AN ACT to establish the north carolina Healing Arts Commission and to create licensure processes for reflexologists, naturopathic doctors, and music therapists.

The General Assembly of North Carolina enacts:

SECTION 1.(a)  Chapter 90 of the General Statutes is amended by adding a new Article to read:

Article 44.

Healing Arts.

Part 1. North Carolina Healing Arts Commission.

§ 90‑750.1.  Title and purpose.

(a)        This Article shall be known and may be cited as the North Carolina Healing Arts Act.

(b)        The North Carolina Healing Arts Act is established to safeguard the public health, safety, and welfare; to protect the public from being harmed by unqualified persons; to assure the highest degree of professional services and conduct on the part of practitioners of the healing arts; to provide for the establishment of licensure requirements; and to ensure the availability of healing arts services of high quality to persons in need of such services.

§ 90‑750.2.  Definitions.

The following definitions apply in this Article:

(1)        Advisory committee. – A committee charged with supervising the day‑to‑day regulation of a healing arts profession. Advisory committees shall screen applicants for licensure and conduct all investigations necessary to give recommendations to the Commission.

(2)        Commission. – The North Carolina Healing Arts Commission, as established pursuant to G.S. 90‑750.3.

(3)        Healing arts. – The use of allopathic, complementary, or alternative approaches to the art and science of medicine for the prevention, identification, and treatment of human physical or mental conditions, diseases, ailments, illnesses, infirmities, pain, defects, or injuries and the promotion and restoration of health and wellness.

(4)        Healing arts profession. – Any of the professions listed in G.S. 90‑750.8.

(5)        North Carolina Healing Arts License. – A license in a healing arts profession issued pursuant to this Article.

§ 90‑750.3.  North Carolina Healing Arts Commission; composition; terms; compensation.

(a)        The North Carolina Healing Arts Commission is hereby created. The Commission shall consist of the following members: one member of the public and two members of each healing arts profession. The initial Commission members shall be appointed on or before January 1, 2024, as follows:

(1)        The General Assembly, upon the recommendation of the President Pro Tempore of the Senate, shall appoint one reflexologist to serve an initial term of three years.

(2)        The General Assembly, upon the recommendation of the Speaker of the House of Representatives, shall appoint one music therapist to serve an initial term of two years.

(3)        The General Assembly, upon the recommendation of the Speaker of the House of Representatives, shall appoint one naturopathic doctor to serve an initial term of two years.

(4)        The Governor shall appoint one reflexologist to serve an initial term of two years.

(5)        The Governor shall appoint one music therapist to serve an initial term of three years.

(6)        The Governor shall appoint one naturopathic doctor who shall serve an initial term of one year.

(7)        The Governor shall appoint one member of the public who shall serve an initial term of three years.

(b)        Once the initial terms described in subsection (a) of this section expire, the appointing authorities shall appoint members to the Commission for terms of three years. Any healing arts professions created after January 1, 2024, shall have two members on the Commission, both of whom shall serve three‑year terms. One of these members shall be appointed by the Governor. The second member shall be appointed by the General Assembly. The Speaker of the House of Representatives shall make a recommendation to be approved by the General Assembly for the first term, and the President Pro Tempore of the Senate shall make a recommendation to be approved by the General Assembly for the second term. The Speaker of the House of Representatives and the President Pro Tempore of the Senate shall thereafter alternate recommendations for subsequent terms.

(c)        Any vacancies on the Commission shall be filled by the appointing authority initially filling that position, except that any vacancy in appointments by the General Assembly shall be filled in accordance with G.S. 120‑122. Individuals appointed to fill vacancies shall serve until the normal expiration of the term they were appointed to fill.

(d)       Members of the Commission shall be citizens of the United States, residents of the State of North Carolina, and hold a North Carolina Healing Arts License in their respective healing arts profession under this Article. The initial reflexologist appointee shall have been a North Carolina resident for at least two years prior to appointment, certified by a national entity that certifies reflexologists, and eligible for licensure under G.S. 90‑750.14. Upon appointment, the reflexologist appointee shall immediately seek to obtain a North Carolina Healing Arts License in reflexology under this Article and must remain in good standing with the Commission during the appointee's term. The initial music therapist appointee shall have been a North Carolina resident for at least two years prior to appointment, certified by a national entity that certifies music therapists, and eligible for licensure under G.S. 90‑750.24. Upon appointment, the initial music therapist appointee shall immediately seek to obtain a North Carolina Healing Arts License in music therapy under this Article and must remain in good standing with the Commission during the appointee's term. The initial naturopathic doctor appointee shall have been a North Carolina resident for at least two years prior to appointment, certified by a national entity that certifies naturopathic doctors, and eligible for licensure under G.S. 90‑750.33. Upon appointment, the initial naturopathic doctor appointee shall immediately seek to obtain a North Carolina Healing Arts License in naturopathic medicine under this Article and must remain in good standing with the Commission during the appointee's term. Initial appointees for healing arts professions created after January 1, 2024, shall be North Carolina residents for at least two years prior to appointment, certified by a national entity that certifies the appointee's healing arts profession, eligible for licensure under this Article, immediately seek to obtain a North Carolina Healing Arts License in their respective profession under this Article, and remain in good standing for the duration of their terms. Public members of the Committee shall not be:

(1)        An agent or employee trained or experienced in the practice of healing arts.

(2)        An agent or employee of a person engaged in the practice of healing arts.

(3)        A spouse of an individual licensed pursuant to this Article.

(4)        Any person with significant financial interest in a health service or profession.

(e)        The Commission may remove any of its members for neglect of duty, incompetence, or unprofessional conduct. A member subject to disciplinary proceedings as a licensed healing arts professional shall be disqualified from participating in the official business of the Commission until the charges have been resolved.

