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RULE PROPOSALS
VOLUME 45, ISSUE 7
ISSUE DATE: APRIL 1, 2013
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF MEDICAL EXAMINERS
ACUPUNCTURE EXAMINING BOARD

Proposed Amendments: N.J.A.C. 13:35-9.1, 9.2, 9.4, 9.5, 9.8 through 9.16, and 9.20

Proposed New Rule: N.J.A.C. 13:35-9.12A

Proposed Repeals: N.J.A.C. 13:35-9.6, 9.17, 9.18, and 9.19



Purpose and Scope; Definitions; Education Required for Licensure; New Jersey Acupuncture Safety and Jurisprudence Examination; Training Required of a Physician or Dentist; Fee Schedule; Biennial License Renewal; License Suspension; Reinstatement of Suspended License; Inactive Status; Return from Inactive Status; Display of License; Informed Consent; Medical Malpractice; Scope of Practice; Herbology; Guest Acupuncturist; Unlicensed Practice of Acupuncture; Precautionary and Sterilization Procedures; Preparation of Patient Records; Computerized Records; Access to or Release of Information; Confidentiality, Transfer, or Disposal of Records; Tutorial Applications and Design of Tutorial Program; Responsibilities of Supervising Acupuncturist; Responsibilities of the Acupuncture Apprentice; Continuing Professional Education Requirements
 
Authorized By: Acupuncture Examining Board, Renee Clark, Executive Director and State Board of Medical Examiners, William Roeder, Executive Director.
 
Authority: N.J.S.A. 45:2C-3 and P.L. 2009, c. 56.
 
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
 
Proposal Number: PRN 2013-059.
 
Submit comments by: July 31, 2013 to:
 
   Renee Clark, Executive Director
   State Acupuncture Examining Board
   Division of Consumer Affairs
   124 Halsey Street
   PO Box 45002
   Newark, New Jersey 07101
 
The agency proposal follows:
 
Summary

P.L. 2009, c. 56 amended N.J.S.A. 45:2C-1 et seq. governing the regulation of acupuncturists in New Jersey. The Acupuncture Examining Board (Board) proposes to amend or repeal several rules in N.J.A.C. 13:35-9 in order to effectuate P.L. 2009, c. 56.

P.L. 2009, c. 56 amended N.J.S.A. 45:2C-1 et seq., so that acupuncturists are now licensed by the Board, not certified. Accordingly, throughout the rules, the terms "certified," "certification," and "certificate holder" are proposed to be changed to "licensed," "license," and "licensee," respectively. Previously, N.J.S.A. 45:2C-9 permitted an applicant to qualify for certification as an acupuncturist by completing a tutorial. P.L. 2009, c. 56 amended N.J.S.A. 45:2C-9 by deleting the provision that permitted an applicant to complete a tutorial program. The Board proposes to repeal N.J.A.C. 13:35-9.17, 9.18, and 9.19, which outline the requirements for a tutorial program. The Board also proposes to amend N.J.A.C. 13:35-9.1, 9.2, 9.4, 9.8, 9.12, 9.13, and 9.14, to delete references to tutorial programs and the training agreements, plans, and programs that were part of tutorial programs.

The Board proposes to amend N.J.A.C. 13:35-9.2 to provide new definitions for the terms "ACOAM," "adjunctive therapies," "gua sha," "glandulars," "herbology," "oriental dietary therapy," "oriental medicine," "qigong," and "tuina." The Board also proposes to amend the definition of "acupuncture" to recognize that it includes the practice of oriental medicine and adjunctive therapies. The definition of "acupuncture program" is proposed for amendment to require that such programs be at least three, rather than two, years long.

Under N.J.S.A. 45:2C-9 prior to amendment, the holder of a license to practice medicine and surgery satisfied the educational requirements for certification as an acupuncturist. P.L. 2009, c. 56 amended N.J.S.A. 45:2C-9 by deleting this provision. The Board proposes to amend N.J.A.C. 13:35-9.4 to remove provisions that recognized that holding a license to practice medicine and surgery satisfied the educational requirements for licensure. N.J.A.C. 13:35-9.4(a)1 requires a baccalaureate degree to meet the requirements of subsection (b). this subsection does not establish baccalaureate degree requirements and the Board proposes to amend this rule to delete the cross-reference to subsection (b).

The Board proposes to amend N.J.A.C. 13:35-9.5 to clarify that an applicant who is required to retake the licensing examination must pass the examination before being issued a license.

