HB 147-PRACTICE OF NATUROPATHY  3:50:05 PM CHAIR MINA announced that the first order of business would be HOUSE BILL NO. 147, "An Act relating to the practice of naturopathy." 3:50:28 PM REPRESENTATIVE MIKE PRAX, Alaska State Legislature, as prime sponsor, read the sponsor statement [hard copy included in the committee file] for HB 147, which read as follows [original punctuation provided]: House Bill 147 allows licensed Alaska naturopathic doctors to apply for a temporary endorsement to practice closer to their level of education and training. This will enable Alaskans to choose their preferred healthcare style and help alleviate the shortage of primary care providers in the state. Approximately 50 licensed naturopaths provide effective care for thousands of Alaskans with chronic diseases like obesity, diabetes, and hypertension in an overburdened healthcare system. However, current limitations on naturopathic care require patients to schedule duplicate appointments for prescriptions increasing healthcare congestion and costs. HB 147 allows licensed naturopaths to obtain a temporary license endorsement through a written agreement with a supervising physician. This endorsement prohibits the prescription of controlled substances, chemotherapy drugs, antipsychotic drugs, radioactive substances, and performing invasive surgeries. After one year under this agreement, licensed Alaska naturopaths may get an ongoing endorsement linked to the regular licensing renewal process. The legislation requires all licensed Alaska naturopaths to complete sixty hours of continuing education every two years, including twenty hours in pharmacotherapy. HB 147 authorizes state licensing personnel to suspend or revoke an endorsement after investigating a complaint against a licensed naturopath. The legislation also makes prescribing medicine without an endorsement illegal and addresses fraudulent actions to obtain an endorsement. Naturopathic education emphasizes holistic disease prevention rather than simply treating symptoms. In the long term, naturopathic care offers affordable and enhanced health outcomes for patients, insurers, and the state, while providing Alaskans the opportunity to select the type of healthcare that best suits their needs. Please join me in supporting House Bill 147. 3:55:23 PM RILEY NYE, Staff, Representative Mike Prax, on behalf of Representative Prax, prime sponsor, gave the sectional analysis [included in the committee file] for HB 147, which read as follows [original punctuation provided]: Section 1 adds new sections AS 08.45.033(Issuance of Temporary Endorsement) and AS 08.45.034 (Issuance of Endorsement) Creates a new section of Alaska law to allow licensed Alaska naturopaths to apply for a temporary endorsement to prescribe a limited range of prescription medications upon showing they have: • passed the pharmacology portion of the Naturopathic Physicians Licensing Exam or equivalent test, and • meet other applicable requirements established by the Division of Corporations, Business and Professional Licensing (DCBPL or Division). Naturopaths holding a valid temporary endorsement may prescribe a limited range of prescription medications under a written collaborative agreement with a licensed Alaska physician who has been prescribing and administering prescription drugs for at least five years. The collaborative physician will evaluate the naturopath's prescriptive practice and provide feedback. The temporary endorsement must be in place for a minimum of twelve months and the collaborative oversight must be reported on a form approved by DCBPL. At the conclusion of the twelve-month period, the collaborative physician is required to recommend to DCBPL whether the naturopath should receive further supervision, be issued an endorsement, or be denied an endorsement. The temporary endorsement terminates on the date a naturopath is issued, or denied, an endorsement to prescribe. After considering the recommendation of a collaborative physician, DCBPL will determine whether to issue, or deny, an endorsement to a naturopath or require further prescriptive supervision. A naturopath who receives an endorsement to prescribe and administer may do so under the limitation of AS 08.45.050. Section 2 adds new sections AS 08.45.037 (Continuing Education Requirements) and AS 08.45.038 (Standards for License Renewal) Creates a new requirement for all licensed naturopaths in Alaska to provide proof of completing sixty hours of division-approved continuing education as part of their biannual license renewal process. The required sixty hours must include a minimum of twenty hours of continuing education focused on pharmacotherapy. DCBPL may exempt a naturopath from a portion of this ongoing training for extenuating circumstances. However, DCBPL may not grant an exemption for more than fifteen hours total in a fouryear period. This partial waiver provision is similar to statutory provisions for other medical professionals in Alaska that acknowledge the potential for serious illness, military service, family emergencies or natural disasters to limit an ability to complete some continuing medical education. This section also establishes standards for license renewal that require naturopaths to pay an appropriate fee, show they meet the continuing education requirements, disclose whether they have been found to have perpetrated a crime that adversely reflects on their ability to practice safely and have a current cardiopulmonary resuscitation certificate. Section 3 amends AS 08.45.050 (Restrictions on Practice of Naturopathy) Amends existing law to clarify that naturopaths prescribing and administering medications under a temporary, or ongoing, prescription endorsement may NOT prescribe: 1. a prescription drug except as allowed under their temporary or ongoing prescriptive endorsement, 2. a poison, 3. a chemotherapy drug 4. an antipsychotic drug, or 5. administer a therapeutic ionizing radiation or radioactive substance. In addition, existing statutory prohibitions against a naturopath engaging in surgery or using the word "physician" in the person's title are preserved in law. Section 4 amends AS 08.45.060 (Grounds for Suspension, Revocation, or Refusal to Issue a License) Expands existing Alaska law to clarify that DCBPL has full authority to take disciplinary action against a temporary, or ongoing, prescriptive endorsement held by a licensed Alaskan naturopath if the division determines the endorsement was secured through deceit, fraud, or intentional misrepresentation. Section 5 amends AS 08.45.070(a) (Disciplinary Sanctions) Expands existing Alaska law to clarify that DCBPL can exercise the same disciplinary authority over a naturopath's temporary, or ongoing, prescriptive endorsement as it does over a naturopath's license