(f)        Any member of the Commission may be removed from office by the Governor for good cause shown.

(g)        A Commission member may not receive compensation but may receive reimbursement as provided in G.S. 93B‑5. The officers of the Commission shall include a chair, a secretary, and any other officers deemed necessary by the Commission to carry out the purposes of this Article. All officers shall be elected annually by the Commission at its first meeting held after appointments to the Commission are made. The Commission shall hold a meeting within 45 days after the appointment of new Commission members. All officers shall serve one‑year terms and shall serve until their successors are elected and qualified. No person shall chair the Commission for more than five consecutive years. The Commission may adopt rules governing the calling, holding, and conducting of regular and special meetings. A majority of Commission members present and voting constitutes a quorum, and no action may be taken without a quorum.

§ 90‑750.4.  Powers of the Commission.

The Commission shall have the following powers and duties:

(1)        Administer and enforce the provisions of this Article.

(2)        Adopt, amend, or repeal rules necessary to conduct its business, carry out its duties, and administer this Article.

(3)        Appoint and maintain advisory committees to fulfill the daily regulation of healing arts professions.

(4)        Issue, renew, deny, suspend, or revoke Healing Arts Licenses, order probation, issue reprimands, and conduct any disciplinary actions authorized by this Article.

(5)        Authorize expenditures deemed necessary to carry out the provisions of this Article from fees paid to the Commission pursuant to this Article.

(6)        Remit to advisory committees funds sufficient for those advisory committees to carry out their duties.

(7)        Conduct any administrative hearings necessary for the administration of this Article, including disciplinary hearings to enforce the provisions of this Article.

(8)        Establish fees as necessary for the administration of this Article.

§ 90‑750.5.  Expenses and fees.

(a)        All fees shall be payable to and deposited in the name of the Commission in financial institutions designated by the Commission as official depositories. These fees shall be used to carry out the purposes of this Article.

(b)        All salaries, compensation, and expenses incurred or allowed to carry out the purposes of this Article shall be paid by the Commission exclusively out of the fees received by the Commission as authorized by this Article or funds received from other sources. In no case shall any salary, expense, or other obligation authorized by this Article be charged against the State treasury.

(c)        The Commission shall establish fees for healing arts professions not exceeding the following amounts:

(1)....... Issuance of a North Carolina Healing Arts License........................... $300.00

(2)....... North Carolina Healing Arts License renewal (annually).................. $350.00

(3)....... Late renewal....................................................................................... $200.00.

§ 90‑750.6.  Violations.

(a)        Any person violating any provision of this Article shall be punished as follows:

(1)        For the first violation, the individual shall receive a written warning.

(2)        For the second violation, the individual shall be subject to a civil penalty of no more than two hundred dollars ($200.00).

(3)        For the third and each subsequent violation, the individual shall be subject to a civil penalty of no more than two hundred dollars ($200.00) for each violation and shall be guilty of a Class 1 misdemeanor.

(b)        The clear proceeds of a civil penalty assessed under this section shall be remitted to the Civil Penalty and Forfeiture Fund in accordance with G.S. 115C‑457.2.

§ 90‑750.7.  Injunction.

As an additional remedy, the Commission may proceed in superior court to enjoin and restrain any person from violating the prohibitions of this Article. The Commission shall not be required to post bond when seeking an injunction pursuant to this section.

§ 90‑750.8.  Healing arts professions.

The following are the healing arts professions subject to this Article:

(1)        Reflexologists.

(2)        Music therapists.

(3)        Naturopathic physicians.

Part 2. Reflexology.

§ 90‑750.10.  Reflexology as a healing arts profession.

It is the policy of this State that the practice of reflexology shall be considered a healing arts profession.

§ 90‑750.11.  Definitions.

The following definitions apply in this Part:

(1)        Certifying entity. – The American Reflexology Certification Board or its successor.

(2)        Committee. – The North Carolina Reflexology Advisory Committee.

(3)        National certification. – A determination by the certifying entity that an individual has passed the certifying entity's national exam and that the individual has an active status with the certifying entity.

(4)        North Carolina Licensed Reflexologist. – An individual that (i) is certified by the certifying entity as a certified reflexologist and (ii) has been issued a North Carolina Healing Arts License in reflexology by the Commission.

(5)        Reflexology. – A protocol of manual techniques, including thumb‑ and finger‑walking, hook and backup, and rotating‑on‑a‑point, that are applied to specific reflex areas predominantly on the feet and hands and that stimulate the complex neural pathways linking body systems and support the body's efforts to function optimally. The practice of reflexology is not massage and bodywork therapy as defined in Article 36 of this Chapter.

§ 90‑750.12.  North Carolina Reflexology Advisory Committee.

(a)        Establishment. – The North Carolina Reflexology Advisory Committee is created. The Committee consists of three members serving staggered terms. The initial Committee members shall be appointed on or before January 1, 2024, as follows:

(1)        The Commission shall appoint from a list of names submitted by the North Carolina Reflexology Association or its successor two reflexologists eligible for licensure under this Article. One member shall serve an initial term of three years, and one member shall serve an initial term of two years.

(2)        The Commission shall appoint one public member who shall serve an initial term of one year.

Upon the expiration of the terms of the initial Committee members, each subsequent member shall be appointed for a term of three years. The term of a member shall begin on January 1 of each year. A member shall serve until the member's successor is appointed. No member shall serve on the Committee for more than two consecutive full terms.

(b)        Qualifications. – The initial reflexologist appointees shall be citizens of the United States and North Carolina residents for at least two years prior to appointment, certified by the certifying entity as a reflexologist, and eligible to obtain a North Carolina Healing Arts License in reflexology under G.S. 90‑750.14. Upon appointment, each initial reflexologist appointee shall immediately seek to obtain a North Carolina Healing Arts License in reflexology under this Article and shall remain in good standing with the Committee during the appointee's term. Subsequent reflexologist appointees shall be citizens of the United States, residents of North Carolina, North Carolina Licensed Reflexologists, and appointed by the Commission from a list of names supplied by the North Carolina Reflexology Association or its successor. Public members of the Committee shall not be:

(1)        An agent or employee trained or experienced in the practice of reflexology.

