ARC 8702C

ARC 8702C

Proposing rulemaking related to licensure of acupuncturists
and providing an opportunity for public comment

A Regulatory Analysis for this rulemaking was published in the Iowa Administrative Bulletin on October 16, 2024. A public hearing was held on the following date(s):

●November 5, 2024

The Department of Inspections, Appeals, and Licensing received no public comments.

Persons who wish to make oral comments at a public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rulemaking.

Any persons who intend to attend a public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs.

ITEM 1.Rescind 653—Chapter 17 and adopt the following new chapter in lieu thereof:

CHAPTER 17

LICENSURE OF ACUPUNCTURISTS

653—17.1(148E) Scope of chapter. The rules in this chapter only apply to individuals licensed under Iowa Code chapter 148E. In accordance with Iowa Code section 148E.3, the rules in this chapter do not apply to the following:

1.A person otherwise licensed by the state to practice medicine and surgery, osteopathic medicine and surgery, chiropractic, podiatry, or dentistry who is exclusively engaged in the practice of the person’s profession.

2.A student practicing acupuncture under the direct supervision of a licensed acupuncturist as part of a course of study approved by the board.

653—17.2(148E) Definitions. The definitions stated in Iowa Code section 148E.1 apply to this chapter, in addition to those listed below.

“Accreditation Commission for Acupuncture and Oriental Medicine” or “ACAOM” means the United States-based accreditation commission that certifies acupuncture and oriental medicine training programs and colleges.

“Acupuncture needle” means a solid-core instrument including but not limited to acupuncture needles, dermal needles, intradermal needles, press tacks, plum blossom needles, prismatic needles, and disposable lancets.

“Acupuncture point” means a specific anatomical location on the human body that serves as the treatment site for the use of acupuncture.

“Applicant” means a person not otherwise authorized to practice acupuncture under Iowa Code section 148E.3 who applies to the board for a license.

“Ashi acupuncture point” means an acupuncture point that is located according to tenderness upon palpation. An ashi acupuncture point is also known as a trigger point.

“Committee” means the licensure committee of the board with oversight responsibility for administration of the licensure of acupuncturists.

“Department” means the department of inspections, appeals, and licensing.

“Disclosure sheet” means the written information licensed acupuncturists must provide to patients on initial contact.

“Disposable needles” means presterilized needles that are discarded after initial use pursuant to Iowa Code section 148E.5.

“License” means a license issued by the board pursuant to Iowa Code section 148E.2.

“Licensee” means a person holding a license to practice acupuncture issued by the board pursuant to Iowa Code chapter 148E.

“National Certification Commission for Acupuncture and Oriental Medicine” or “NCCAOM” means the United States-based commission that validates entry-level competency in the practice of acupuncture and oriental medicine through professional certification.

653—17.3(147,148E) Eligibility for licensure.

17.3(1) Eligibility requirements. To be licensed to practice acupuncture by the board, a person shall meet all of the following requirements:

a.Fulfill all the application requirements as specified in 653—17.4(147,148E).

b.Hold current active status as a diplomate in NCCAOM or, after June 1, 2004, hold current active status as a diplomate in acupuncture or oriental medicine from NCCAOM.

c.Demonstrate sufficient knowledge of the English language to understand and be understood by patients and board and committee members.

(1)An applicant who passed the NCCAOM written and practical examination components in English may be presumed to have sufficient proficiency in English.

(2)An applicant who passed NCCAOM written or practical examination components in a language other than English shall pass the Test of Spoken English (TSE) or the Test of English as a Foreign Language (TOEFL) examinations administered by the Educational Testing Service.

d.Successfully complete a three-year postsecondary training program or acupuncture college program that is accredited by, in candidacy for accreditation by, or that meets the standards of the Accreditation Commission for Acupuncture and Oriental Medicine.

e.Successfully complete a course in clean needle technique approved by the NCCAOM.

f.The applicant’s license is not denied by the board due to the commission of a disqualifying offense, as provided in 653—subrule 9.3(3).

17.3(2) Waiver prohibited. Provisions of this rule are not subject to waiver pursuant to 653—Chapter 3 or any other provision of law.

653—17.4(147,148E) Application requirements.

