renewal. 09 (c) The department may exempt a naturopath licensed under this chapter from 10 the requirements of (b) of this section upon an application by the naturopath giving 11 evidence satisfactory to the department that the naturopath is unable to comply with 12 the requirements because of extenuating circumstances. However, the department may 13 not exempt a naturopath from 14 (1) more than 15 hours of continuing education in a five-year period; 15 (2) the requirement to receive at least two hours of education in pain 16 management and opioid use and addiction. 17 Sec. 08.45.038. Standards for license renewal. The department shall renew a 18 license issued under this chapter to a licensee who 19 (1) applies on a form provided by the department and pays the required 20 fee; 21 (2) meets the continuing education requirements established under 22 AS 08.45.037; 23 (3) has not been convicted of, or pled guilty or no contest to, a crime 24 that adversely reflects on the applicant's ability or competency to practice as a 25 naturopath or that jeopardizes the safety or well-being of a patient; 26 (4) has a current cardiopulmonary resuscitation certification; and 27 (5) has, at least once in the six years immediately preceding the 28 application, submitted to the department fingerprints and the fees required by the 29 Department of Public Safety under AS 12.62.160 for the department to forward to the 30 Department of Public Safety to obtain a report of criminal justice information under 31 AS 12.62.160 and a national criminal history record check under AS 12.62.400.

01 * Sec. 8. AS 08.45 is amended by adding a new section to read: 02 Sec. 08.45.045. Practice of naturopathy. (a) A naturopath licensed under this 03 chapter may 04 (1) only provide naturopathic services that are consistent with the 05 standards and scope of naturopathic education, naturopathic training, and the 06 naturopath's experience, as established by regulations adopted by the department; 07 (2) prescribe and administer for preventive and therapeutic purposes 08 (A) natural therapeutic substances, including food, extracts of 09 food, vitamins, minerals, enzymes, whole gland substances, botanical 10 medicines, and homeopathic preparations; 11 (B) natural therapies, including health care counseling, 12 nutritional counseling and dietary therapy, naturopathic manipulation, 13 naturopathic physical applications, and therapeutic devices; 14 (C) devices for contraception; and 15 (D) drugs, except as provided in AS 08.45.050, if the 16 naturopath has passed the elective pharmacology examination portion of the 17 Naturopathic Physicians Licensing Examination; 18 (3) perform procedures in the office using operative, electrical, or other 19 methods, including the use of antiseptics and local anesthetics, for the surgical repair 20 and care of superficial lacerations, abrasions, and lesions and the removal of foreign 21 bodies located in the superficial tissues of the human body; the procedures may not 22 include general or spinal anesthetics, major surgery, surgery of the body cavities, 23 plastic surgery, surgery involving the eyes, or surgery involving tendons, ligaments, 24 nerves, or blood vessels; and 25 (4) perform or order for diagnostic purposes a physical or orificial 26 examination, an ultrasound, phlebotomy, a clinical laboratory test or examination, or a 27 physiological function test. 28 (b) In this section, "naturopathic physical application" means the therapeutic 29 use by a naturopath of the actions or devices of electrical muscle stimulation, galvanic 30 treatment, diathermy, ultrasound, ultraviolet light, constitutional hydrotherapy, and 31 naturopathic manipulative therapy.

01 * Sec. 9. AS 08.45.050 is amended to read: 02 Sec. 08.45.050. Restrictions on practice of naturopathy. A person who 03 practices naturopathy may not 04 (1) give, prescribe, or recommend in the practice 05 (A) a cancer chemotherapeutic agent [A PRESCRIPTION 06 DRUG]; or 07 (B) a controlled substance; 08 [(C) A POISON;] 09 (2) engage in surgery, except as authorized by AS 08.45.045(a)(3); 10 (3) use the word "physician" in the person's title. 11 * Sec. 10. AS 08.45 is amended by adding new sections to read: 12 Sec. 08.45.053. Public health duties. A naturopath, consistent with the scope 13 of practice provided under this chapter, has the same duty as a physician licensed 14 under AS 08.64 regarding public health laws, reportable diseases and conditions, 15 communicable disease control and prevention, recording of vital statistics, health and 16 physical examinations, and municipal boards of health. 17 Sec. 08.45.055. Duty of naturopaths to report. (a) A naturopath who 18 professionally treats a person licensed to practice naturopathy in this state for 19 alcoholism or drug addiction, or for mental, emotional, or personality disorders, shall 20 report the treatment to the department if the treating naturopath reasonably believes 21 that the person may constitute a danger to the health and welfare of the patients of the 22 person or the public if that person continues in practice. The report must state the 23 name and address of the person and the condition found. 24 (b) Upon receiving a report under (a) of this section, the department shall 25 investigate the matter and, upon a finding that there is reasonable cause to believe that 26 the naturopath who is the subject of the report is a danger to the health or welfare of 27 the public or to the naturopath's patients, the department may appoint a committee of 28 health care professionals to examine the naturopath and report its findings to the 29 department. Notwithstanding the provisions of this subsection, the department may 30 summarily suspend a license under AS 08.45.070(c) before appointing an examining 31 committee or before the committee makes or reports its findings.