(2)        An agent or employee of a person engaged in the practice of reflexology.

(3)        A member of a healing arts profession or a person enrolled in a program to become a member of a healing arts profession.

(4)        A spouse of an individual licensed under this Article.

(5)        Any person with significant financial interest in a health service or profession.

(c)        Meetings. – The Committee shall elect annually a chair and other officers as it deems necessary to carry out the purposes of this Article. The Committee may hold additional meetings upon the call of the chair or any two Committee members. A majority of the Committee shall constitute a quorum.

(d)       Compensation of Members; Expenses; Employees. – Members of the Committee shall receive no compensation for their services but shall receive per diem and necessary travel and subsistence expenses as provided in G.S. 138‑5 and G.S. 138‑6. In no event shall the State of North Carolina be liable for expenses incurred by the Committee in excess of the income derived from this Article.

§ 90‑750.13.  Powers and duties of Committee.

The Committee shall have the following powers and duties:

(1)        Administer and coordinate the provisions of this Part.

(2)        Make recommendations to the Commission to adopt, amend, or repeal rules to administer and enforce this Part.

(3)        Establish and determine qualification and fitness of applicants for a North Carolina Healing Arts License in reflexology under this Part.

(4)        Make recommendations to the Commission to issue, renew, deny, suspend, revoke, or refuse to issue or renew North Carolina Healing Arts License in reflexology under this Article.

(5)        Make recommendations to the Commission to discipline North Carolina Licensed Reflexologists.

(6)        Advise the Commission to seek civil and criminal penalties against nonlicensed individuals engaged in the practice of reflexology.

(7)        Provide all North Carolina Licensed Reflexologists with a wallet‑sized card identifying the bearer as a North Carolina Licensed Reflexologist.

(8)        Maintain a list of all reflexologists in the State who hold a North Carolina Healing Arts License in reflexology.

§ 90‑750.14.  Healing arts licensure in reflexology application and requirements.

Each individual desiring to obtain a North Carolina Healing Arts License in reflexology under this Article shall apply to the Committee in accordance with the procedures and rules prescribed by the Commission. The Committee shall recommend that the Commission issue a North Carolina Healing Arts License in reflexology to any applicant who furnishes evidence satisfactory to the Committee that the applicant meets all of the following criteria:

(1)        The applicant is at least 18 years of age.

(2)        The applicant is of good moral character as determined by the Committee.

(3)        The applicant holds a national certification issued by the certifying entity.

(4)        The applicant has paid an application or renewal fee to the Commission as specified in G.S. 90‑750.5.

§ 90‑750.15.  License renewal.

Every North Carolina Healing Arts License in reflexology issued by the Commission shall be renewed on or before January 1 every year. The Committee shall recommend that the Commission renew the North Carolina Healing Arts License in reflexology of any individual who files a renewal application with the committee and who meets the criteria set forth in G.S. 90‑750.14.

§ 90‑750.16.  Compensation for reflexology services.

(a)        Compensation may be received for reflexology services only when those services are performed by an individual holding a North Carolina Healing Arts License in reflexology. Nonlicensed individuals who provide reflexology services or who engage in the practice of reflexology are subject to the penalties in G.S. 90‑750.6 or an injunction under G.S. 90‑750.7 unless any of the following applies:

(1)        The individual is a reflexology student working to obtain a certification of completion from a nationally recognized reflexology education program.

(2)        The individual holds a certification of completion from a nationally recognized reflexology education program, and that program was completed no more than six months prior to that individual receiving compensation for reflexology services.

(b)        Unless all reflexology services are performed by individuals holding a North Carolina Healing Arts License in reflexology, a place of business where reflexology services are offered for compensation shall be subject to a civil penalty of no more than five hundred dollars ($500.00) for each violation and a suspension of any license to operate the business for no more than 90 days. The clear proceeds of the civil penalty assessed under this section shall be remitted to the Civil Penalty and Forfeiture Fund in accordance with G.S. 115C‑457.2. The Commission shall enforce the provisions of this subsection.

§ 90‑750.17.  License to be displayed; advertising.

(a)        At all places of business in which compensated reflexology services are offered, a valid and up‑to‑date license for all individuals offering compensated reflexology services shall be displayed in a prominent place.

(b)        All public advertising designed to attract clients for reflexology services shall identify that the services will be performed by an individual holding a North Carolina Healing Arts License in reflexology.

(c)        No individual shall use the title North Carolina Licensed Reflexologist unless that individual holds a valid North Carolina Healing Arts License in reflexology issued by the Commission. Individuals holding themselves out as North Carolina Licensed Reflexologists shall carry the identification card described in G.S. 90‑750.13(7) at all times when providing reflexology services. Individuals in violation of this subsection are subject to the penalties in G.S. 90‑750.6 or an injunction under G.S. 90‑750.7.

§ 90‑750.18.  Reciprocity.

The Committee may recommend that the Commission grant, upon application and payment of proper fees, a North Carolina Healing Arts License in reflexology to a person who has been licensed or certified to practice reflexology in another state or territory of the United States whose standards of competency are substantially equivalent to the requirements for licensure provided in this Article.

§ 90‑750.19.  Exemptions.

This Part shall not apply to an individual who may apply pressure to the reflex areas on the hands, feet, and outer ears in the regular course of that individual's work, so long as (i) the individual is licensed by this State as a massage and bodywork therapist, physician, chiropractor, acupuncturist, physical therapist, cosmetologist, registered nurse, or as a member of other professions licensed by the State and (ii) this application of pressure to the reflex areas on the hands, feet, and outer ears accounts for no more than twenty‑five percent (25%) of that individual's work.