N.J.A.C. 13:35-9.6 sets forth requirements that a physician or dentist must meet in order to practice acupuncture. P.L. 2009, c. 56 established that such a physician or dentist is subject to oversight by the Board of Medical Examiners or the Board of Dentistry. It is therefore no longer appropriate for the Board to have rules establishing standards for physicians or dentists and the Board proposes to repeal N.J.A.C. 13:35-9.6.

The Board proposes to amend the heading of N.J.A.C. 13:35-9.8 to delete the word "refunds." N.J.A.C. 13:35-9.8(b) and (c) refer to refund of examination fees. As the Board no longer charges an examination fee, it proposes to delete these two subsections. N.J.A.C. 13:35-9.9 incorrectly references the rule on fees as N.J.A.C. 13:35-9.6. This rule was recodified as N.J.A.C. 13:35-9.8 in 2010, see 41 N.J.R. 2617(a); 42 N.J.R. 1216(a), effective June 21, 2010. The Board proposes to amend N.J.A.C. 13:35-9.9 to reflect this recodification. Prior to amendment, N.J.S.A. 45:2C-5 required that an initial acupuncture treatment be performed only upon a referral or diagnosis from a physician. P.L. 2009, c. 56 amended this, so that a referral is no longer required for an initial acupuncture treatment. The amendments to the law imposed two new requirements on licensed acupuncturists: that they advise patients as to the importance of consulting a physician and that they maintain medical malpractice insurance. The Board proposes to amend the heading of N.J.A.C. 13:35-9.11 to delete "referral" from the heading and add "medical malpractice." The Board proposes to delete subsection (a) of the rule, which deals with the required referral or diagnosis from a physician. The Board proposes to amend the rule to require that acupuncturists obtain informed written consent from patients and signed forms indicating that they informed their patients as of the importance of consulting physicians as part of their records. The Board also proposes to amend the rule to require licensed acupuncturists to maintain medical malpractice insurance in the sum of one million dollars per occurrence and three million dollars per policy year. The Board researched the amount of malpractice insurance required in other states and found that the average amount was the one million/three million the Board proposes for its licensees.

P.L. 2009, c. 56 recognizes that acupuncture includes the practice of Oriental medicine. The Board proposes to amend N.J.A.C. 13:35-9.12 to include new procedures in the acupuncture scope of practice pursuant to the expanded scope provided in P.L. 2009, c. 56. The Board proposes to delete reference to stimulating acupuncture points and channels in subsection (b). This reference is no longer accurate as the practice of acupuncture, pursuant to P.L. 2009, c. 56, now encompasses more than just stimulating acupuncture points and channels. The Board proposes to amend the rule to correct spellings and to recognize several new procedures, such as Oriental dietary therapy, lifestyle and behavioral education, Qigong, diagnostic and assessment techniques, Taiji, energetic therapy, biofeedback, and percutaneous electrical nerve stimulation, [page=730] which are now part of acupuncture practice. The Board proposes to allow acupuncturists to recommend the use of meditation and products that facilitate health to patients and to use non-insertive pressure needles when providing acupuncture at subsections (c) and (d), respectively. The rule currently allows acupuncturists to use disposable lancets when providing acupuncture. As there is no difference between disposable and other kinds of lancets, it is not necessary to limit acupuncturists to use only disposable lancets. The Board proposes to amend the rule to allow acupuncturists to use any kind of lancet. The Board also proposes to amend N.J.A.C. 13:35-9.12, so that it is clear that the only acupuncturists who can perform herbology are those who have met the requirements set forth in N.J.A.C. 13:35-9.12A and to permit licensees to offer goods and devices to patients. Licensees may charge only a fair market value for these goods and devices.

P.L. 2009, c. 56 permits acupuncturists who complete specific education to use herbology as part of their acupuncture practice. The Board proposes new N.J.A.C. 13:35-9.12A to set forth that education. An acupuncturist who seeks to practice herbology must submit to the Board proof that he or she is certified in Chinese Herbology or Oriental Medicine by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). The rule provides an alternative route to obtain permission to practice herbology for acupuncturists who obtained their license prior to November 2, 2009. The proposed new rule also provides an alternative route for students who were enrolled in an acupuncture program prior November 2, 2009. These alternative routes will be valid only for six months from the effective date of the new rule. The proposed new rule requires that any acupuncturist who is permitted to practice herbology to complete at least 10 hours of continuing education related to herbology every biennial renewal period.

