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.
*sb0470*

SENATE BILL 470
J2 6lr2637
CF HB 520
By: Senator Hayes
Introduced and read first time: February 2, 2026
Assigned to: Finance

A BILL ENTITLED

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 dose may be dis pensed by a naturopathic doctor; altering the 5
methods by which a naturopathic doctor may administer medication; renaming the 6
Naturopathic Doctors Formulary Council to be the Naturopathic Doctors Formulary 7
Council for Controlled Dangerous Substances and alt ering the Council’s purpose; 8
altering the requirements for renewal of a naturopathic doctor license; altering the 9
grounds for discipline of naturopathic doctors; requiring the State Board of 10
Physicians to include certain information regarding professional liability insurance 11
on a naturopathic doctor’s licensee profile; requiring naturopathic doctors to notify 12
patients in a certain manner, post certain information, and provide certain 13
verification to the Board on request relating to professional liability in surance; and 14
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

BY adding to 22
Article – Health Occupations 23
Section 14–5F–18(a)(28) through (31), 14–5F–20(g), 14–5F–20.1, and 14–5F–20.2 24
Annotated Code of Maryland 25
(2021 Replacement Volume and 2025 Supplement) 26

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 27
That the Laws of Maryland read as follows: 28
2 SENATE BILL 470

Article – Health Occupations 1

12–102. 2

(f) (1) This title does not prohibit a dentist, physician, nurse or midwife, 3
NATUROPATHIC DOCTOR, or podiatrist from personally dispensing a starter dosage of a 4
prescription drug or device to a patient of the dentist, physician, nurse or midwife, 5
NATUROPATHIC DOCTOR, or podiatrist, provided that: 6

(i) The starter dosage complies with the labeling requirements o f § 7
12–505 of this title; 8

(ii) No charge is made for the starter dosage; and 9

(iii) The dentist, physician, nurse or midwife, NATUROPATHIC 10
DOCTOR, or podiatrist enters an appropriate record on the patient’s chart. 11

(2) For the purposes of paragraph (1) of this subsection, “starter dosage” 12
means an amount of drug or device sufficient to begin therapy: 13

(i) Of short duration of 72 hours or less; or 14

(ii) Prior to obtaining a larger quantity of the drug or device to 15
complete the therapy. 16

14–5F–01. 17

(a) In this subtitle the following words have the meanings indicated. 18

(b) “Approved naturopathic medical program” means a naturopathic medical 19
education program: 20

(1) In the United States that: 21

(i) Provides the degree of Doctor of Nat uropathy or Doctor of 22
Naturopathic Medicine; 23

(ii) Offers a 4 –year graduate –level, full –time didactic and 24
supervised clinical training; 25

(iii) Is accredited, or has achieved candidacy status for accreditation, 26
by the Council on Naturopathic Medical E ducation or an equivalent federally and 27
Board–recognized accrediting body for naturopathic medical programs; and 28

SENATE BILL 470 3

(iv) Is part of an institution of higher education that is either 1
accredited, or is a candidate for accreditation, by a regional or nation al institutional 2
accrediting agency recognized by the United States Secretary of Education; or 3

(2) In a diploma –granting, degree –equivalent college or university in 4
Canada that: 5

(i) Offers graduate–level, full–time didactic and supervised clinical 6
training; 7

(ii) Is accredited, or has achieved candidacy status for accreditation, 8
by the Council on Naturopathic Medical Education or an equivalent federally and 9
Board–recognized accrediting body for naturopathic medical programs; and 10

(iii) Has provincial approval for participation in government–funded 11
student aid programs. 12

(c) “Board” means the State Board of Physicians. 13

(d) “Committee” means the Naturopathic Medicine Advisory Committee. 14

(E) “CONTROLLED DANGEROUS SUBSTANCE” HAS THE MEANING STATED IN 15
§ 5–101 OF THE CRIMINAL LAW ARTICLE. 16

[(e)] (F) “Council” means the Naturopathic Doctors Formulary Council FOR 17
CONTROLLED DANGEROUS SUBSTANCES. 18