01 (c) If the department finds that a naturopath is unable to continue in practice 02 with reasonable safety to the naturopath's patients or to the public, the department 03 shall initiate action to suspend, revoke, limit, or condition the naturopath's license to 04 the extent necessary for the protection of the naturopath's patients and the public. 05 (d) A naturopath may not refuse to submit a report under this section or 06 withhold from the department or its investigators evidence related to an investigation 07 under this section on the grounds that the report or evidence 08 (1) concerns a matter that was disclosed in the course of a confidential 09 naturopath-patient or psychotherapist-patient relationship or during a meeting of a 10 hospital medical staff, governing body, or committee that was exempt from the public 11 meeting requirements of AS 44.62.310; or 12 (2) is required to be kept confidential under AS 18.23.030. 13 (e) An action may not be brought against a person for damages resulting from 14 a report made in good faith to a public agency by the person or participation by the 15 person in an investigation by a public agency or an administrative or judicial 16 proceeding relating to the report if the report relates to a naturopath licensed under this 17 chapter. 18 Sec. 08.45.058. Naturopaths to report certain injuries. (a) A naturopath who 19 initially treats or attends to a person with an injury described in (b) of this section shall 20 promptly make an oral report of the injury to the Department of Public Safety, a local 21 law enforcement agency, or a village public safety officer. The naturopath shall submit 22 a written report of an injury described in (b)(1) of this section to the Department of 23 Public Safety within three business days after the naturopath provides treatment. A 24 report filed under this subsection must be on a form provided by the Department of 25 Public Safety. 26 (b) The following injuries shall be reported under (a) of this section: 27 (1) second or third degree burns to five percent or more of a patient's 28 body; 29 (2) a bullet wound, powder burn, or other injury apparently caused by 30 the discharge of a firearm; 31 (3) an injury apparently caused by a knife, axe, or other sharp or

01 pointed instrument, unless the injury was clearly accidental; and 02 (4) an injury that is likely to cause the death of the patient, unless the 03 injury was clearly accidental. 04 (c) A person who, in good faith, makes a report under this section, or who 05 participates in a judicial proceeding related to a report under this section, is immune 06 from any civil or criminal liability that might otherwise be incurred as a result of 07 making the report or participating in the judicial proceeding. 08 * Sec. 11. AS 08.45.060 is amended to read: 09 Sec. 08.45.060. Grounds for suspension, revocation, or refusal to issue a 10 license. The department may, after a hearing, impose a disciplinary sanction on a 11 person licensed under this chapter when the department finds that the licensee 12 (1) secured a license through deceit, fraud, or intentional 13 misrepresentation; 14 (2) engaged in deceit, fraud, or intentional misrepresentation in the 15 course of providing professional services or engaging in professional activities; 16 (3) advertised professional services in a false or misleading manner; 17 (4) has been convicted, including conviction based on a guilty plea 18 or a plea of nolo contendere, of a 19 (A) class A or unclassified felony or a [OTHER] crime in 20 another jurisdiction with elements similar to a class A or unclassified 21 felony in this jurisdiction; 22 (B) class B or class C felony or a crime in another 23 jurisdiction with elements similar to a class B or class C felony in this 24 jurisdiction if the felony or other crime is substantially related to the 25 qualifications, functions, or duties of the licensee; or 26 (C) crime involving the unlawful procurement, sale, 27 prescription, or dispensing of drugs [THAT AFFECTS THE LICENSEE'S 28 ABILITY TO CONTINUE TO PRACTICE COMPETENTLY AND 29 SAFELY]; 30 (5) failed to comply with this chapter, with a regulation adopted under 31 this chapter, or with an order of the department;