N.J.A.C. 13:35-9.16 requires licensees to maintain as part of their records an indication that a referral or diagnosis from a physician was made for a patient. As a referral or diagnosis from a physician is no longer required, the Board proposes to delete this provision. The Board proposes to amend the rule to require that licensees maintain in their records documentation of any recommendations made to a patient as to the use of meditation or products that facilitate health.

The Board proposes to amend N.J.A.C. 13:35-9.20 to correct a mistaken reference to the number of continuing education credits acupuncturists are required to complete every biennial renewal period, from 20 to 30, as required under subsection (c).

The Board has determined that the comment period for this notice of proposal shall be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this notice is excepted from the rulemaking calendar requirement.
 
Social Impact

The proposed amendments and repeals will benefit those who receive acupuncture services by requiring that acupuncturists advise patients as to the importance of consulting a physician. Requiring acupuncturists to maintain medical malpractice insurance will benefit society by ensuring that licensed acupuncturists have the resources to cover any damages due to malpractice on their part. Proposed amendments to N.J.A.C. 13:35-9.12 will benefit the public by increasing the services that acupuncturists can provide to patients. Proposed new N.J.A.C. 13:35-9.12A will protect patients by ensuring that the acupuncturists who practice herbology have sufficient education to provide this service in a safe and effective manner.
 
Economic Impact

The statutory requirement that licensed acupuncturists maintain medical malpractice insurance will impose costs on licensees. Research indicates that such insurance can cost between $ 600.00 and $ 1,000 a year. These costs are outweighed by the benefits the public receives by ensuring that licensed acupuncturists have the resources to cover any damages due to malpractice on the part of the licensed acupuncturist. The proposed education requirements for licensed acupuncturists who seek to practice herbology will impose costs on such licensees. It costs $ 725.00 to become certified in herbology by NCCAOM and $ 220.00 to renew this certification, which is valid for four years. These costs are outweighed by the benefit patients receive from acupuncturists being properly educated to provide herbology in a safe and effective manner. The proposed amendments, repeals, and new rule do not impose any other costs.
 
Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments, repeals, and new rule do not involve any Federal standards or requirements.
 
Jobs Impact

The Board does not believe that the proposed amendments, repeals, and new rule will have an impact on jobs in New Jersey.
 
Agriculture Industry Impact

The Board does not believe that the proposed amendments, repeals, and new rule will have any impact on the agriculture industry of this State.
 
Regulatory Flexibility Analysis

Since acupuncturists are individually licensed by the Board, they may be considered "small businesses" under the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq.

Costs that small businesses may incur are the same for all acupuncturists incur as summarized in the Economic Impact statement above. The Board does not believe that acupuncturists will need to employ any professional services in order to comply with the proposed amendments, repeals, and new rule. The proposed amendments, repeals, and new rule imposes compliance, recordkeeping, and reporting requirements as summarized in the Summary above.

As the proposed amendments, repeals, and new rule protects the health, safety, and welfare of patients who receive acupuncture services, the Board believes that the rules must be uniformly applied to all acupuncturists and no exemptions are provided based on the size of the acupuncturist's business.
 
Housing Affordability Impact Analysis

The proposed amendments, repeals, and new rule will have an insignificant impact on affordable housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the rules concern the practice of acupuncturists.
 
Smart Growth Development Impact Analysis

The proposed amendments, repeals, and new rule will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules would evoke a change in housing production in Planning Areas 1 or 2, or within designated centers, under the State Development and Redevelopment Plan in New Jersey because the rules concern the practice of acupuncturists.
 
Full text of the rules proposed for repeal may be found in the New Jersey Administrative Code at N.J.A.C. 13:35-9.6, 9.17, 9.18, and 9.19.
 
Full text of the proposed amendments and new rule follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):
 
SUBCHAPTER 9.    ACUPUNCTURE
 
13:35-9.1   Purpose and scope
 
(a) (No change.)
 
(b) [These rules] The rules of this subchapter shall apply to all persons [certified] licensed as acupuncturists by the State of New Jersey, applicants for such [certification] licensure, guest acupuncturists granted temporary permission by the Board to perform acupuncture pursuant to N.J.A.C. 13:35-9.13, students participating in an approved course of study[,] or school [or tutorial program] in acupuncture, and persons licensed in New Jersey as physicians or dentists who practice acupuncture, provided that their courses of training have included acupuncture.
 