17.4(1) Application for licensure. To apply for a license to practice acupuncture, an applicant shall:

a.Submit the completed application form provided by the board, including required credentials and documents, a completed fingerprint packet and a sworn statement by the applicant attesting to the truth of all information provided by the applicant;

b.Pay the nonrefundable initial application fee identified in 653—subrule 8.2(1); and

c.Pay the fee identified in 653—subrule 8.2(5) for the evaluation of the fingerprint packet and the national criminal history background checks by the division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI).

17.4(2) Contents of the application form. Each applicant shall submit the following information on the application form provided by the board:

a.The applicant’s full legal name, date and place of birth, home address, mailing address, principal business address, and personal email address regularly used by the applicant or licensee for correspondence with the board;

b.A chronology accounting for all time periods from the date the applicant entered an acupuncture and oriental medicine training program or college to the date of the application;

c.The other jurisdictions in the United States or other nations or territories in which the applicant is authorized to practice acupuncture, including license, certificate of registration or certification numbers, and date of issuance;

d.Full disclosure of the applicant’s involvement in civil litigation related to the practice of acupuncture in any jurisdiction of the United States, other nations or territories. Copies of the legal documents may be requested if needed during the review process;

e.A statement disclosing and explaining any informal or nonpublic actions, warnings issued, investigations conducted, or disciplinary actions taken, whether by voluntary agreement or formal action, by a medical, acupuncture or professional regulatory authority, an educational institution, a training or research program, or a health facility in any jurisdiction;

f.A statement disclosing and explaining any charge of a misdemeanor or felony involving the applicant filed in any jurisdiction, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside;

g.The NCCAOM score report verification form submitted directly to the board by the NCCAOM;

h.An NCCAOM certificate that demonstrates that the applicant holds current active status as a diplomate in acupuncture or oriental medicine from the NCCAOM;

i.Proof of successful completion of a course in clean needle technique approved by the NCCAOM;

j.A description of the applicant’s clinical acupuncture training, work experience and, where applicable, supporting documentation;

k.A copy of the applicant’s acupuncture degree issued by an educational institution. If a copy of the acupuncture degree cannot be provided because of extraordinary circumstances, the board may accept other reliable evidence that the applicant obtained an acupuncture degree from a specific educational institution;

l.A complete translation of any diploma not written in English. An official transcript, written in English and received directly from the educational institution, showing graduation from an acupuncture training program or an educational institution is a suitable alternative;

m.A sworn statement from an official of the educational institution certifying the date the applicant received the acupuncture degree and acknowledging what, if any, derogatory comments exist in the institution’s record about the applicant. If a sworn statement from an official of the educational institution cannot be provided because of extraordinary circumstances, the board may accept other reliable evidence that the applicant obtained an acupuncture degree from a specific educational institution;

n.An official transcript sent directly from an acupuncture training program or an educational institution attended by the applicant and, if requested by the board, an English translation of the official transcript;

o.Proof of the applicant’s proficiency in the English language, when the applicant has not passed the English version of the NCCAOM written and practical examinations;

p.Verification of an applicant’s hospital and clinical staff privileges and other professional experience for the past five years if requested by the board; and

q.A completed fingerprint packet to facilitate a national criminal history background check. The fee for evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed to the applicant.

17.4(3) Application cycle. If the applicant does not submit all materials, including a completed fingerprint packet, within 90 days of the board’s initial request for further information, the application is inactive.

a.To reactivate the application, an applicant shall submit a nonrefundable reactivation of application fee identified in 653—subrule 8.2(2) and shall update application materials if requested by the board. The period for requesting reactivation is limited to 30 days from the date the applicant is notified that the application is inactive, unless the applicant is granted an extension in writing by the committee or the board.

b.Once the application reactivation period is expired, applicants must reapply and submit a new, nonrefundable initial application fee and a new application, including required documents and credentials.

17.4(4) Applicant responsibilities. An applicant for licensure to practice acupuncture bears full responsibility for each of the following:

a.Paying all fees charged by regulatory authorities, national testing or credentialing organizations, health facilities, and educational institutions providing the information specified in subrule 17.4(2);

b.Providing accurate, up-to-date, and truthful information on the application form, including but not limited to that specified under subrule 17.4(2) related to prior professional experience, education, training, examination scores, diplomate status, licensure or registration, and disciplinary history; and

c.Submitting English translations of documents in foreign languages bearing the affidavit of the translator certifying that the translation is a true and complete translation of the foreign language original. The applicant shall bear the expense of the translation.