Part 3. Music Therapy.

§ 90‑750.20.  Music therapy as a healing arts profession.

It is the policy of this State that the practice of music therapy shall be considered a healing arts profession.

§ 90‑750.21.  Definitions.

The following definitions apply in this Part:

(1)        Certifying entity. – The Certification Board for Music Therapists.

(2)        Committee. – The North Carolina Music Therapy Advisory Committee.

(3)        Music therapy. – The clinical and evidence‑based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program, including (i) assessment of a client's emotional, physical, and spiritual health; social functioning; communication abilities; and cognitive skills through the client's history and observation and interaction of the client in music and nonmusic settings, (ii) development and implementation of treatment plans, based on a client's assessed needs, using music interventions, including music improvisation, receptive music listening, song writing, lyric discussion, music and imagery, music performance, learning through music, and movement to music, and (iii) evaluation and documentation of the client's response to treatment.

(4)        Music therapy services. – The provision of services to accomplish music therapy goals, including (i) conducting an individualized assessment for the purpose of collecting systematic, comprehensive, and accurate data necessary to determine the course of action subsequent to the individualized treatment plan, (ii) planning and developing the individualized music therapy treatment plan that identifies an individual's goals, objectives, and potential treatment intervention strategies, (iii) implementing the individualized music therapy treatment plan consistent with the individual's overall treatment program, (iv) systematically evaluating and comparing the individual's response to the individualized music therapy treatment plan and suggesting modifications, as appropriate, (v) developing a discharge plan in collaboration with the individual, the individual's family, treatment team, and other identified support networks, when appropriate, (vi) minimizing the impact of environmental constraints as a barrier to participation in least restrictive environments for individuals engaging in music therapy, (vii) collaborating with and educating the individual, family, caregiver, and others to foster an environment responsive to the developmental needs of the individual as addressed in music therapy, and (viii) consulting with groups, programs, organizations, or communities to improve accessibility to music therapy services.

(5)        National certification. – A determination by the certifying entity that an individual has satisfied the certifying entity's requirements and that the individual has an active status with the certifying entity.

(6)        North Carolina Licensed Music Therapist. – An individual who has been issued a North Carolina Healing Arts License in music therapy by the Commission.

§ 90‑750.22.  North Carolina Music Therapy Advisory Committee.

(a)        Establishment. – The North Carolina Music Therapy Advisory Committee is created. The Committee consists of three members serving staggered terms. The initial Committee members shall be appointed on or before January 1, 2024, as follows:

(1)        The Commission shall appoint from a list of names submitted by the Music Therapy Association of North Carolina or its successor two music therapists eligible to obtain a North Carolina Healing Arts License in music therapy under this Article. One member shall serve an initial term of three years, and one member shall serve an initial term of two years.

(2)        The Commission shall appoint one public member who shall serve an initial term of one year.

Upon the expiration of the terms of the initial Committee members, each subsequent member shall be appointed for a term of three years. The term of a member shall begin on January 1 of each year. A member shall serve until the member's successor is appointed. No member shall serve on the Committee for more than two consecutive full terms.

(b)        Qualifications. – The initial music therapist appointees shall be citizens of the United States and North Carolina residents for at least two years prior to appointment, certified by the certifying entity as a music therapist, and eligible to obtain a North Carolina Healing Arts License in music therapy under G.S. 90‑750.24. Upon appointment, each initial music therapist appointee shall immediately seek to obtain a North Carolina Healing Arts License in music therapy under this Article and shall remain in good standing with the Committee during the appointee's term. Subsequent music therapist appointees shall be citizens of the United States, residents of North Carolina, North Carolina Licensed Music Therapists, and appointed by the Commission from a list of names supplied by the Music Therapy Association of North Carolina or its successor. Public members of the Committee shall not be:

(1)        An agent or employee trained or experienced in the practice of music therapy.

(2)        An agent or employee of a person engaged in the practice of music therapy.

(3)        A member of a healing arts profession or a person enrolled in a program to become a member of a healing arts profession.

(4)        A spouse of an individual licensed under this Article.

(5)        Any person with significant financial interest in a health service or profession.

(c)        Meetings. – The Committee shall elect annually a chair and other officers as it deems necessary to carry out the purposes of this Article. The Committee may hold additional meetings upon the call of the chair or any two Committee members. A majority of the Committee shall constitute a quorum.

(d)       Compensation of Members; Expenses; Employees. – Members of the Committee shall receive no compensation for their services but shall receive per diem and necessary travel and subsistence expenses as provided in G.S. 138‑5 and G.S. 138‑6. In no event shall the State of North Carolina be liable for expenses incurred by the Committee in excess of the income derived from this Article.

§ 90‑750.23.  Powers and duties of Committee.

The Committee shall have the following powers and duties:

(1)        Administer and coordinate the provisions of this Part.

(2)        Make recommendations to the Commission to adopt, amend, or repeal rules to administer and enforce this Part.

(3)        Establish and determine qualification and fitness of applicants for a North Carolina Healing Arts License in music therapy under this Part.

(4)        Make recommendations to the Commission to issue, renew, deny, suspend, revoke, or refuse to issue or renew a North Carolina Healing Arts License in music therapy under this Article.

(5)        Make recommendations to the Commission to discipline North Carolina Licensed Music Therapists.

(6)        Advise the Commission to seek civil and criminal penalties against nonlicensed individuals engaged in the practice of music therapy.

(7)        Provide all North Carolina Licensed Music Therapists with a wallet‑sized card identifying the bearer as a North Carolina Licensed Music Therapist.

(8)        Maintain a list of all music therapists in the State who hold a North Carolina Healing Arts License in music therapy.