13:35-9.2   Definitions
 
For purposes of this subchapter, the following terms shall have the following meanings:
 
"ACAOM" means the Accreditation Commission for Acupuncture and Oriental Medicine.
 
"Acupuncture" means the practice of Oriental medicine based on traditional Oriental medical theories, including stimulation of a certain point or points on or near the surface of the body by the insertion of [page=731] special needles to prevent or modify the perception of pain or to normalize physiological functions including pain control and for the treatment of certain diseases or dysfunctions of the body. "Acupuncture" includes the techniques electroacupuncture, mechanical stimulation, adjunctive therapies, and moxibustion.
 
"Acupuncture program" means a course of study in acupuncture that is at least [two] three years long and which is in addition to and separate from a baccalaureate degree program.
 
["Acupuncture tutorial" means an acupuncture tutorial program which has been approved by the Acupuncture Examining Board and which provides applicants who successfully complete the program with the requirements to sit for the examination for certification as an acupuncturist.]
 
"Acupuncturist" means an individual [certified] licensed by the Board to perform acupuncture services.
 
["Apprentice" means a person who is registered with the Board in order to participate in an acupuncture tutorial under a supervising acupuncturist.]
 
"Adjunctive therapies" means those practices taught in ACAOM-approved schools and through NCCAOM-approved continuing education courses that are complementary to the performance of acupuncture.
 
. . .
 
["Certified," "certification," and "certificate" mean Board-issued authorization that an individual possesses the qualifications to perform acupuncture services.]
 
. . .
 
"Glandulars" means non-prescriptive supplements that are derived from glands.
 
"Gua sha" means scraping applied to the surface of the skin with a round edged tool for therapeutic purposes.
 
. . .
 
"Herbology" means the administration or recommendation of botanical, mineral, or animal substances, and includes prepared and raw forms of single herbs or formulas, and dietary supplements that incorporate herbs as ingredients. "Herbology" does not include the injection of herbs.
 
. . .
 
"Oriental dietary therapy" means dietary and nutritional counseling and the recommendation of foods for therapeutic purposes.
 
"Oriental medicine" means a whole medical system originating in East Asia that aims to treat disease and support the body's ability to heal itself with a diverse range of traditional and modern therapeutic interventions.
 
"Qigong" means breathing techniques and exercises that promote health.
 
. . .
 
["Supervising acupuncturist" or "supervisor" means a certified acupuncturist who is approved by the Board to provide an acupuncture tutorial to a trainee.]
 
. . .
 
["Training agreement" means the written tutorial agreement between the supervisor and the trainee.
 
"Training plan" means the written tutorial plan that is filed with and approved by the Board.
 
"Training program" means and encompasses the agreement and the plan.]
 
"Tuina" means a form of massage therapy based on traditional Oriental medical theories using or incorporating traction, manipulation of acupressure points, acupoint stimulation, and joint mobilization for therapeutic purposes.
 
13:35-9.4   Education required for [certification] licensure
 
(a) In order to qualify for [certification] licensure, an applicant shall meet one of the following education requirements:
 
1. Obtain a baccalaureate degree[, which meets the requirements of (b) below,] from a school within the United States and graduate from an acupuncture program, which meets the requirements of (e) below; or
 
2. Obtain the equivalent of a baccalaureate degree from a school in another country and complete either:
 
i. (No change.)
 
ii. An acupuncture program that is part of the baccalaureate degree program or its equivalent in another country[;].
 
[3. Hold an unencumbered license as a physician in New Jersey or a license as a dentist in New Jersey. An applicant who qualifies for certification by this method shall submit to the Board proof that he or she holds a license to practice medicine and surgery in New Jersey or a license to practice dentistry in New Jersey; or
 
4. Successfully complete a tutorial program in acupuncture, which meets the requirements set forth in N.J.A.C. 13:35-9.17.]
 
(b)-(d) (No change.)
 
(e) An acupuncture program that is required for [certification] licensure shall be given by a school accredited by the Accreditation Commission for Acupuncture and Oriental Medicine, the Commission on Recognition of Post-Secondary Accreditation, or the United States Department of Education. A list of accredited acupuncture schools shall be maintained by the Board and provided to an applicant upon request. An applicant shall arrange for the school of acupuncture to submit a certified transcript confirming that a diploma was awarded to the applicant directly to the Board.
 