to practice. This authority allows the division to revoke, suspend, censure or reprimand the licensee as well as place them on probation that limits their practice or requires additional professional training and reporting. Section 6 amends AS 08.45.070(c) (Disciplinary Sanctions) Expands existing Alaska law to clarify that DCBPL can summarily suspend a temporary, or ongoing, prescriptive endorsement during a final hearing or appeals process if the division determines doing otherwise would endanger the public health. Section 7 amends AS 08.45.080 (Unlicensed Practice a Misdemeanor) Expands existing Alaska law to clarify that a licensed Alaska naturopath is guilty of a class A misdemeanor if they are found to have prescribed a prescription medication without having a valid temporary, or ongoing, endorsement to do so. Section 8 amends AS 08.45.090 (Fraudulent License) Expands existing Alaska law to clarify that a naturopath who obtains, or attempts to obtain, a temporary endorsement to prescribe prescription medications fraudulently is punishable by a fine of not more than five hundred dollars or by imprisonment for not more than six months, or both. 4:02:06 PM REPRESENTATIVE GRAY raised concern about excluding chemotherapy and antipsychotic drugs from the scope of naturopaths. He said that it would be beneficial for these physicians to be allowed to prescribe these drugs as they serve purposes outside of their original intended use. 4:03:28 PM REPRESENTATIVE PRAX deferred to an expert on pharmacy to answer that question. 4:04:13 PM CHAIR MINA announced invited testimony. 4:04:55 PM LAURA CULBERSON FARR, Executive Director, American Association of Naturopathic Physicians, testified in support of HB 147. She explained that naturopathic doctors (NDs) have prescribing authority in 15 jurisdictions and in some states NDs have nearly if not equal prescribing authority as medical doctors (MDs). She emphasized that HB 147 would not be an "experiment" for NDs in the country. She said that many NDs have more pharmacology course hours than others with prescribing authority, stating that that hour comparison is not enough to determine prescription authority. She said that while NDs do not have a residency requirement, residencies do not equate to prescribing authority, as other states allow certain occupations to prescribe drugs without residencies, such as physician assistants. She emphasized the history of safe prescriptions by NDs in other states. 4:10:19 PM REPRESENTATIVE SCHWANKE asked about the history of ND's full prescriptive authority in Vermont. MS. FARR responded that Vermont passed their prescribing authority legislation in 2012, a bill which HB 147 is modeled after. She said that since 2012, ND prescription has gone smoothly with no restrictions. 4:12:26 PM REPRESENTATIVE GRAY described his prescribing authority as a physician's assistant (PA) and said HB 147 does not ask for that much; it is "a modest bill." REPRESENTATIVE SCHWANKE asked what would happen if a supervising MD requested that the ND under their supervision does not utilize their prescribing authority. 4:14:05 PM GLENN SAVIERS, Deputy Director, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community & Economic Development, responded that the particular circumstances would need to be considered. She explained that there would be an investigation, and each case would be treated individually. 4:15:11 PM CLYDE JENSEN, PhD, Professor, National University of Natural Medicine, testified in support of HB 147. He spoke from his own experience to compare the pharmacology education NDs and MDs receive, explaining they are held to the same standards of care and require the same number of classroom hours. He stated that NDs are supervised by other NDs, who have experience also prescribing treatments other than drugs, while MDs are often expected to prescribe drugs as treatments. He stated that ongoing education is expected of all physicians across the country and emphasized that NDs are equally educated and qualified to prescribe drugs. 4:20:27 PM MR. JENSEN spoke to Representative Gray's previous question regarding drugs that could be useful for NDs to be allowed to prescribe but would be excluded from their prescriptive authority under HB 147. He said that NDs have always faced opposition from "conventional medical professions" when seeking prescriptive authority and he believes the intent of HB 147 would be to reduce the opportunity for opposition or debate. 4:21:20 PM SHANNON BRADEN, ND, Board Member, Federation of Naturopathic Medicine Regulatory Authorities (FNMRA), provided an overview of the federation and its disciplinary authorities regarding NDs. She stated that the FNMRA supports HB 147. She said that in Oregon over the past 7 years, NDs received far fewer disciplinary actions compared to MDs and other physicians. She said that between 2010-2024, in states where NDS have broad prescriptive rights, there were zero disciplinary actions taken against NDs for inappropriate prescribing. She emphasized that similar results would be expected in Alaska under HB 147. 4:26:54 PM NATALIE WIGGINS, ND, Board Member, Alaska Association of Naturopathic Doctors, testified in support of HB 147.. She began by describing the healthcare crisis in Alaska, attributing such high costs to the limited access to care in the state. She stated that NDs are ready and able to fill that gap but are prohibited by their limited scope of practice. She described the rigorous education and training required by NDs, including their education in pharmacology and medication management. While some argue that this training does not equate to residency experience, she argued that residency experience does not equate to safe prescriptions. Dr. Wiggins stated that HB 147 would be a cautious and reasonable step forward for NDs. She explained that limiting the prescriptive authority of NDs places a burden on patients, often requiring additional appointments to receive necessary prescriptions from other physicians. 4:33:41 PM REPRESENTATIVE GRAY offered his experience in emergency care and the demand he faced from patients to prescribe medications. He stated that he believes people who visit a naturopath are less likely to ask for prescription medications. He asked if any testifiers could speak to that point. 4:35:38 PM DR. WIGGINS responded that there is a very thoughtful process NDs take when making prescriptions, which includes taking the time to consider non-medication treatment options. 4:36:41 PM REPRESENTATIVE SCHWANKE spoke about people self-diagnosing and getting medication online and asked whether HB 147 would encourage those people to seek care from NDs instead. DR. WIGGINS answered that that is absolutely true. 4:38:50 PM CHAIR MINA announced that HB 147 was held over.