17.4(5) Licensure application review process. The process below is utilized to review each application. Priority is given to processing a licensure application when a written request is received in the board office from an applicant whose practice will primarily involve provision of services to underserved populations, including but not limited to persons who are minorities or low-income or who live in rural areas.

a.An application for initial licensure is considered open from the date the application form is received in the board office with the nonrefundable initial application fee.

b.After reviewing each application, staff will notify the applicant about how to resolve any problems identified by the reviewer. An applicant shall provide additional information when requested by staff or the board.

c.If the final review indicates no questions or concerns regarding the applicant’s qualifications for licensure, staff may administratively grant the license. The staff may grant the license without having received a report on the applicant from the FBI.

d.If the final review indicates questions or concerns that cannot be remedied by continued communication with the applicant, the executive director, the director of licensure and the director of legal affairs will determine if the questions or concerns indicate any uncertainty about the applicant’s current qualifications for licensure.

(1)If there is no current concern, staff will administratively grant the license.

(2)If any concern exists, the application will be referred to the committee.

e.Staff will refer to the committee for review matters that include but are not limited to: falsification of information on the application, criminal record, malpractice, substance abuse, competency, physical or mental illness, or professional disciplinary history.

f.If the committee is able to eliminate questions or concerns without dissension from staff or a committee member, the committee may direct staff to issue the license administratively.

g.If the committee is not able to eliminate questions or concerns without dissension from staff or a committee member, the committee will recommend that the board:

(1)Request an investigation;

(2)Request that the applicant appear for an interview;

(3)If an applicant has not engaged in active practice in the past three years in any jurisdiction of the United States, require an applicant to:

1.Successfully complete continuing education or retraining programs in areas directly related to the safe and healthful practice of acupuncture deemed appropriate by the board or committee;

2.Successfully pass a competency evaluation approved by the board;

3.Successfully pass an examination approved by the board; or

4.Successfully complete a reentry to practice program or monitoring program approved by the board;

(4)Issue a license;

(5)Issue a license under certain terms and conditions or with certain restrictions;

(6)Request that the applicant withdraw the licensure application; or

(7)Deny a license.

h.The board will consider applications and recommendations from the committee and will:

(1)Request an investigation;

(2)Request that the applicant appear for an interview;

(3)If an applicant has not engaged in active practice in the past three years in any jurisdiction of the United States, require an applicant to:

1.Successfully complete continuing education or retraining programs in areas directly related to the safe and healthful practice of acupuncture deemed appropriate by the board or committee;

2.Successfully pass a competency evaluation approved by the board;

3.Successfully pass an examination approved by the board; or

4.Successfully complete a reentry to practice program or monitoring program approved by the board;

(4)Issue a license;

(5)Issue a license under certain terms and conditions or with certain restrictions;

(6)Request that the applicant withdraw the licensure application; or

(7)Deny a license. The board may deny a license for any grounds on which the board may discipline a license.

17.4(6) Grounds for denial of licensure. The board, on the recommendation of the committee, may deny an application for licensure for any of the following reasons:

a.Failure to meet the requirements for licensure specified in rule 653—17.3(147,148E) as authorized by Iowa Code section 148E.2 or of this chapter.

b.Pursuant to Iowa Code section 147.4, upon any of the grounds for which licensure may be revoked or suspended as specified in Iowa Code sections 147.55 and 148E.8 or in 481—Chapter 8.

17.4(7) Preliminary notice of denial. Prior to the denial of licensure to an applicant, the board will issue a preliminary notice of denial that will be sent to the applicant by regular, first-class mail at the address provided by the applicant. The preliminary notice of denial is a public record and cites the factual and legal basis for denying the application, notifies the applicant of the appeal process, and specifies the date upon which the denial will become final if it is not appealed.

