State Board of Physicians - Naturopathic Doctors - Scope of Practice, Renewals, and Professional Liability Insurance

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb0520*

HOUSE BILL 520
J2 6lr2190
CF SB 470
By: Delegate Cullison Delegates Cullison, Alston, Bagnall, Guzzone, S. Johnson,
Kaufman, Lopez, Martinez, Rosenberg, Ross, Taveras, White Holland, and
Woorman
Introduced and read first time: January 27, 2026
Assigned to: Health
Committee Report: Favorable with amendments
House action: Adopted
Read second time: February 26, 2026

CHAPTER ______

AN ACT concerning 1

State Board of Physicians – Naturopathic Doctors – Scope of Practice, 2
Renewals, and Professional Liability Insurance 3

FOR the purpose of altering the drugs that may be prescribed, provided, or administered 4
or for which a start starter dose may be dispensed by a naturopathic doctor; altering 5
the methods by which a naturopathic doctor may administer medication; renaming 6
repealing the Naturopathic Doctors Formulary Council to be the Naturopathic 7
Doctors Formulary Council for Controlled Da ngerous Substances and altering the 8
Council’s purpose; altering the requirements for renewal of a naturopathic doctor 9
license; altering the grounds for discipline of naturopathic doctors; requiring the 10
State Board of Physicians to include certain informati on regarding professional 11
liability insurance on a naturopathic doctor’s licensee profile; requiring naturopathic 12
doctors to notify patients in a certain manner, post certain information, and provide 13
certain verification to the Board on request relating to professional liability 14
insurance; and generally relating to naturopathic doctors. 15

BY repealing and reenacting, with amendments, 16
Article – Health Occupations 17
Section 12 –102(f), 14 –5F–01, 14–5F–04.1, 14–5F–14, 14 –5F–15(c), and 18
14–5F–18(a)(26) and (27) 19
Annotated Code of Maryland 20
(2021 Replacement Volume and 2025 Supplement) 21

2 HOUSE BILL 520

BY repealing 1
Article – Health Occupations 2
Section 14–5F–04.1 3
Annotated Code of Maryland 4
(2021 Replacement Volume and 2025 Supplement) 5

BY adding to 6
Article – Health Occupations 7
Section 14–5F–18(a)(28) through (31), 14–5F–20(g), 14–5F–20.1, and 14–5F–20.2 8
Annotated Code of Maryland 9
(2021 Replacement Volume and 2025 Supplement) 10

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That the Laws of Maryland read as follows: 12

Article – Health Occupations 13

12–102. 14

(f) (1) This title does not prohibit a dentist, physician, nurse or midwife, 15
NATUROPATHIC DOCTOR, or podiatrist from personally dispensing a starter dosage of a 16
prescription drug or device to a patient of the dentist, physician, nurse or midwife, 17
NATUROPATHIC DOCTOR, or podiatrist, provided that: 18

(i) The starter dosage complies with the labeling re quirements of § 19
12–505 of this title; 20

(ii) No charge is made for the starter dosage; and 21

(iii) The dentist, physician, nurse or midwife, NATUROPATHIC 22
DOCTOR, or podiatrist enters an appropriate record on the patient’s chart. 23

(2) For the purposes of paragraph (1) of this subsection, “starter dosage” 24
means an amount of drug or device sufficient to begin therapy: 25

(i) Of short duration of 72 hours or less; or 26

(ii) Prior to obtaining a larger quantity of the drug or device to 27
complete the therapy. 28

14–5F–01. 29

(a) In this subtitle the following words have the meanings indicated. 30

(b) “Approved naturopathic medical program” means a naturopathic medical 31
education program: 32

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(1) In the United States that: 1

(i) Provides the degree of Docto r of Naturopathy or Doctor of 2
Naturopathic Medicine; 3

(ii) Offers a 4 –year graduate –level, full –time didactic and 4
supervised clinical training; 5

(iii) Is accredited, or has achieved candidacy status for accreditation, 6
by the Council on Naturopathic M edical Education or an equivalent federally and 7
Board–recognized accrediting body for naturopathic medical programs; and 8

(iv) Is part of an institution of higher education that is either 9
accredited, or is a candidate for accreditation, by a regional o r national institutional 10
accrediting agency recognized by the United States Secretary of Education; or 11

(2) In a diploma –granting, degree –equivalent college or university in 12
Canada that: 13