(f)-(g) (No change.)
 
13:35-9.5   New Jersey acupuncture safety and jurisprudence examination
 
(a)-(b) (No change.)
 
(c) An applicant who has passed the acupuncture safety and jurisprudence examination shall become [certified] licensed within six months of passing the examination. If an applicant fails to become [certified] licensed within the six months, he or she shall be required to retake and pass the examination before being issued a [certificate] license.
 
13:35-9.6   (Reserved)
 
13:35-9.8   Fee schedule[; refunds]
 
(a) The Board shall charge the following fees:
 
1.-3. (No change.)
 


4. Duplicate or replacement of biennial registration

[certificate] license

$ 25.00

 

5. Late Fee (biennial [certification] license)

$ 50.00

 

6. Inactive [Certificate] License Fee

 

(to be determined by

Director by regulation)

 

7. (No change.)

 

[8. Tutorials:

 

i. Supervisor:

 

(1) Application Fee

$ 50.00

 

(2) Initial Registration

$ 125.00

 

(3) Renewal, Annually

$ 125.00

 

(4) Delinquency Fee

$ 50.00

 

ii. Trainee:

 

(1) Application Fee

$ 25.00

 

(2) Initial Registration

$ 60.00]


 
Recodify existing 9. and 10. as 8. and 9. (No change in text.)
 
[(b) The examination fee will be refunded only if the application is rejected by the Board or withdrawn by the candidate within 14 days of receipt of the application by the Board.
 
(c) After the 14-day period in (b) above, an applicant who fails to sit for an examination for which payment has been submitted may, one time only, have the fee credited toward the next scheduled examination. The fee will be entirely forfeited if the applicant fails to sit for the succeeding examination.]
 
[(d)] (b) (No change in text.)
 
13:35-9.9   Biennial [certificate] license renewal; [certificate] license suspension; reinstatement of suspended [certificate] license; inactive status; return from inactive status
 
(a) All [certificates] licenses to practice acupuncture issued by the Board shall be issued for a two-year biennial [certification] licensure period. A [certificate holder] licensee who seeks renewal of the [page=732] [certificate] license shall submit a renewal application and the renewal fee set forth in N.J.A.C. 13:35-[9.6]9.8 prior to the expiration date of the [certificate] license.
 
(b) (No change.)
 
(c) If a [certificate holder] licensee does not renew the [certificate] license prior to its expiration date, the [certificate holder] licensee may renew the [certificate] license within 30 days of its expiration by submitting a renewal application, a renewal fee, and a late fee, as set forth in N.J.A.C. 13:35-[9.6]9.8. During this 30-day period, the [certificate] license shall be valid, and the [certificate holder] licensee shall not be deemed to be engaged in unauthorized practice.
 
(d) A [certificate] license that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended [certificate] license shall be deemed to be engaged in unauthorized practice.
 
(e) A [certificate holder] licensee whose [certificate] license has been automatically suspended for five years or less for failure to renew pursuant to (d) above may be reinstated by the Board upon completion of the following:
 
1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-[9.6]9.8;
 
2. Completion of the continuing education units required for each biennial registration period for which the [certificate holder] license was suspended; and
 
3. Submission of an affidavit of employment listing each job held during the period of the suspended [certificate] license, which includes the name, address, and telephone number of each employer.
 
(f) In addition to the fulfilling the requirements set forth in (e) above, a [certificate holder] licensee whose [certificate] license has been automatically suspended for more than five years who wishes [to return] to have his or her [certificate] license reinstated shall reapply for [certification] licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her [certificate] license.
 
(g) Renewal applications shall provide the [certificate holder] licensee with the option of either active or inactive status. A [certificate holder] licensee electing inactive status shall pay the inactive [certificate] license fee set forth in N.J.A.C. 13:35-[9.6]9.8 and shall not engage in the practice of acupuncture.
 
(h) A [certificate holder] licensee who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board upon completion of the following:
 
1. (No change.)
 
2. The completion of the continuing education units required for each biennial [certification] registration period for which the [certificate holder] licensee was on inactive status; and
 
3. Submission of an affidavit of employment listing each job held during the period the [certificate holder] licensee was on inactive status, which includes the name, address, and telephone number of each employer.
 