[(f)] (G) (1) “Device” means a device used in the diagnosis, treatment, or 19
prevention of disease. 20

(2) “Device” does not include: 21

(i) Any surgical or dental instrument; 22

(ii) Any physical therapy equipment; 23

(iii) Any X–ray apparatus; or 24

(iv) Any component part or accessory of any of the items listed in 25
items (i) through (iii) of this paragraph. 26

[(g)] (H) “Emergency use epinephrine” means a portable, disposable drug 27
delivery device or product approved by the federal Food and Drug Administration that 28
contains a premeasured single dose of epinephrine that is used to treat anaphylaxis in an 29
emergency situation. 30

4 SENATE BILL 470

[(h)] (I) “Formulary” means a list of [drugs and devices ] CONTROLLED 1
DANGEROUS SUBSTANCES developed and adopted in accordance with § 14–5F–04.1 of this 2
subtitle. 3

[(i)] (J) “Licensed naturopathic doctor” means a naturopathic doctor who is 4
licensed to practice naturopathic medicine. 5

[(j)] (K) “Naturopathic doctor” means an individual who practices naturopathic 6
medicine. 7

[(k)] (L) (1) “Naturopathic medicine” means the prevention, diagnosis, and 8
treatment of human health conditions, injury, and disease using only patient education and 9
naturopathic therapies and therapeutic substances recognized by the Council of 10
Naturopathic Medical Education. 11

(2) “Naturopathic medicine” includes: 12

(i) Counseling; 13

(ii) The practice o f the mechanical sciences of healing, including 14
mechanotherapy, articular manipulation, corrective and orthopedic gymnastics, 15
hydrotherapy, electrotherapy, and phototherapy; 16

(iii) The practice of the material sciences of healing, including 17
nutrition, phytotherapy, treatment by natural substances, and external applications; [and] 18

(iv) Prescribing, [dispensing] PROVIDING, or administering 19
nonprescription [and prescription] drugs and devices [listed in the formulary]; 20

(V) PRESCRIBING OR ADMINISTERING: 21

1. PRESCRIPTION DRUGS AN D DEVICES THAT ARE N OT 22
CONTROLLED DANGEROUS SUBSTANCES; AND 23

2. CONTROLLED DANGEROUS SUBSTANCES LISTED IN 24
THE FORMULARY; AND 25

(VI) DISPENSING A STARTER DOSAGE OF A DRUG OR DEVICE 26
DESCRIBED IN ITEM (V) OF THIS PARAGRAPH. 27

[(l)] (M) “Naturopathic musculoskeletal mobilization” means the treatment by 28
manual and other mechanical means of all body tissues exclusive of high –velocity thrusts 29
at or beyond the end range of normal joint motion. 30

[(m)] (N) “Nonprescription drug” means a drug that: 31
SENATE BILL 470 5

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

(2) Is labeled for use by a consumer in accordance with State and federal 2
law. 3

[(n)] (O) “Prescription drug” means any drug defined in § 503(b) of the federal 4
Food, Drug, and Cosmetic Act if the drug’s label is required to bear the statement “Rx only”. 5

14–5F–04.1. 6

(a) (1) There is a Naturopathic Doctors Formulary Council FOR 7
CONTROLLED DANGEROUS SUBSTANCES within the Board. 8

(2) The Council consists of the following members: 9

(i) The Deputy Secretary of Public Health Services, or the Deputy 10
Secretary’s designee; and 11

(ii) The following members, appointed by the Board: 12

1. Two individuals who: 13

A. Practice naturopathic medicine in the State; 14

B. Are certifi ed by the North American Board of 15
Naturopathic Examiners; 16

C. Have a minimum of 2 [years] YEARS’ experience; and 17

D. Are licensed naturopathic doctors; 18

2. Two licensed physicians who practice in the State; 19

3. One pharmacist who has a background in pharmacognosy 20
and who practices in the State; and 21

4. One consumer. 22

(3) (i) The term of an appointed member is 4 years. 23

(ii) At the end of a term, an appointed member continues to serve 24
until a successor is appointed. 25