§ 90‑750.24.  North Carolina Healing Arts License in music therapy requirements.

Each individual desiring to obtain a North Carolina Healing Arts License in music therapy under this Article shall apply to the Committee in accordance with the procedures and rules prescribed by the Commission. The Committee shall recommend that the Commission issue a North Carolina Healing Arts License in music therapy to any applicant who furnishes evidence satisfactory to the Committee that the applicant meets all of the following criteria:

(1)        Is 18 years of age or older.

(2)        Is of good moral character as determined by the Committee.

(3)        Has successfully completed an academic program accredited by the American Music Therapy Association (AMTA) with at least a bachelor's degree majoring in music therapy from an accredited college or university.

(4)        Has successfully completed the certification examination offered by the Certification Board for Music Therapists or its successor organization to become a Music Therapist‑Board Certified (MT‑BC).

(5)        Has successfully completed a minimum of 1,200 hours of clinical training with at least 180 hours in preinternship experiences and at least 900 hours in internship experiences. For purposes of this subdivision, the internship may be approved by an academic institution, the AMTA, or both.

(6)        Has paid an application or renewal fee.

§ 90‑750.25.  License renewal.

Every North Carolina Healing Arts License in music therapy issued by the Commission shall be renewed on or before January 1 every five years. The Committee shall recommend that the Commission renew the license of any individual who files a renewal application with the committee and who meets the licensure criteria set forth in G.S. 90‑750.14.

§ 90‑750.26.  Compensation for music therapy services.

Compensation may be received for music therapy services only when those services are performed by an individual holding a national certification. Nonlicensed individuals who provide music therapy services or who engage in the practice of music therapy are subject to the penalties in G.S. 90‑750.6 or an injunction under G.S. 90‑750.7.

§ 90‑750.27.  North Carolina Licensed Music Therapist.

No individual shall use the title North Carolina Licensed Music Therapist unless that individual holds a valid North Carolina Healing Arts License in music therapy issued by the Commission. Individuals holding themselves out as North Carolina Licensed Music Therapists shall carry the identification card described in G.S. 90‑750.23(7) at all times when providing music therapy. Individuals in violation of this section are subject to the penalties in G.S. 90‑750.6 or an injunction under G.S. 90‑750.7.

§ 90‑750.28.  Reciprocity.

The Committee may recommend that the Commission grant, upon application and payment of proper fees, a North Carolina Healing Arts License in music therapy to a person who has been licensed or certified to practice music therapy in another state or territory of the United States whose standards of competency are substantially equivalent to the requirements for licensure provided in this Article.

Part 4. Naturopathic Doctors.

§ 90‑750.30.  Naturopathic medicine as a healing arts profession.

It is the policy of this State that the practice of naturopathic medicine shall be considered a healing arts profession.

§ 90‑750.31.  Definitions.

The following definitions apply in this Part:

(1)        Approved program of naturopathic medicine. – A program that meets all of the following conditions:

a.         A program that provides graduate‑level, full‑time didactic and supervised clinical training in naturopathic medicine that is accredited, or has achieved candidacy status for accreditation, by the Council on Naturopathic Medical Education or an equivalent federally recognized accrediting body for the naturopathic medical profession recognized by the Committee, or if the program existed prior to the existence of the Council on Naturopathic Medical Education, the program must (i) have provided graduate‑level, full‑time didactic and supervised clinical training in naturopathic medicine for a duration of not less than 132 weeks and required completion within a period of not less than 35 months, (ii) be recognized as a reputable program by, and in good standing with, the Committee, and (iii) if the program is still in existence, be currently accredited, or have achieved candidacy status for accreditation by the Council on Naturopathic Medical Education or an equivalent federally recognized accrediting body for the naturopathic medical profession recognized by the Committee.

b.         A program that is offered by an institution of higher education that is accredited by a regional or national institutional accrediting body recognized by the United States Secretary of Education.

c.         If the program is offered in the United States, a program that awards the degree of Doctor of Naturopathy or Doctor of Naturopathic Medicine. If the program is offered in Canada, a program that awards the degree or diploma of Doctor of Naturopathy or Doctor of Naturopathic Medicine and is offered by an institution of higher education that has provincial approval for participation in government‑funded student aid programs.

d.         A program that has been approved by the Committee to meet the standards established by its rules.

(2)        Committee. – The North Carolina Naturopathic Medicine Advisory Committee.

(3)        Council. – The Naturopathic Doctors Formulary Council.

(4)        Criminal history. – A history of conviction, or of having pled guilty or no contest to a State or federal crime, whether a misdemeanor or felony.

(5)        Integrative medicine. – As defined in G.S. 90‑1.1.

(6)        Natural medicines. – Any herbal, nutritional, supplemental, homeopathic, or other nonprescription remedies.

(7)        Naturopathic medicine. – A system of natural health care that employs diagnosis and treatment using diagnostic techniques and natural therapies for the promotion, maintenance, and restoration of health and the prevention of disease, including all of the following:

a.         The administration or provision of any of the following for preventive and therapeutic purposes: natural medicines, natural therapies, natural topical medicines, hydrotherapy, dietary therapy, and naturopathic physical medicine.

b.         The use of diagnostic procedures, including physical and orificial examination, but excluding endoscopy, sigmoidoscopy, and colonoscopy.

c.         The ordering, performing, and interpretation of laboratory tests and diagnostic imaging.

(8)        Naturopathic physical medicine. – The manual use of massage, stretching, resistance, or naturopathic manipulation.

(9)        North Carolina Licensed Naturopathic Doctor. – An individual who has been issued a North Carolina Healing Arts License in naturopathic medicine by the Commission.

§ 90‑750.32.  Practice of naturopathic medicine; scope of practice.