(i) In addition to the fulfilling the requirements set forth in (h) above, a [certificate holder] licensee who has been on inactive status for more than five years who wishes to return to practice shall reapply for [certification] licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her [certificate] license.
 
13:35-9.10   Display of [certificate] license
 
A [certified] licensed acupuncturist shall post his or her [certificate] license in a conspicuous location in his or her office. If a [certified] licensed acupuncturist has more than one office, he or she shall obtain from the Board a duplicate [certificate] license for each location.
 
13:35-9.11   [Referral; informed] Informed consent; medical malpractice
 
[(a) A certified acupuncturist may perform initial acupuncture treatment only on presentation by the patient of a referral by or diagnosis from a licensed physician. The referring or diagnosing physician shall provide to the treating acupuncturist a diagnosis and preevaluation of the patient.]
 
[(b)] (a) The acupuncturist shall fully disclose to the patient such information as will enable the patient to make an evaluation of the nature of the treatment and of any attendant risks, as well as of available alternative options and the risks and likely outcomes of those alternatives. The acupuncturist shall obtain, and maintain as part of his or her patient records, informed written consent from the patient before beginning acupuncture treatment.
 
(b) A licensed acupuncturist shall advise every patient as to the importance of consulting with a licensed physician regarding the patient's condition.
 
(c) A licensed acupuncturist shall maintain as part of his or her patient records a form, with the date and the signatures of the patient and the licensed acupuncturist, indicating that the licensed acupuncturist has advised the patient as required under (b) above.
 
(d) Licensed acupuncturists shall maintain medical malpractice insurance in the sum of $ 1 million per occurrence and $ 3 million per policy year.
 
13:35-9.12   Scope of practice
 
(a) The use of any of the following to effect the stimulation of acupuncture points and channels is within the scope of practice of [certified] licensed acupuncturists and shall be performed only by acupuncturists [certified] licensed by the Board, individuals permitted to practice pursuant to N.J.S.A. 45:2C-8 and N.J.A.C. 13:35-9.6, students in acupuncture programs that meet the requirements of N.J.A.C. 13:35-9.4(e), or guest acupuncturists permitted to perform acupuncture in New Jersey pursuant to N.J.A.C. 13:35-9.13 [or apprentices in acupuncture tutorial programs that meet the requirements of N.J.A.C. 13:35-9.17]:
 
1.-4. (No change.)
 
(b) [Certified] Licensed acupuncturists, individuals permitted to practice pursuant to N.J.S.A. 45:2C-8 and N.J.A.C. 13:35-9.6, students in acupuncture programs that meet the requirements of N.J.A.C. 13:35-9.4(e), or guest acupuncturists permitted to perform acupuncture in New Jersey pursuant to N.J.A.C. 13:35-9.13 [or apprentices in acupuncture tutorial programs that meet the requirements of N.J.A.C. 13:35-9.17] may, in addition to the methods listed in (a) above, use any of the following [methods to effect the stimulation of acupuncture points and channels] as part of his or her professional practice:
 
1.-5. (No change.)
 
6. [Gwa-sha] Gua sha scraping techniques;
 
7. (No change.)
 
8. [Tui-na] Tuina;
 
9.-11. (No change.)
 
[12. Herbal applications;]
 
[13.] 12. (No change in text.)
 
[14.] 13. Breathing techniques; [and]
 
[15. Exercise to promote health and energetic balance.]
 
14. Therapeutic exercise and techniques;
 
15. Oriental dietary therapy;
 
16. Lifestyle and behavioral education;
 
17. Percutaneous and transcutaneous electrical nerve stimulation;
 
18. Qigong;
 
19. Biofeedback and other devices that utilize color, light, sound, and electromagnetic energy for therapeutic purposes;
 
20. Diagnostic and assessment techniques that are taught in ACAOM-approved schools and through NCCAOM-approved continuing education courses and which assist in acupuncture and Oriental medicine diagnosis, corroboration, and monitoring of a treatment plan or in making a determination to refer a patient to another healthcare provider;
 
21. Taiji; and
 
22. Energetic therapy.
 
[page=733] (c) Licensed acupuncturists, individuals permitted to practice pursuant to N.J.S.A. 45:2C-8 and N.J.A.C. 13:35-9.6, students in acupuncture programs that meet the requirements of N.J.A.C. 13:35-9.4(e), or guest acupuncturists permitted to perform acupuncture in New Jersey pursuant to N.J.A.C. 13:35-9.13 may recommend to patients the use of:
 
1. Meditation; and
 
2. Products that facilitate health, such as:
 
i. Homeopathic medicine that is recognized in the official Homeopathic Pharmacopoeia of the United States;
 
ii. Vitamins;
 
iii. Minerals;
 
iv. Enzymes;
 
v. Glandulars;
 
vi. Amino acids;
 
vii. Nonprescription substances; and
 
viii. Nutritional or dietary supplements that meet Food and Drug Administration labeling requirements, 21 CFR 101.36, unless otherwise prohibited by State or Federal law.
 