(4) A member of the Council: 26

(i) May not receive compensation as a member of the Council; but 27
6 SENATE BILL 470

(ii) Is entitled to reimbursement for expenses under the Standard 1
State Travel Regulations, as provided in the State budget. 2

(5) The Board shall designate the chair of the Council. 3

(6) The Board shall provide staff for the Council. 4

(b) The Council shall: 5

(1) Develop and recommend to the Board a formulary FOR CONTROLLED 6
DANGEROUS SUBSTANCES for use by licensed naturopathic doctors; 7

(2) Annually review the formulary adopted by the Board under subsection 8
(c) of this section to determine if any changes are necessary for compliance with current 9
prescribing standards or the practice of naturopathic medicine; 10

(3) Otherwise review the formulary at the direction of the Board; and 11

(4) Make recommendations to the Board based on the reviews conducted 12
under items (2) and (3) of this subsection. 13

(c) (1) The Board shall adopt a formulary based on the recommendations of 14
the Council made under subsection (b) of this section. 15

(2) The Board may modify or reject any recommendation of the Council 16
regarding the formulary. 17

(d) [(1)] The formulary adopted by the Board [shall include: 18

(i) Nonprescription drugs and devices; 19

(ii) Prescription oxygen and emergency use epinephrine; and 20

(iii) Prescription diaphragms and cervical caps for contraception. 21

(2) The formulary may not include: 22

(i) Except as provided in paragraph (1)(ii) and (iii) of this subsection, 23
prescription drugs or devices; or 24

(ii) Controlled substances ] MAY INCLUDE ONLY CON TROLLED 25
DANGEROUS SUBSTANCES LISTED IN SCHEDULE III, SCHEDULE IV, OR SCHEDULE 26
V UNDER TITLE 5, SUBTITLE 4 OF THE CRIMINAL LAW ARTICLE. 27

14–5F–14. 28
SENATE BILL 470 7

(a) A license authorizes a licensee, consistent with naturopathic education and 1
training and competence demonstrated by passing the naturopathic physician licensing 2
examination, to: 3

(1) Order and perform physical and laboratory examinations for diagnostic 4
purposes, including phlebotomy, clinical laboratory tests, orif icial examinations, 5
electrocardiograms with over read by a cardiologist, and physiological function tests; 6

(2) Order diagnostic imaging studies and interpret the reports of diagnostic 7
imaging studies; 8

(3) Dispense or order natural medicines of mineral, animal, or botanical 9
origin, including food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, 10
enzymes, botanicals and their extracts, botanical medicines, homeopathic medicines, and 11
all diet ary supplements and nonprescription drugs [listed in the formulary ] that use 12
various routes of administration, including oral, nasal, auricular, ocular, rectal, vaginal, 13
transdermal, [and] intramuscular, SUBCUTANEOUS, AND INTRAVENOUS; 14

(4) Administer natural medicines of mineral, animal, or botanical origin, 15
including food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, 16
botanicals and their extracts, botanical medicines, homeopathic medicines, and all dietary 17
supplements and n onprescription drugs [listed in the formulary ] using various routes of 18
administration, including oral, nasal, auricular, ocular, rectal, vaginal, [and] transdermal, 19
INTRAMUSCULAR, SUBCUTANEOUS, AND INTRAVENOUS; 20

(5) Administer emergency use epinephrine; 21

(6) Administer or perform hot or cold hydrotherapy, naturopathic physical 22
medicine, electromagnetic energy, and therapeutic exercise for the purpose of providing 23
basic therapeutic care services, except that if a referral to another licensed provider is 24
appropriate for ongoing rehabilitation or habilitation services, the naturopathic doctor shall 25
make the referral; 26

(7) Provide health education and health counseling; [and] 27

(8) Perform naturopathic musculoskeletal mobilization; 28

(9) PRESCRIBE, PROVIDE, AND ADMINISTER NONPR ESCRIPTION 29
DRUGS AND DEVICES; 30

(10) SUBJECT TO ITEM (11) OF THIS SUBSECTION , PRESCRIBE, 31
DISPENSE A STARTER D OSAGE OF , AND ADMINISTER WITHI N THE SCOPE OF 32
NATUROPATHIC MEDICINE A PRESCRIPTION DRUG OR DEVICE; AND 33