(a)        Practice of Naturopathic Medicine. – A naturopathic doctor is a licensed health care provider having the same responsibilities as other licensed or registered health care providers regarding public health laws, reportable diseases and conditions, communicable disease control and prevention, and the recording of vital statistics. In diagnosing and treating an individual, a naturopathic doctor may employ the following therapies:

(1)        Dispense, administer, order, and advise the use of natural remedies derived from or substantially similar to molecular structure or function to natural sources for preventive and therapeutic purposes, including food, extracts of food, nutraceuticals, vitamins, minerals, amino acids, enzymes, botanicals and their extracts, homeopathic remedies prepared according to the Homeopathic Pharmacopoeia of the United States, and all dietary supplements and nonprescription drugs, as defined by the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 301 et seq.

(2)        Order and perform physical examinations and physiological function tests.

(3)        Order, perform, and interpret laboratory tests, including performing waived tests, as defined by the United States Food and Drug Administration Clinical Laboratory Improvement Amendments of 1988 (CLIA), including obtaining specimens to access and treat disease.

(4)        Order diagnostic imaging, including X ray, MRI, CT scan, ultrasound, mammogram, and bone densitometry. The scope of this subdivision excludes electrocardiograms, echocardiograms, electroencephalograms, and nuclear imaging.

(5)        Perform hot or cold hydrotherapy, naturopathic physical medicine, electromagnetic therapy, and therapeutic exercise.

(6)        Perform health education and health counseling, including dietary and lifestyle counseling.

(7)        Utilize routes of administration for substances, including oral, nasal, auricular, ocular, rectal, vaginal, and transdermal.

(8)        Perform care incidental to superficial lacerations and abrasions, including the application of topical and local anesthetics and antimicrobials.

(b)        Prohibitions. – A naturopathic doctor may practice only within the scope of practice authorized in this Article. A naturopathic doctor may not practice as any other health care professional licensed or registered under another Article of this Chapter unless otherwise licensed or registered by this State to do so. A naturopathic doctor may not perform any of the following functions unless otherwise licensed by this State to do so:

(1)        Prescribe, dispense, or administer any prescription drug or controlled substance, except as authorized by this Article.

(2)        Use general or spinal anesthetics.

(3)        Perform surgical procedures.

(4)        Administer ionizing radioactive substances for therapeutic purposes.

(5)        Child delivery.

(6)        Diagnose and treat cancer. This prohibition does not apply to adjunctive or complementary care of patients who have previously been or are currently diagnosed with cancer.

§ 90‑750.33.  North Carolina Licensed Naturopathic Doctor; license required; exemptions.

(a)        No individual shall practice, attempt to practice, or claim to practice naturopathic medicine unless the person has been licensed under the provisions of this Article.

(b)        Only an individual licensed under this Article may use the titles Naturopathic Doctor, Doctor of Naturopathic Medicine, Doctor of Naturopathy, Naturopathic Medicine, Naturopath, Licensed Naturopathic Doctor, or the abbreviations N.D. or ND, or any other titles, words, letters, abbreviations, or insignia indicating or implying that the individual is a licensed naturopathic doctor unless the individual has been licensed as a naturopathic doctor under this Article.

(c)        Exemptions. – Nothing in this Part shall be construed to prohibit or affect any of the following:

(1)        The practice of a profession by an individual who is licensed or registered under other laws of this State and is performing services within the authorized scope of practice.

(2)        The practice of naturopathic medicine by a person employed by the federal government while the person is engaged in the performance of duties prescribed by laws and regulations of the United States.

(3)        A person rendering aid in an emergency situation when no fee or other compensation for the service is received.

(4)        The practice of naturopathic medicine by a naturopathic doctor duly licensed or registered in another state, territory, or the District of Columbia when called into this State to consult with a licensed or registered health care provider for a period not to exceed six months.

(5)        The practice of naturopathic medicine by students completing a clinical requirement for graduation from an approved program of naturopathic medicine, so long as the practice is performed under the supervision of a physician licensed under Article 1 of this Chapter or a naturopathic doctor licensed under this Article and the clinical requirement does not exceed one year.

(6)        A person who does not hold himself or herself out to be a naturopathic doctor when furnishing information to customers or selling, administering, or utilizing nutritional supplements, herbs, food, homeopathic preparations, and such physical forces as heat, cold, water, touch, and light at the person's retail, health spa, or health consulting establishment.

§ 90‑750.34.  North Carolina Naturopathic Medicine Advisory Committee.

(a)        Establishment. – The North Carolina Naturopathic Medicine Advisory Committee is created. The Committee consists of three members serving staggered terms. The initial Committee members shall be appointed on or before January 1, 2024, as follows:

(1)        The Commission shall appoint from a list of names submitted by the North Carolina Association of Naturopathic Physicians or its successor two naturopathic doctors eligible to obtain a North Carolina Healing Arts License in naturopathic medicine under this Article. One member shall serve an initial term of three years, and one member shall serve an initial term of two years.

(2)        The Commission shall appoint one public member who shall serve an initial term of one year.

Upon the expiration of the terms of the initial Committee members, each subsequent member shall be appointed for a term of three years. The term of a member shall begin on January 1 of each year. A member shall serve until the member's successor is appointed. No member shall serve on the Committee for more than two consecutive full terms.

(b)        Qualifications. – The initial naturopathic doctor appointees shall be citizens of the United States and North Carolina residents for at least two years prior to appointment, graduates of an approved program of naturopathic medicine, and eligible to obtain a North Carolina Healing Arts License in naturopathic medicine under G.S. 90‑750.37. Upon appointment, each initial naturopathic doctor appointee shall immediately seek to obtain a North Carolina Healing Arts License in naturopathic medicine under this Article and shall remain in good standing with the Committee during the appointee's term. Subsequent naturopathic doctor appointees shall be citizens of the United States, residents of North Carolina, North Carolina Licensed Naturopathic Doctors, and appointed by the Commission from a list of names supplied by the North Carolina Association of Naturopathic Physicians or its successor. Public members of the Committee shall not be:

(1)        An agent or employee trained or experienced in the practice of naturopathic medicine.