01 (6) continued to practice after becoming unfit due to 02 (A) professional incompetence; 03 (B) addiction or severe dependency on alcohol or a drug that 04 impairs the licensee's ability to practice safely; 05 (C) physical or mental disability; 06 (7) engaged in unprofessional conduct, in sexual misconduct, or in 07 lewd or immoral conduct in connection with the delivery of professional service to 08 patients; in this paragraph, "sexual misconduct" includes sexual contact, as 09 defined by the department in regulations adopted under this chapter, or 10 attempted sexual contact with a patient outside the scope of generally accepted 11 methods of examination or treatment of the patient, regardless of the patient's 12 consent or lack of consent, during the term of the naturopath-patient 13 relationship, as defined by the department in regulations adopted under this 14 chapter, unless the patient was the licensee's spouse at the time of the contact or, 15 immediately preceding the naturopath-patient relationship, was in a dating, 16 courtship, or engagement relationship with the licensee; 17 (8) has procured, sold, prescribed, or dispensed drugs in violation 18 of a law, regardless of whether there has been a criminal action or harm to a 19 patient; 20 (9) intentionally or negligently permitted the performance of 21 patient care by a person under the licensee's supervision that does not conform to 22 minimum professional standards, even if the patient was not injured; 23 (10) has demonstrated professional incompetence, gross 24 negligence, or repeated negligent conduct; the department may not make a 25 finding of professional incompetence solely on the basis that a licensee's practice 26 is unconventional or experimental in the absence of demonstrable physical harm 27 to a patient; 28 (11) has violated AS 18.16.010; 29 (12) has violated a code of ethics adopted by regulation by the 30 department; 31 (13) has denied care or treatment to a patient or person seeking

01 assistance from the licensee if the only reason for the denial is the failure or 02 refusal of the patient to agree to arbitrate as provided in AS 09.55.535(a); 03 (14) has had a license or certificate to practice naturopathy in 04 another state or a province or territory of Canada denied, suspended, revoked, 05 surrendered while under investigation for an alleged violation, restricted, limited, 06 conditioned, or placed on probation unless the denial, suspension, revocation, or 07 other action was caused by the failure of the licensee to pay fees to that state, 08 territory, or province; 09 (15) has violated any federal law pertaining to medical practice 10 and drugs. 11 * Sec. 12. AS 08.45.060 is amended by adding a new subsection to read: 12 (b) In a case involving (a)(14) of this section, the final findings of fact, 13 conclusions of law, and order of the authority that suspended or revoked a license or 14 certificate constitutes a prima facie case that the license or certificate was suspended 15 or revoked and the grounds under which the suspension or revocation was granted. 16 * Sec. 13. AS 08.45.070(a) is amended to read: 17 (a) When the department [IT] finds that a licensee under this chapter has 18 violated a provision of this chapter [AS 08.45.040 - 08.45.050] or is guilty of an 19 offense under AS 08.45.060, the department may impose the following sanctions 20 singly or in combination: 21 (1) permanently revoke the license to practice; 22 (2) suspend the license for a determinate period of time; 23 (3) censure the licensee; 24 (4) issue a letter of reprimand to the licensee; 25 (5) place the licensee on probationary status and require the licensee to 26 (A) report regularly to the department on [UPON] matters 27 involving the basis of probation; 28 (B) limit practice to those areas prescribed; 29 (C) continue professional education until a satisfactory degree 30 of skill has been attained in areas determined by the department to need 31 improvement;

01 (6) impose limitations or conditions on the practice of the licensee; 02 (7) impose a civil penalty of not more than $25,000. 03 * Sec. 14. AS 08.45.070 is amended by adding new subsections to read: 04 (d) The department may reinstate a license that has been suspended or revoked 05 if, after a hearing, the department finds that the applicant is able to practice 06 naturopathy with reasonable skill and safety. 07 (e) The department may suspend a license upon receiving a certified copy of 08 evidence that a license to practice naturopathy in another state or a province or 09 territory of Canada has been suspended or revoked. The suspension remains in effect 10 until a hearing is held by the department. 11 (f) The department shall promptly report to the National Practitioner Data 12 Bank maintained by the United States Department of Health and Human Services for 13 inclusion in the data bank license refusals under this chapter and actions taken by the 14 department under this section, including the imposition of a fine and the suspension or 15 surrender of a license. 16 * Sec. 15. AS 08.45 is amended by adding new sections to read: 17 Sec. 08.45.105. Automatic suspension for mental incompetency. 18 Notwithstanding AS 44.62, if a person holding a license to practice naturopathy under 19 this chapter is adjudged mentally incompetent or insane by a final order or 20 adjudication of a court of competent jurisdiction or by voluntary commitment to an 21 institution for the treatment of mental illness, the person's license shall be suspended 22 by the department. The suspension shall continue in effect until the court finds or 23 adjudges that the person has been restored to reason or until a licensed psychiatrist 24 approved by the department determines that the person has been restored to reason. 25 Sec. 08.45.110. Voluntary surrender. The department may accept the 26 voluntary surrender of a license. A license may not be reinstated unless the department 27 determines, under regulations adopted by the department, that the person is competent 28 to resume practice. However, a license may not be reinstated if the voluntary surrender 29 resulted in the dropping or suspension of civil or criminal charges against the licensee. 30 Sec. 08.45.115. Medical and psychiatric examinations. For the purposes of 31 an investigation under this chapter, the department may require a person to whom the