17.4(8) Appeal procedure. An applicant who has received a preliminary notice of denial may appeal the denial and request a hearing on the issues related to the preliminary notice of denial by serving a request for hearing upon the executive director not more than 30 calendar days following the date when the preliminary notice of denial was mailed. The applicant’s current address shall be provided in the request for hearing. The request is deemed filed on the date it is received in the board office. If the request is received with a USPS nonmetered postmark, the board will consider the postmark date as the date the request is filed. The request shall specify the factual or legal errors and that the applicant desires an evidentiary hearing and may provide additional written information or documents in support of licensure.

17.4(9) Hearing. If an applicant appeals the preliminary notice of denial and requests a hearing, the hearing will be a contested case open to the public and conducted in accordance with 481—Chapter 506.

17.4(10) Finality. If an applicant does not appeal a preliminary notice of denial in accordance with subrule 17.4(8), the preliminary notice of denial automatically becomes final. A final denial of an application for licensure is a public record.

17.4(11) Failure to pursue appeal. If an applicant appeals a preliminary notice of denial in accordance with subrule 17.4(8) but the applicant fails to pursue that appeal to a final decision within one year from the date of the preliminary notice of denial, the board may dismiss the appeal. The appeal may be dismissed only after the board sends a written notice by first-class mail to the applicant at the applicant’s last-known address. The notice will state that the appeal will be dismissed and the preliminary notice of denial will become final if the applicant does not contact the board to schedule the appeal hearing within 30 days of the date the letter is mailed from the board office. Upon dismissal of an appeal, the preliminary notice of denial becomes final. A final denial of an application for licensure under this rule is a public record.

17.4(12) Waiver prohibited. Provisions of this rule are not subject to waiver pursuant to 481—Chapter 6 or any other provision of law.

653—17.5(147,148E,272C) Biennial renewal of license required. Pursuant to Iowa Code section 148E.2, a license expires on October 31 of even-numbered years and can be renewed for the fee identified in 653—paragraph 8.2(2)“c.” The applicant for renewal shall provide an NCCAOM certificate that demonstrates that the applicant holds current active status as a diplomate in acupuncture or oriental medicine from the NCCAOM.

17.5(1) Expiration date. Certificates of licensure to practice acupuncture expire on October 31 in even years.

17.5(2) Prorated fees. The first renewal fee for a license will be prorated on a monthly basis according to the date of issue.

17.5(3) Renewal requirements and penalties for late renewal. The licensee is responsible for renewing the license prior to its expiration. Failure of the licensee to receive notice does not relieve the licensee of responsibility for renewing that license.

a.Upon receipt of the completed renewal application, staff will administratively issue a license that expires on October 31 of even-numbered years. In the event the board receives adverse information on the renewal application, the board will issue the renewal license but may refer the adverse information for further consideration.

b.Every renewal shall be displayed in connection with the original certificate of licensure.

c.If the licensee fails to submit the renewal application and renewal fee prior to the expiration date on the current license, a penalty stated in 657—paragraph 8.2(2)“g” will be assessed for renewal in the grace period, a period up until January 1.

17.5(4) Inactive license. Failure of a licensee to renew by January 1 will result in inactivation of the license, and the license will be invalid.

a.Licensees are prohibited from engaging in the practice of acupuncture with an inactive or lapsed license.

b.Having an acupuncturist license in lapsed status does not preclude the board from taking disciplinary actions authorized in Iowa Code section 147.55 or 148E.8.

653—17.6(147,272C) Reactivation of an inactive license.

17.6(1) Reactivation requirements. Licensees who allow their licenses to go inactive by failing to renew may apply for reactivation of a license. Pursuant to Iowa Code section 147.11, applicants for reactivation shall:

a.Submit completed application for reactivation of a license to practice acupuncture. The application shall include the following information:

(1)The applicant’s full legal name, date and place of birth, home address, mailing address, principal business address, and personal email address regularly used by the applicant or licensee for correspondence with the board.

(2)Every jurisdiction in which the applicant is or has been authorized to practice, including license numbers and dates of issuance.

(3)Full disclosure of the applicant’s involvement in civil litigation related to the practice of acupuncture in any jurisdiction of the United States, other nations or territories. Copies of the legal documents may be requested if needed during the review process.