(i) Offers graduate–level, full–time didactic and supervised clinical 14
training; 15

(ii) Is accredited, or has achieved candidacy status for accreditation, 16
by the Council on Naturopathic Medical Education or an equivalent federally and 17
Board–recognized accrediting body for naturopathic medical programs; and 18

(iii) Has provincial approval for participation in government–funded 19
student aid programs. 20

(c) “Board” means the State Board of Physicians. 21

(d) “Committee” means the Naturopathic Medicine Advisory Committee. 22

(E) “CONTROLLED DANGEROUS SUBSTANCE” HAS THE MEANING STATED IN 23
§ 5–101 OF THE CRIMINAL LAW ARTICLE. 24

[(e)] (F) “Council” means the Naturopathic Doctors Formulary Council FOR 25
CONTROLLED DANGEROUS SUBSTANCES. 26

[(f)] (G) (E) (1) “Device” means a device used in the diagnosis, treatment, or 27
prevention of disease. 28

(2) “Device” does not include: 29

(i) Any surgical or dental instrument; 30

(ii) Any physical therapy equipment; 31
4 HOUSE BILL 520

(iii) Any X–ray apparatus; or 1

(iv) Any component part or accessory of any of the items listed in 2
items (i) through (iii) of this paragraph. 3

[(g)] (H) (F) “Emergency use epinephrine” means a portable, disposable drug 4
delivery device or product approved by the federal Food and Drug Administration that 5
contains a premeasured single dose of epinephrine that is used to treat anaphylaxis in an 6
emergency situation. 7

[(h)] (I) “Formulary” means a list of [drugs and devices ] CONTROLLED 8
DANGEROUS SUBSTANCES developed and adopted in accordance with § 14–5F–04.1 of this 9
subtitle. 10

[(i)] (J) (G) “Licensed naturopathic doctor” means a naturopathic doctor who is 11
licensed to practice naturopathic medicine. 12

[(j)] (K) (H) “Naturopathic doctor” means an individual who practices naturopathic 13
medicine. 14

[(k)] (L) (I) (1) “Naturopathic medicine” means the prevention, diagnosis, and 15
treatment of human health conditions, injury, and disease using only patient education and 16
naturopathic therapies and therapeutic substances recognized by the Council of 17
Naturopathic Medical Education. 18

(2) “Naturopathic medicine” includes: 19

(i) Counseling; 20

(ii) The practice of the mechanical sciences of healing, including 21
mechanotherapy, articular manipulation, corrective and orthopedic gymnastics, 22
hydrotherapy, electrotherapy, and phototherapy; 23

(iii) The practice of the material sciences of h ealing, including 24
nutrition, phytotherapy, treatment by natural substances, and external applications; [and] 25

(iv) Prescribing, [dispensing] PROVIDING, or administering 26
nonprescription [and prescription] drugs and devices [listed in the formulary]; 27

(V) PRESCRIBING OR ADMINISTERING: 28

1. PRESCRIPTION DRUGS AN D DEVICES THAT ARE N OT 29
CONTROLLED DANGEROUS SUBSTANCES; AND 30

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2. CONTROLLED DANGEROUS SUBSTANCES LISTED IN 1
THE FORMULARY; AND 2

2. BIOIDENTICAL HORMONES; AND 3

(VI) DISPENSING A STARTER DOSAGE OF A DRUG OR DEVICE 4
DESCRIBED IN ITEM (V) OF THIS PARAGRAPH. 5

[(l)] (M) (J) “Naturopathic musculoskeletal mobilization” means the treatment by 6
manual and other mechanical means of all body tissues exclusive of high –velocity thrusts 7
at or beyond the end range of normal joint motion. 8

[(m)] (N) (K) “Nonprescription drug” means a drug that: 9

(1) May be sold without a prescription; and 10

(2) Is labeled for use by a consumer in accordance with State and federal 11
law. 12

[(n)] (O) (L) “Prescription drug” means any drug defined in § 503(b) of the federal 13
Food, Drug, and Cosmetic Act if the drug’s label is required to bear the statement “Rx only”. 14

14–5F–04.1. 15

(a) (1) There is a Naturopathic Doctors Formulary Council FOR 16
CONTROLLED DANGEROUS SUBSTANCES within the Board. 17