01 department has issued a license to submit to drug or alcohol testing or a medical or 02 psychiatric examination by a practitioner appointed by the department. An 03 examination shall be at the department's expense. 04 Sec. 08.45.120. Reports relating to malpractice actions and claims. A 05 naturopath licensed under this chapter shall report in writing to the department 06 concerning the outcome of each medical malpractice claim or civil action in which 07 damages have been or are to be paid by or on behalf of the licensee to the claimant or 08 plaintiff, whether by judgment or under a settlement. This report shall be made within 09 30 days after resolution of the claim or termination of the civil action. 10 Sec. 08.45.125. Penalty for practicing without a license. Except for a person 11 licensed or authorized under another chapter of this title who engages in practices for 12 which that person is licensed or authorized under that chapter, a person practicing 13 naturopathy in the state without a valid license is guilty of a class A misdemeanor. 14 Each day of illegal practice is a separate offense. 15 Sec. 08.45.130. Prohibited use of title. A person may not use in connection 16 with the person's name or otherwise assume or advertise a title or description tending 17 to convey the impression that the person is a naturopath licensed under this chapter 18 unless the person is licensed under this chapter. 19 * Sec. 16. AS 08.45.200(3) is repealed and reenacted to read: 20 (3) "naturopathy" means a system of health care practiced by a 21 naturopath for the prevention, diagnosis, and treatment of human health conditions, 22 injury, and disease for the purpose of promoting or restoring health by the support and 23 stimulation of an individual's inherent self-healing processes through education of the 24 individual and the use of natural therapies, therapeutic devices and substances, and 25 other therapeutic interventions consistent with naturopathic medical training. 26 * Sec. 17. AS 08.45.200 is amended by adding new paragraphs to read: 27 (4) "accredited naturopathic medical school" means a college or 28 university and program granting a degree of doctor of naturopathy or naturopathic 29 medicine that is accredited by or is a candidate for accreditation with the Council on 30 Naturopathic Medical Education or another accrediting agency recognized by the 31 United States Department of Education;

01 (5) "naturopath" means a person licensed and authorized to practice 02 naturopathy in the state who, because of specialized education from an accredited 03 naturopathic medical school, is capable of performing acts of medical diagnosis and 04 prescription of therapeutic substances and procedures that are consistent with 05 naturopathic medical education. 06 * Sec. 18. AS 12.62.400(a) is amended by adding a new paragraph to read: 07 (21) licensure as a naturopath under AS 08.45. 08 * Sec. 19. The uncodified law of the State of Alaska is amended by adding a new section to 09 read: 10 TRANSITION: EFFECT ON CURRENT LICENSEES. On and after the effective 11 date of secs. 1 - 18 of this Act, a person who holds a valid license to practice naturopathy on 12 the effective date of secs. 1 - 18 of this Act may continue to engage in the practice of 13 naturopathy under the license until the license expires normally under AS 08.45, as AS 08.45 14 read before the effective date of secs. 1 - 18 of this Act, but shall otherwise comply with 15 AS 08.45, as amended by secs. 1 - 18 of this Act. 16 * Sec. 20. The uncodified law of the State of Alaska is amended by adding a new section to 17 read: 18 TRANSITION: REGULATIONS. The Department of Commerce, Community, and 19 Economic Development may adopt regulations necessary to implement the changes made by 20 this Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not 21 before the effective date of the law implemented by the regulation. 22 * Sec. 21. Section 20 of this Act takes effect immediately under AS 01.10.070(c). 23 * Sec. 22. Except as provided in sec. 21 of this Act, this Act takes effect January 1, 2022.