Since the first U.S. practice laws were passed in Maryland, Nevada and Oregon in 1973, the acupuncture profession has succeeded in having acupuncture legislation passed in more than 40 states and the District of Columbia.
Until recently, Michigan was one of the few states that did not have an acupuncture law in effect. In 1998, Frank Kelley, the state's attorney general, ruled that acupuncture fell under the practice of medicine. While his ruling gave acupuncturists the ability to practice, they were allowed to do so only under the referral of, or supervision by, a medical doctor or osteopath. Furthermore, they could provide treatment only after a doctor had first examined the patient and determined that acupuncture would be an effective form of care.
In December 2004, the acupuncture profession appeared on the verge of a significant legislative victory when both houses of the Michigan Legislature passed House Bill 5205, a law that would have created a registration process for acupuncturists and formed a state acupuncture board. Unfortunately, HB 5205 became the victim of a pocket veto by Gov. Jennifer Granholm, as the Legislature adjourned less than a week after the bill was delivered to the governor's desk.1
Following Gov. Granholm's pocket veto, a joint project established by the American Association of Oriental Medicine and the American Acupuncture Council began to work toward the passage of an acupuncture law in Michigan. Established as part of a 2004 agreement between the two organizations,2 the project was designed to target a state that did not provide full licensing for acupuncturists, and to help get licensing laws passed in that state. The AAOM and AAC were joined in their efforts by the Michigan Association of Acupuncture and Oriental Medicine (MAAOM), which had voiced its support for HB 5205. The MAAOM and AAOM provided technical expertise and grassroots support, while the AAC provided funding for lobbyists and other expenses.
On March 24, 2005, due in large part to the lobbying efforts of all three organizations, Sen. Beverly Hammerstrom and 14 co-sponsors introduced Senate Bill 351, which included language nearly identical to HB 5205. On Feb. 22, 2006, after passage by both the House and Senate, Gov. Granholm signed SB 351 into law, making Michigan the 43rd state to have in place laws that regulate the practice of acupuncture by licensed acupuncturists.
"I'm very thrilled. We've come a long way," said Deborah Lincoln, RN, MSN, Dipl.Ac., president of the Michigan Association of Acupuncture and Oriental Medicine, which supported both SB 351 and HB 5205. "Without a law like this, acupuncturists have more or less worked under the radar."
"When Senator Hammerstrom approached me about supporting her legislation in the House, I immediately signed on," added Rep. Kevin Green, who introduced the House version of the bill (HB 4589) in April 2005. "Studies have shown that acupuncture can have very beneficial effects on people suffering from various conditions, but we also want to be sure that people practicing under the title of acupuncturists are properly registered for the security of all parties."
SB 351 takes effect July 1, 2006. Among other things, the bill:
Gives acupuncturists more freedom in the care and treatment of patients. With the passage of SB 351, acupuncturists will no longer be required to work under the direct supervision of a licensed physician.
Provides a clear definition of acupuncture. According to the legislation, acupuncture "means the insertion and manipulation of needles through the surface of the human body at specific locations on the human body for the prevention or correction of disease, injury, pain, or other condition."
Places limits on who can use the title of "acupuncturist." The new law prohibits individuals from using the titles "acupuncturist," "certified acupuncturist" or "registered acupuncturist" unless they are authorized to do so. (Licensed physicians and individuals certified by the National Acupuncture Detoxification Association are exempt from this provision.)
Establishes a regulatory agency for the practice of acupuncture. SB 351 creates the Michigan Board of Acupuncture, which will operate under the auspices of the Department of Community Health. The board will be comprised of nine voting members, including four acupuncturist members.
At press time, Gov. Granholm had yet to name any acupuncturists to the board. Once an appropriate number of members have been appointed to the board, it (in consultation with the Department of Community Health) will establish rules regarding standards for registration. According to the state's Bureau of Health Professions, appliance for (and issuance of) registrations will begin once a set of rules has been established and formally approved.
The passage of SB 351 was a collaborative lobbying effort between the Michigan Association of Acupuncture and Oriental Medicine, the American Association of Oriental Medicine and the American Acupuncture Council. In a prepared statement, Michael Schroeder, the AAC's vice president and general counsel, commented on the impact SB 351 will have on the profession in Michigan.
"We believe strongly in the governing and empowerment of practice rights for the profession," Schroeder said. "We are elated that the law in Michigan has been signed by the governor. We were happy to coordinate the effort with the AAOM for the passage of the law. There was strong grassroots support from the Michigan Association of Acupuncture and Oriental Medicine, which has endorsed the AAC. The need for MD supervision has been eliminated. This has been a victory for the profession and the patients they serve."
Kentucky Moves Toward Licensure
In related news, the introduction of House Bill 17 in Kentucky represents a significant step toward full licensure for practicing acupuncturists. Rather than licensure, however, HB 17 calls for a certification process, under which practitioners would use the "CAc" designation and be listed as certified acupuncturists. The profession would be regulated by the Kentucky Board of Medical Licensure and an eight-member Acupuncture Advisory Committee, with four acupuncture practitioners serving on the committee.
To qualify for certification, an applicant would need to submit a board-approved application, be "of good character and reputation," have passed an NCCAOM-administered acupuncture examination, and be a graduate of an ACAOM-approved acupuncture program. Acupuncturists legally authorized to practice in other states also could be certified to practice in Kentucky, provided the other state "has standards substantially equivalent" to Kentucky.
The scope of practice currently proposed under HB 17 would be rather limited. Specifically, the practice of acupuncture would include "the insertion of acupuncture needles, with or without accompanying electrical or thermal stimulation," along with acupressure, cupping, moxibustion and dermal friction "for purposes of changing the flow of energy in the body." However, acupuncturists would not be allowed to practice laser acupuncture, or to perform osteopathic manipulations, chiropractic adjustments, physical therapy or surgery. In addition, acupuncturists would need to complete 30 hours of continuing education units every two years as a condition for renewal of their certificate.
All certified acupuncturists would also be required to develop a written plan for consultation, emergency transfer, and referral of patients to appropriate health care facilities or to other health care practitioners. While diagnosis is not included in an acupuncturist's scope of practice, if a patient discloses that he or she suffers from a "potentially serious disorder or condition" during an interview regarding the patient's medical history, the acupuncturist must verify that the patient currently is under the care of a physician and consult with the treating physician before performing acupuncture.3 If the patient refuses to provide a medical history or disclose information regarding any of those conditions, acupuncture treatment shall not be provided.
House Bill 17 was introduced by Rep. Denver Butler, and was pre-filed in September 2005, making it one of the first bills to be considered by the Kentucky Legislature for the 2006 session. At present, the bill appears well on its way to being passed and signed into law. After receiving a favorable review by the House Licensing and Occupations Committee, the bill passed the Kentucky House 96-0 on Feb. 7. It is currently under review by the Senate Rules Committee.
Look for an update on the status of HB 17 in future issues of Acupuncture Today.
National Acupuncture Foundation Acupuncture and Oriental Medicine State Laws and Regulations, 2005 edition, p. 127.
American Acupuncture Council helps profession get to next level. $1 million commitment to research, legislation, technology, promotion and education. Acupuncture Today, January 2005.
Potentially serious disorders and conditions include: hypertension and cardiac conditions; acute, severe abdominal pain; undiagnosed neurological changes; unexplained weight loss or gain in excess of 15 percent of the patient's body weight in less than a three-month period; suspected fracture or dislocation; suspected systemic infections; serious hemorrhagic disorder; acute respiratory distress without a previous history; pregnancy; diabetes; cancer.
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