(2) The Council consists of the following members: 18

(i) The Deputy Secretary of Public Health Services, or the Deputy 19
Secretary’s designee; and 20

(ii) The following members, appointed by the Board: 21

1. Two individuals who: 22

A. Practice naturopathic medicine in the State; 23

B. Are certified by the North American Board of 24
Naturopathic Examiners; 25

C. Have a minimum of 2 [years] YEARS’ experience; and 26

D. Are licensed naturopathic doctors; 27

2. Two licensed physicians who practice in the State; 28
6 HOUSE BILL 520

3. One pharmacist who has a background in pharmacognosy 1
and who practices in the State; and 2

4. One consumer. 3

(3) (i) The term of an appointed member is 4 years. 4

(ii) At the end of a term, an appointed member continues to serve 5
until a successor is appointed. 6

(4) A member of the Council: 7

(i) May not receive compensation as a member of the Council; but 8

(ii) Is entitled to reimbursement for expenses under the Standard 9
State Travel Regulations, as provided in the State budget. 10

(5) The Board shall designate the chair of the Council. 11

(6) The Board shall provide staff for the Council. 12

(b) The Council shall: 13

(1) Develop and recommend to the Board a formulary FOR CONTROLLED 14
DANGEROUS SUBSTANCES for use by licensed naturopathic doctors; 15

(2) Annually review the formulary adopted by the Board under subsection 16
(c) of this section to determine if any changes are necessary for compliance with current 17
prescribing standards or the practice of naturopathic medicine; 18

(3) Otherwise review the formulary at the direction of the Board; and 19

(4) Make recommendations to the Board based on the reviews conducted 20
under items (2) and (3) of this subsection. 21

(c) (1) The Board shall adopt a formulary based on the recommendations of 22
the Council made under subsection (b) of this section. 23

(2) The Board may modify or reject any recommendation of the Council 24
regarding the formulary. 25

(d) [(1)] The formulary adopted by the Board [shall include: 26

(i) Nonprescription drugs and devices; 27

(ii) Prescription oxygen and emergency use epinephrine; and 28
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(iii) Prescription diaphragms and cervical caps for contraception. 1

(2) The formulary may not include: 2

(i) Except as provided in paragraph (1)(ii) and (iii) of this subsection, 3
prescription drugs or devices; or 4

(ii) Controlled substances ] MAY INCLUDE ONLY CON TROLLED 5
DANGEROUS SUBSTANCES LISTED IN SCHEDULE III, SCHEDULE IV, OR SCHEDULE 6
V UNDER TITLE 5, SUBTITLE 4 OF THE CRIMINAL LAW ARTICLE. 7

14–5F–14. 8

(a) A license authorizes a licensee, consistent with naturopathic education and 9
training and competence demonstrated by passing the naturopathic physician licensing 10
examination, to: 11

(1) Order and perform physical and laboratory examinations for diagnostic 12
purposes, including phlebotomy, clinical laboratory tests, orificial examinations, 13
electrocardiograms with over read by a cardiologist, and physiological function tests; 14

(2) Order diagnostic imaging studies and interpret the reports of diagnostic 15
imaging studies; 16

(3) Dispense or order natural medicines of mineral, animal, or botanical 17
origin, including food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, 18
enzymes, botanicals and their extracts, botanical medicine s, homeopathic medicines, and 19
all dietary supplements and nonprescription drugs [listed in the formulary ] that use 20
various routes of administration, including oral, nasal, auricular, ocular, rectal, vaginal, 21
transdermal, [and] intramuscular, SUBCUTANEOUS, AND INTRAVENOUS; 22

(4) Administer natural medicines of mineral, animal, or botanical origin, 23
including food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, 24
botanicals and their extracts, botanical medicines, homeopathic medicines, and all dietary 25
supplements and nonprescription drugs [listed in the formulary ] using various routes of 26
administration, including oral, nasal, auricular, ocular, rectal, vaginal, [and] transdermal, 27
INTRAMUSCULAR, SUBCUTANEOUS, AND INTRAVENOUS; 28

(5) Administer emergency use epinephrine; 29

(6) Administer or perform hot or cold hydrotherapy, naturopathic physical 30
medicine, electromagnetic energy, and therapeutic exercise for the purpose of providing 31
basic therapeutic care services, except that if a ref erral to another licensed provider is 32
appropriate for ongoing rehabilitation or habilitation services, the naturopathic doctor shall 33
make the referral; 34
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(7) Provide health education and health counseling; [and] 1