8 SENATE BILL 470

(11) PRESCRIBE, DISPENSE A STARTER DOSAGE OF, AND ADMINISTER 1
WITHIN THE SCOPE OF NATUROPATHIC MEDICIN E A CONTROLLED DANGE ROUS 2
SUBSTANCE LISTED IN THE FORMULARY IF THE LICENSEE HAS A VALID: 3

(I) STATE CONTROLLED DANG EROUS SUBSTANCE 4
REGISTRATION; AND 5

(II) FEDERAL DRUG ENFORCEMENT AGENCY REGISTRATION. 6

(b) A license does not authorize a licensee to: 7

(1) Except for a [prescription drug or device included in the formulary 8
under § 14 –5F–04.1(d)(1)(ii) or (iii) of this subtitle, prescribe, ] STARTER DOSAGE 9
DISPENSED I N ACCORDANCE WITH § 12–102 OF THIS ARTICLE , dispense[, or 10
administer] any prescription drug or device; 11

(2) PRESCRIBE OR ADMINIST ER ANY CONTROLLED DA NGEROUS 12
SUBSTANCE NOT LISTED IN THE FORMULARY; 13

[(2)] (3) Perform surgical procedures; 14

[(3)] (4) Practice or claim to practice as a medical doctor or physician, an 15
osteopath, a dentist, a podiatrist, an optometrist, a psychologist, a nurse practitioner, a 16
physician assistant, a chiropractor, a physical therapist, an acupuncturist, or any other 17
health care professional unless licensed under this article; 18

[(4)] (5) Use general or spinal anesthetics; 19

[(5)] (6) Administer ionizing radioactive substances for therapeutic 20
purposes; 21

[(6)] (7) Perform chiropractic adjustments or manipulations that include 22
high–velocity thrusts at or beyond the end range of normal joint motion unless the licensee 23
is also a licensed chiropractor; 24

[(7)] (8) Perform acupuncture unless the licensee is also a licensed 25
acupuncturist; or 26

[(8)] (9) Prescribe, dispense, or administer any prescription [or 27
nonprescription] drug or device [listed in the formulary] for cosmetic purposes. 28

14–5F–15. 29

(c) The Board shall renew the license of a licensee who: 30

SENATE BILL 470 9

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

(2) Is of good moral character; 2

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

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

(5) Meets the continuing education requirements adopted by the Board [; 5
and 6

(6) Provides evidence of biennial cardiopulmonary resuscitation 7
certification]. 8

14–5F–18. 9

(a) Subject to the hearing provisions of § 14–405 of this title, a disciplinary panel, 10
on the affirmative vote of a majority of a quorum of the disciplinary panel, may deny a 11
license to any applica nt, reprimand any licensee, place any licensee on probation, or 12
suspend or revoke a license of any licensee if the applicant or licensee: 13

(26) Violates any provision of this title or any regulation adopted by the 14
Board; [or] 15

(27) Fails to complete a criminal history records check under § 14 –308.1 of 16
this title; 17

(28) EXCEPT AS TO AN ASSOC IATION THAT HAS REMA INED 18
IN CONTINUOUS EXISTENCE SINCE JULY 1, 1963: 19

(I) ASSOCIATES WITH A PHA RMACIST AS A PARTNER OR 20
CO–OWNER OF A PHARMACY FOR THE PURPOSE OF OPERATING A PHARMACY; 21

(II) EMPLOYS A PHARMACIST FOR THE PURPOSE OF OPERATING 22
A PHARMACY; OR 23

(III) CONTRACTS WITH A PHAR MACIST FOR THE PURPO SE OF 24
OPERATING A PHARMACY; 25

(29) FAILS TO COMPLY WITH § 1–223 OF THIS ARTICLE; 26

(30) FAILS TO COMPLY WITH THE REQUIREMENT S OF THE 27
PRESCRIPTION DRUG MONITORING PROGRAM UNDER TITLE 21, SUBTITLE 2A OF 28
THE HEALTH – GENERAL ARTICLE; OR 29