[(c)] (d) [Certified] Licensed acupuncturists, individuals permitted to practice pursuant to N.J.S.A. 45:2C-8 and N.J.A.C. 13:35-9.6, students in acupuncture programs that meet the requirements of N.J.A.C. 13:35-9.4(e), or guest acupuncturists permitted to perform acupuncture in New Jersey pursuant to N.J.A.C. 13:35-9.13 [or apprentices in acupuncture tutorial programs which meet the requirements of N.J.A.C. 13:35-9.17] may use the following when providing acupuncture:
 
1.-4. (No change.)
 
5. Prismatic needles; [and]
 
[6. Disposable lancets.]
 
6. Lancets; and
 
7. Non-insertive pressure needles.
 
[(d)] (e) [Certified] Licensed acupuncturists, students in acupuncture programs that meet the requirements of N.J.A.C. 13:35-9.4(e), or guest acupuncturists permitted to perform acupuncture in New Jersey pursuant to N.J.A.C. 13:35-9.13 [or apprentices in acupuncture tutorial programs which meet the requirements of N.J.A.C. 13:35-9.17] shall not use the following when providing acupuncture:
 
1.-3. (No change.)
 
(f) The only licensed acupuncturists who may practice herbology are those qualified to do so under N.J.A.C. 13:35-9.12A.
 
(g) Licensed acupuncturists may offer and provide to a patient, at fair market value, goods and devices.
 
13:35-9.12A   Herbology
 
(a) Except as set forth in (b) and (c) below, a licensed acupuncturist shall practice herbology only if he or she submits proof to the Board of current certification in Chinese Herbology or Oriental Medicine from the NCCAOM and has a letter from the Board recognizing that the licensed acupuncturist has submitted this information.
 
(b) Prior to (six months after the effective date of this rule), a licensed acupuncturist who obtained his or her license on or before November 2, 2009 may obtain a letter from the Board recognizing that he or she may practice herbology if he or she:
 
1. Successfully completed an herbology program from a school accredited by the ACAOM;
 
2. Passed the NCCAOM herbology examination;
 
3. Was ever certified in Chinese Herbology or Oriental Medicine by NCCAOM; or
 
4. Passed the NCCAOM herbology examination module.
 
(c) Prior to (six months after the effective date of this rule), a licensed acupuncturist who was enrolled in a school accredited by the ACAOM on or before November 2, 2009 may obtain a letter from the Board recognizing that he or she may practice herbology if:
 
1. He or she graduated from the ACAOM accredited school in which he or she was enrolled in on or before November 2, 2009; and
 
2. The school had a program in Chinese herbal medicine.
 
(d) A licensed acupuncturist who is permitted to practice herbology pursuant to (a), (b), or (c) above shall complete at least 10 hours of continuing education related to the practice of herbology as part of the 30 hours of continuing education he or she is required to complete pursuant to N.J.A.C. 13:35-9.20.
 
13:35-9.13   Guest acupuncturist
 
(a) An individual who is not a [certified] licensed acupuncturist, an individual who is permitted to practice pursuant to N.J.S.A. 45:2C-8 and N.J.A.C. 13:35-9.7, or a student in an acupuncture program that meets the requirements of N.J.A.C. 13:35-9.4(e) [or an apprentice in an acupuncture tutorial program, which meets the requirements of N.J.A.C. 13:35-9.17,] may perform acupuncture services as a guest acupuncturist if:
 
1.-3. (No change.)
 
(c)-(d) (No change.)
 
13:35-9.14   [Uncertified] Unlicensed practice of acupuncture
 
(a) An individual is engaging in [uncertified] unlicensed practice of acupuncture if the individual engages in any of the practices outlined in N.J.A.C. 13:35-9.12(a) and is not:
 
1. [Certified] Licensed by the Board as an acupuncturist;
 
2. (No change.)
 