(8) Perform naturopathic musculoskeletal mobilization; 2

(9) PRESCRIBE, PROVIDE, AND ADMINISTER NONPR ESCRIPTION 3
DRUGS AND DEVICES; AND 4

(10) SUBJECT TO ITEM (11) OF THIS SUBSECTION , PRESCRIBE 5
PRESCRIBE, DISPENSE A STARTER D OSAGE OF , AND ADMINISTER WITHI N THE 6
SCOPE OF NATUROPATHIC MEDICINE A PRESCRIPTION DRUG OR DEVICE; AND. 7

(11) PRESCRIBE, DISPENSE A STARTER DOSAGE OF, AND ADMINISTER 8
WITHIN THE SCOPE OF NATUROPATHIC MEDICIN E A CONTROLLED DANGE ROUS 9
SUBSTANCE LISTED IN THE FORMULARY IF THE LICENSEE HAS A VALID: 10

(I) STATE CONTROLLED DAN GEROUS SUBSTANCE 11
REGISTRATION; AND 12

(II) FEDERAL DRUG ENFORCEMENT AGENCY REGISTRATION. 13

(b) A license does not authorize a licensee to: 14

(1) Except for a [prescription drug or device included in the formulary 15
under § 14 –5F–04.1(d)(1)(ii) or (iii) of this subtitle, prescribe, ] STARTER DOSAGE 16
DISPENSED IN ACCORDA NCE WITH § 12–102 OF THIS ARTICLE , dispense[, or 17
administer] any prescription drug or device; 18

(2) PRESCRIBE OR ADMINIST ER ANY CONTROLLED DA NGEROUS 19
SUBSTANCE NOT LISTED IN THE FORMULARY; 20

[(2)] (3) Perform surgical procedures; 21

[(3)] (4) Practice or claim to practice as a medical doctor or physician, an 22
osteopath, a dentist, a podiatrist, an optometrist, a psychologist, a nurse practitioner, a 23
physician assistant, a chiropractor, a physica l therapist, an acupuncturist, or any other 24
health care professional unless licensed under this article; 25

[(4)] (5) Use general or spinal anesthetics; 26

[(5)] (6) Administer ionizing radioactive substances for therapeutic 27
purposes; 28

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[(6)] (7) Perform chiropractic adjustments or manipulations that include 1
high–velocity thrusts at or beyond the end range of normal joint motion unless the licensee 2
is also a licensed chiropractor; 3

[(7)] (8) Perform acupuncture unless the licensee is also a lice nsed 4
acupuncturist; or 5

[(8)] (9) Prescribe, dispense, or administer any prescription [or 6
nonprescription] drug or device [listed in the formulary] for cosmetic purposes. 7

14–5F–15. 8

(c) The Board shall renew the license of a licensee who: 9

(1) Submits a renewal application on the form that the Board requires; 10

(2) Is of good moral character; 11

(3) Pays a renewal fee set by the Board; 12

(4) Is otherwise entitled to be licensed; AND 13

(5) Meets the continuing education requirements adopted by the Board[; 14
and 15

(6) Provides evidence of biennial cardiopulmonary resuscitation 16
certification]. 17

14–5F–18. 18

(a) Subject to the hearing provisions of § 14–405 of this title, a disciplinary panel, 19
on the affirmative vote of a majority of a quorum of the disc iplinary panel, may deny a 20
license to any applicant, reprimand any licensee, place any licensee on probation, or 21
suspend or revoke a license of any licensee if the applicant or licensee: 22

(26) Violates any provision of this title or any regulation adopte d by the 23
Board; [or] 24

(27) Fails to complete a criminal history records check under § 14 –308.1 of 25
this title; 26

(28) EXCEPT AS TO AN ASSOC IATION THAT HAS REMA INED 27
IN CONTINUOUS EXISTENCE SINCE JULY 1, 1963: 28

(I) ASSOCIATES WITH A PHA RMACIST AS A PAR TNER OR 29
CO–OWNER OF A PHARMACY FOR THE PURPOSE OF OPERATING A PHARMACY; 30
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(II) EMPLOYS A PHARMACIST FOR THE PURPOSE OF OPERATING 1
A PHARMACY; OR 2