(2)        An agent or employee of a person engaged in the practice of naturopathic medicine.

(3)        A member of a healing arts profession or a person enrolled in a program to become a member of a healing arts profession.

(4)        A spouse of an individual licensed under this Article.

(5)        Any person with significant financial interest in a health service or profession.

(c)        Meetings. – The Committee shall elect annually a chair and other officers as it deems necessary to carry out the purposes of this Article. The Committee may hold additional meetings upon the call of the chair or any two Committee members. A majority of the Committee shall constitute a quorum.

(d)       Compensation of Members; Expenses; Employees. – Members of the Committee shall receive no compensation for their services but shall receive per diem and necessary travel and subsistence expenses as provided in G.S. 138‑5 and G.S. 138‑6. In no event shall the State of North Carolina be liable for expenses incurred by the Committee in excess of the income derived from this Article.

§ 90‑750.35.  Powers and duties of Committee.

The Committee shall have the following powers and duties:

(1)        Administer and enforce the provisions of this Part.

(2)        Make recommendations to the Commission to adopt, amend, or repeal rules to administer and enforce this Part, including rules for approved continuing education.

(3)        Establish and determine qualification and fitness of applicants for a North Carolina Healing Arts License in naturopathic medicine under this Part.

(4)        Make recommendations to the Commission to issue, renew, deny, suspend, revoke, or refuse to issue or renew a North Carolina Healing Arts License in naturopathic medicine under this Article.

(5)        Make recommendations to the Commission to discipline North Carolina Licensed Naturopathic Doctors.

(6)        Advise the Commission to seek civil and criminal penalties against nonlicensed individuals engaged in the practice of naturopathic medicine.

(7)        Maintain a list of all naturopathic doctors in the State who hold a North Carolina Healing Arts License in naturopathic medicine.

(8)        Make recommendations to the Commission to adopt a formulary based on the recommendations of the Council made under G.S. 90‑750.36. The Committee may modify or reject any recommendation of the Council regarding the formulary.

§ 90‑750.36.  Naturopathic Doctors Formulary Council.

(a)        Composition and Terms. – The Naturopathic Doctors Formulary Council is formed within and appointed by the Committee and exists under the supervision of the Committee. The Council shall develop and recommend to the Committee, on an ongoing basis, a formulary for naturopathic doctors to use in practice.

(1)        The Council consists of the following members:

a.         Two naturopathic doctors who (i) hold a North Carolina Healing Arts License in naturopathic medicine, (ii) practice naturopathic medicine in North Carolina, (iii) have a minimum of two years of experience practicing naturopathic medicine, and (iv) have resided in North Carolina for at least two years prior to appointment.

b.         One physician licensed under Article 1 of Chapter 90 of the General Statutes who is involved in the practice of integrative medicine or teaches integrative medicine at a medical school and practices in the State.

c.         One physician licensed under Article 1 of Chapter 90 of the General Statutes who practices in the State.

d.         One pharmacist who has a background in pharmacognosy and who practices in the State.

e.         One member of the public who is not a licensed or registered health care professional and is not employed in a health care profession and resides in this State.

(2)        Members appointed under subdivision (1) of this subsection shall serve for a term of three years and shall continue to serve after the expiration of the term until a successor is appointed by the Committee.

(b)        Powers and Duties. – The Council shall have the following powers and duties:

(1)        Develop and recommend to the Committee a formulary for use by licensed naturopathic doctors.

(2)        Review, annually and at the discretion of the Committee, the formulary adopted by the Commission to determine whether any changes are necessary for compliance with current prescribing standards or the practice of naturopathic standards.

(3)        Recommend to the Committee any changes that, in the Council's discretion, need to be implemented to improve the formulary.

(c)        The formulary recommended to the Committee by the Council shall include natural remedies or a remedy derived from or substantially similar in molecular structure or function to natural sources that may require a prescription. Substances included in the formulary must be allowed within the scope of practice and should be protected within the future scope of practice for naturopathic doctors.

(d)       The Committee shall designate the chair of the Council and shall provide staff necessary to carry out the Council's powers and duties.

(e)        A Council member may not receive compensation but may receive reimbursement, as provided in G.S. 93B‑5.

§ 90‑750.37.  North Carolina Healing Arts License in naturopathic medicine requirements.

Each individual desiring to obtain a North Carolina Healing Arts License in naturopathic medicine under this Article shall apply to the Committee in accordance with the procedures and rules prescribed by the Commission. The Committee shall recommend that the Commission issue a North Carolina Healing Arts License in naturopathic medicine to any applicant who furnishes evidence satisfactory to the Committee that the applicant meets all of the following criteria:

(1)        Is 18 years of age or older.

(2)        Is of good moral and ethical character as determined by the Committee.

(3)        Has graduated from an approved program of naturopathic medicine.

(4)        Meets either of the following two conditions:

a.         Has successfully passed the Naturopathic Physicians Licensing Examination (NPLEX), a competency‑based national naturopathic licensing examination administered by the North American Board of Naturopathic Examiners or an equivalent successor agency recognized by the Committee.

b.         Has successfully passed a competency‑based state or Canadian province naturopathic licensing examination administered prior to the existence of NPLEX and approved by the Committee.