10 SENATE BILL 470

(31) FAILS TO COMPLY WITH THE REQUIREMENTS OF § 12–102 OF THIS 1
ARTICLE. 2

14–5F–20. 3

(G) THE BOARD SHALL INCLUDE O N THE LICENSEE ’S PROFILE , AS 4
REPORTED TO THE BOARD BY THE LICENSEE: 5

(1) WHETHER THE LICENSEE MAINTAINS PROFESSIONAL LIABILITY 6
INSURANCE; AND 7

(2) THE NUMBER OF MEDICAL MALPRACTICE FINAL CO URT 8
JUDGMENTS AND ARBITRATION AWARDS AGAINST THE LICENSEE WITHIN THE MOST 9
RECENT 10–YEAR PERIOD. 10

14–5F–20.1. 11

ON REQUEST OF THE BOARD, A NATUROPATHIC DOCTO R WHO REPORTS TO 12
THE BOARD THAT THE NATURO PATHIC DOCTOR MAINTAINS PROFESSION AL 13
LIABILITY INSURANCE FOR PURPOSES OF THE PUBLIC INDIVIDUAL PROFILE 14
MAINTAINED BY THE BOARD UNDER § 14–5F–20 OF THIS SUBTITLE SHALL PROVIDE 15
THE BOARD WITH VERIFICATI ON OR OTHER DOCUMENT ATION THAT THE 16
NATUROPATHIC DOCTOR MAINTAINS THE INSURA NCE WITHIN 25 BUSINESS DAYS 17
AFTER THE NATUROPATHIC DOCTOR RECEIVES A REQUEST FROM THE BOARD. 18

14–5F–20.2. 19

(A) EACH LICENSEE PRACTICING NATUROPATHIC MEDICINE IN THE STATE 20
SHALL NOTIFY A PATIENT IN WRITING IF: 21

(1) THE LICENSEE DOES NOT MAINTAIN PROFESSIONAL LIABILI TY 22
INSURANCE COVERAGE; OR 23

(2) THE LICENSEE ’S PROFESSIONAL LI ABILITY INSURANCE 24
COVERAGE HAS LAPSED FOR ANY PERIOD OF TIME AND THE LICENSEE’S COVERAGE 25
HAS NOT BEEN RENEWED. 26

(B) THE WRITTEN NOTIFICAT ION PROVIDED TO THE PATIENT UNDER 27
SUBSECTION (A) OF THIS SECTION SHALL BE: 28

(1) PROVIDED: 29

(I) AT THE FIRST VISIT BY THE PATIENT DURIN G ANY PERIOD 30
IN WHICH THE LICENSE E DOES NOT MAINTAIN PROFESSIONAL LIABILI TY 31
SENATE BILL 470 11

INSURANCE, UNLESS THE VISIT IS FOR THE PURPOSE OF R ECEIVING INCIDENTAL 1
MEDICAL CARE THAT WILL BE RENDERED FREE OF CHARGE; AND 2

(II) AS PART OF EACH INFORMED CONSENT OBTAINED BEFORE 3
ANY PROCEDURE DISCUSSED OR OFFERED FOR T HE PATIENT’S CONSIDERATION IS 4
PERFORMED; 5

(2) SIGNED BY THE PATIENT AT THE TIME OF THE PATIENT’S VISIT OR 6
THE INFORMED CONSENT IS SIGNED; AND 7

(3) RETAINED BY THE LICEN SEE AS PART OF THE LICENSEE’S 8
PATIENT RECORDS. 9

(C) EACH LICENSEE PRACTICING NATUROPATHIC MEDICINE IN THE STATE 10
WHO DOES NOT MAINTAIN PROFESSIONAL LIABILITY INSURANCE COVERAGE SHALL 11
POST THIS INFORMATION IN A CONSPICUOUS L OCATION IN THE LICENSEE’S PLACE 12
OF PRACTICE. 13

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 14
October 1, 2026. 15