3. A guest acupuncturist permitted to perform acupuncture services pursuant to N.J.A.C. 13:35-9.13; or
 
4. A student participating in an acupuncture program pursuant to N.J.A.C. 13:35-9.4(e)[; or].
 
[5. An apprentice in an acupuncture tutorial program that meets the requirements of N.J.A.C. 13:35-9.17.]
 
13:35-9.15   Precautionary and sterilization procedures
 
(a)-(e) (No change.)
 
(f) If a [certificate holder] licensee learns that a patient has a blood-borne infectious disease, the [certificate holder] licensee shall use only disposable needles in treating the patient.
 
(g) (No change.)
 
13:35-9.16   Preparation of patient records; computerized records; access to or release of information; confidentiality, transfer or disposal of records
 
(a) (No change.)
 
(b) Acupuncturists shall prepare contemporaneous, permanent professional treatment records. Acupuncturists shall also maintain records relating to billings made to patients and third-party carriers for professional services. All treatment records, bills, and claim forms shall accurately reflect the treatment or services rendered. Treatment records shall be maintained for a period of seven years from the date of the most recent entry.
 
1. To the extent applicable, professional treatment records shall reflect:
 
i.-vi. (No change.)
 
vii. Findings from examinations; [and]
 
viii. [Indication] If a physician has referred a patient for acupuncture, an indication that a referral or diagnosis was made by a physician, including the name of the physician[.]; and
 
ix. Documentation of any recommendations made to a patient for the use of meditation or products that facilitate health.
 
2. Corrections and/or additions may be made to an existing record, provided that each change is clearly identified as such, dated and initialed by the [certificate holder] licensee;
 
3. (No change.)
 
(c) Acupuncturists shall provide access to professional treatment records to a patient or an authorized representative in accordance with the following:
 
1.-4. (No change.)
 
5. The acupuncturist shall not refuse to provide a professional treatment record on the grounds that the patient owes the [certificate holder] licensee an unpaid balance if the record is needed by another health care professional for the purpose of rendering care.
 
(d)-(e) (No change.)
 
(f) If an acupuncturist ceases to engage in practice or it is anticipated that he or she will remain out of practice for more than three months, the acupuncturist or designee shall:
 
1. Establish a procedure by which patients can obtain a copy of the treatment records or acquiesce in the transfer of those records to another [certificate holder] licensee who is assuming responsibilities of the [page=734] practice. However, an acupuncturist shall not charge a patient, pursuant to (c)3 above, for a copy of the records, when the records will be used for purposes of continuing treatment or care.
 
2.-3. (No change.)
 
13:35-9.17, 9.18, and 9.19  (Reserved)
 
13:35-9.20   Continuing professional education requirements
 
(a) (No change.)
 
(b) The provisions of this section shall apply to all acupuncturists applying for biennial [certificate] license renewal except those seeking renewal for the first time.
 
(c) No [certificate] license renewal shall be issued by the Board unless the acupuncturist confirms on the renewal application that he or she completed at least 30 hours of continuing education.
 
(d) Credit for continuing professional education shall be granted as follows for each biennial period:
 
1.-2. (No change.)
 
3. Successfully completing graduate course work related to the practice of acupuncture taken beyond that required for a professional [certificate] license in a college or university that is regionally accredited or accredited by the [Accreditation Commission of Acupuncture and Oriental Medicine (]ACAOM[)]: one continuing education hour per credit hour;
 
4.-9. (No change.)
 
(e)-(g) (No change.)
 
(h) Credits taken in excess of the [20] 30 required for biennial [certificate] license renewal shall not be carried over for use in subsequent renewal periods.
 
(i) The Board may waive continuing education requirements on an individual basis for reasons of hardship, such as illness, disability, active service in the military, or other good cause. An acupuncturist who seeks a waiver of the continuing education requirements shall apply to the Board in writing at least 90 days prior to [certificate] license renewal and set forth in specific detail the reasons for requesting the waiver. The acupuncturist shall provide the Board with such supplemental materials as will support the request for waiver. A waiver of continuing education requirements granted pursuant to this subsection shall be effective only for the biennial period in which such waiver is granted. If the condition(s)[, which] that necessitated the waiver continue into the next biennial period, an acupuncturist shall apply to the Board for the renewal of such waiver for the new biennial period.
 
(j)-(k) (No change.)



 

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