(5)        Has submitted to the Committee a written attestation that is approved by the Committee and that complies with all of the following criteria:

a.         The applicant attests to having a collaboration and consultation agreement with a physician licensed under Article 1 of Chapter 90 of the General Statutes and provides the name and license number of the physician identified in the collaboration and consultation agreement.

b.         An attestation that the physician has been informed of the collaboration and consultation agreement.

c.         The applicant attests to refer patients to physicians and to consult with physicians and other health care providers licensed or registered in this State.

d.         The applicant attests that the collaboration and consultation agreement does not require or implement supervision of the applicant by the physician or health care professional identified in the collaboration or consultation agreement.

(6)        Has submitted to any criminal history record check required by the Commission. The Committee is responsible for providing to the North Carolina Department of Justice the fingerprints of the person to be checked, a form signed by the person consenting to the criminal record check and the use of fingerprints and other identifying information required by the State or national repositories, and any additional information required by the Department of Justice. The Committee and Commission shall keep all information obtained pursuant to this section confidential. If a criminal history record check reveals one or more convictions, the conviction does not automatically bar licensure, in accordance with Chapter 93B of the General Statutes. The Committee shall consider all of the following factors regarding the conviction:

a.         The level of seriousness of the crime.

b.         The date of the crime.

c.         The age of the person at the time of the conviction.

d.         The circumstances surrounding the commission of the crime, if known.

e.         The nexus between the criminal conduct of the person and the job duties of the position to be filled.

f.          The person's prison, jail, probation, parole, rehabilitation, and employment records since the date the crime was committed.

g.         The subsequent commission of a crime by the person.

h.         Any additional criteria specified in G.S. 93B‑8.1.

(7)        Has submitted to the Committee any other documentation the Committee deems necessary to determine the applicant's fitness for licensure under this Article. This documentation may include successful completion of a Committee‑approved jurisprudence examination on State laws and rules related to naturopathic medicine.

(8)        Has paid an application or renewal fee.

§ 90‑750.38.  License renewal and reinstatement.

(a)        Renewal. – Every North Carolina Healing Arts License in naturopathic medicine issued by the Commission shall be renewed on or before January 1 every year. The Committee shall recommend that the Commission renew the license of any individual who files a renewal application with the committee, meets the licensure criteria set forth in G.S. 90‑750.34, and has completed at least 20 hours of continuing education approved by the Committee within the one‑year period immediately prior to the renewal date.

(b)        Reinstatement. – An individual who held a North Carolina Healing Arts License in naturopathic medicine who has allowed the license to lapse by failure to renew within the time allowed under subsection (a) of this section may apply for reinstatement. The Committee may recommend reinstatement of the applicant's license if the applicant pays the required fees, furnishes a statement of the reason for failure to apply for renewal before the deadline, and complies with any other requirements established in rules adopted by the Commission. If the license has lapsed for five years or longer, the Committee may recommend that the Commission require the applicant to satisfactorily complete one or more skills assessment or remediation courses approved by the Commission or to provide proof of active licensure, or registration within the past five years in another state, district, territory, or Canadian province.

§ 90‑750.39.  Reciprocity.

The Committee may recommend the Commission issue, upon application and payment of fees, a North Carolina Healing Arts License in naturopathic medicine to a person who resides in this State and is actively licensed or registered to practice as a naturopathic doctor in another state, district, territory, or Canadian province.

§ 90‑750.40.  Reports; immunity from suit.

(a)        Report. – A person who has reasonable cause to suspect misconduct or incapacity of a North Carolina Licensed Naturopathic Doctor, or who has reasonable cause to suspect that a person is in violation of this Part, may report the relevant facts to the Committee. Upon receipt of a charge, the Committee shall recommend that the Commission investigate the charge and take appropriate action, including discipline, if necessary. Upon receipt of a charge, the Commission may give notice of an administrative hearing or may, after diligent investigation, dismiss unfounded charges. A person who, in good faith, makes a report pursuant to this section is immune from any criminal prosecution or civil liability resulting from making the report.

(b)        Limited Immunity. – Both the Commission and the Committee, including their officers, employees, and staff, are immune from any criminal prosecution or civil liability for exercising, in good faith, the powers and duties given under this Article.

§ 90‑750.41.  Third‑party reimbursement.

Nothing in this Article shall be construed to require direct third‑party reimbursement to persons licensed under this Article.

SECTION 1.(b)  G.S. 90‑18(c) reads as rewritten:

(c)      The following shall not constitute practicing medicine or surgery as defined in this Article:

…

(21)      The practice of naturopathic medicine by a naturopathic doctor licensed under Article 44 of this Chapter.

SECTION 1.(c)  G.S. 90‑624 is amended by adding a new subdivision to read:

(9)      A licensed reflexologist engaged in the practice of reflexology, as defined in G.S. 90‑750.11.

SECTION 1.(d)  Article 13 of Chapter 143B of the General Statutes is amended by adding a new section to read:

§ 143B‑975.  Criminal record checks for applicants for licensure as a naturopathic doctor.

(a)        The Department of Public Safety may provide to the North Carolina Naturopathic Medicine Advisory Committee a criminal history record from the State and National Repositories of Criminal Histories for applicants for licensure by the Committee. Along with a request for criminal history records, the Committee shall provide to the Department of Public Safety the fingerprints of the applicant or subject, a form signed by the applicant consenting to the criminal history record check and use of the fingerprints and other identifying information required by the Repositories, and any additional information required by the Department. The fingerprints shall be forwarded to the State Bureau of Investigation for a search of the State's criminal history record file, and the State Bureau of Investigation shall forward a set of fingerprints to the Federal Bureau of Investigation for a national criminal history record check. The Committee shall keep all information obtained pursuant to this section confidential.

(b)        The Department of Public Safety may charge a fee to offset the cost incurred by the Department of Public Safety to conduct a criminal history record check under this section, but the fee shall not exceed the actual cost of locating, editing, researching, and retrieving the information.

SECTION 2.  Section 1 of this act becomes effective January 1, 2024. The remainder of this act is effective when it becomes law.