(III) CONTRACTS WITH A PHAR MACIST FOR THE PURPO SE OF 3
OPERATING A PHARMACY; 4

(29) FAILS TO COMPLY WITH § 1–223 OF THIS ARTICLE; 5

(30) FAILS TO COMPLY WITH THE REQUIREMENTS OF THE 6
PRESCRIPTION DRUG MONITORING PROGRAM UNDER TITLE 21, SUBTITLE 2A OF 7
THE HEALTH – GENERAL ARTICLE; OR 8

(31) FAILS TO COMPLY WITH THE REQUIREMENTS OF § 12–102 OF THIS 9
ARTICLE. 10

14–5F–20. 11

(G) THE BOARD SHALL INCLUDE O N THE LICENSEE ’S PROFILE , AS 12
REPORTED TO THE BOARD BY THE LICENSEE: 13

(1) WHETHER THE LICENSEE MAINTAINS PROFESSIONAL LIABILITY 14
INSURANCE; AND 15

(2) THE NUMBER OF MEDICAL MALPRACTICE FINAL CO URT 16
JUDGMENTS AND ARBITRATION AWARDS AGAINST THE LICENSEE WITHIN THE MOST 17
RECENT 10–YEAR PERIOD. 18

14–5F–20.1. 19

ON REQUEST OF THE BOARD, A NATUROPATHIC DOCTO R WHO REPORTS TO 20
THE BOARD THAT THE NATURO PATHIC DOCTOR MAINTA INS PROFESSIONAL 21
LIABILITY INSURANCE FOR PURPOSES OF THE PUBLIC INDIVIDUAL PRO FILE 22
MAINTAINED BY THE BOARD UNDER § 14–5F–20 OF THIS SUBTITLE SHALL PROVIDE 23
THE BOARD WITH VERIFICATI ON OR OTHER DOCUMENT ATION THAT THE 24
NATUROPATHIC DOCTOR MAINTAINS THE INSURA NCE WITHIN 25 BUSINESS DAYS 25
AFTER THE NATUROPATHIC DOCTOR RECEIVES A REQUEST FROM THE BOARD. 26

14–5F–20.2. 27

(A) EACH LICENSEE PRACTICING NATUROPATHIC MEDICINE IN THE STATE 28
SHALL NOTIFY A PATIENT IN WRITING IF: 29

HOUSE BILL 520 11

(1) THE LICENSEE DOES NOT MAINTAIN PROFESSIONA L LIABILITY 1
INSURANCE COVERAGE; OR 2

(2) THE LICENSEE ’S PROFESSIONAL LIABILI TY INSURANCE 3
COVERAGE HAS LAPSED FOR ANY PERIOD OF TIME AND THE LICENSEE’S COVERAGE 4
HAS NOT BEEN RENEWED. 5

(B) THE WRITTEN NOTIFICAT ION PROVIDED TO THE PATIENT UNDER 6
SUBSECTION (A) OF THIS SECTION SHALL BE: 7

(1) PROVIDED: 8

(I) AT THE FIRST VISIT BY T HE PATIENT DURING AN Y PERIOD 9
IN WHICH THE LICENSE E DOES NOT MAINTAIN PROFESSIONAL LIABILI TY 10
INSURANCE, UNLESS THE VISIT IS FOR THE PURPOSE OF R ECEIVING INCIDENTAL 11
MEDICAL CARE THAT WILL BE RENDERED FREE OF CHARGE; AND 12

(II) AS PART OF EACH INFORMED CONSENT OBTAINED BEFORE 13
ANY PROCEDURE DISCUSSED OR OFFERED FOR T HE PATIENT’S CONSIDERATION IS 14
PERFORMED; 15

(2) SIGNED BY THE PATIENT AT THE TIME OF THE PATIENT’S VISIT OR 16
THE INFORMED CONSENT IS SIGNED; AND 17

(3) RETAINED BY THE LICEN SEE AS PART OF THE LICEN SEE’S 18
PATIENT RECORDS. 19

(C) EACH LICENSEE PRACTICING NATUROPATHIC MEDICINE IN THE STATE 20
WHO DOES NOT MAINTAIN PROFESSIONAL LIABILITY INSURANCE COVERAGE SHALL 21
POST THIS INFORMATION IN A CONSPICUOUS L OCATION IN THE LICENSEE’S PLACE 22
OF PRACTICE. 23

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 24
October 1, 2026. 25