(4)A statement disclosing and explaining any warnings issued, investigations conducted or disciplinary actions taken, whether by voluntary agreement or formal action, by a medical, acupuncture or professional regulatory authority, an educational institution, a training or research program, or a health facility in any jurisdiction.

(5)Verification of an applicant’s hospital and clinical staff privileges and other professional experience for the past five years if requested by the board.

(6)A chronology accounting for all time periods from the date of initial licensure.

(7)A statement disclosing and explaining any charge of a misdemeanor or felony involving the applicant filed in any jurisdiction, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside.

b.Submit a completed fingerprint packet to facilitate a national criminal history background check. The fee identified in 653—subrule 8.2(5) for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed to the applicant.

c.Pay the reactivation fee identified in rule 653—8.2(147,148,272C) plus the fee identified in 653—subrule 8.2(5) for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks.

d.Provide an NCCAOM certificate which demonstrates that the applicant holds current active status as a diplomate in acupuncture or oriental medicine from the NCCAOM.

e.Meet any new requirements instituted since the license lapsed.

17.6(2) Reactivation restrictions. Pursuant to Iowa Code section 272C.3(2)“d,” the committee may require an applicant who has not engaged in active practice in the past three years in any jurisdiction of the United States to meet any or all of the following requirements prior to reactivation of a license:

a.Successfully complete continuing education or retraining programs in areas directly related to the safe and healthful practice of acupuncture deemed appropriate by the board or committee;

b.Successfully pass a competency evaluation approved by the board;

c.Successfully pass an examination approved by the board; or

d.Successfully complete a reentry to practice program or monitoring program approved by the board.

653—17.7(272C) Continuing education requirements. Licensees shall demonstrate that they hold current active status as a diplomate from the NCCAOM. The NCCAOM requires 60 points of professional development activity every four years. Active NCCAOM certification satisfies the continuing education requirements established in Iowa Code section 272C.2.

653—17.8(147,148E,272C) General provisions.

17.8(1) Diagnostic and treatment modalities. Diagnostic and treatment modalities used by licensees under this chapter may include one or more of the following acupunctural services:

a.The stimulation or piercing of the skin with an acupuncture needle for any of the following purposes:

(1)To evoke a therapeutic physiological response, either locally or distally to the area of insertion or stimulation.

(2)To relieve pain or treat the neuromusculoskeletal system.

(3)To stimulate ashi acupuncture points to relieve pain and dysfunction.

(4)To promote, maintain, and restore health and to prevent disease.

(5)To stimulate the body according to auricular, hand, nose, face, foot or scalp acupuncture therapy.

(6)To use acupuncture needles with or without the use of herbs, electric current, or application of heat.

b.The use of oriental medical diagnosis and treatment, including:

(1)Moxibustion, cupping, thermal methods, magnets, gua sha scraping techniques, acupatches, herbal poultices, hot and cold packs, electromagnetic wave therapy, light and color therapy, sound therapy, or therapy lasers.

(2)Massage, acupressure, reflexology, shiatsu and tui na massage, or manual stimulation, including stimulation by an instrument or mechanical device that does not pierce the skin.

(3)Herbal medicine and dietary supplements, including those of plant, mineral, animal, and nutraceutical origin.

c.Any other adjunctive service or procedure that is clinically appropriate based on the licensee’s training as approved by NCCAOM or ACAOM.

17.8(2) Use and disposal of needles. A licensee shall use only presterilized, disposable needles and shall provide for the disposal of used needles in accordance with the requirements of the department.

17.8(3) Standard of care. A licensee shall be held to the same standard of care as persons licensed to practice medicine and surgery or osteopathic medicine and surgery. Pursuant to Iowa Code section 272C.3, any error or omission, unreasonable lack of skill, or failure to maintain a reasonable standard of care in the practice of acupuncture constitutes malpractice and is grounds for the revocation or suspension of a license to practice acupuncture in this state.

17.8(4) Title. An acupuncturist licensed under this title may use the words “licensed acupuncturist” or “L.Ac.” to connote professional standing after the licensee’s name in accordance with Iowa Code section 147.74(18).

17.8(5) Change of contact information. Licensees shall notify the board of changes in home address, address of the place of practice, home or practice telephone number, or personal email address regularly used by the applicant or licensee for correspondence with the board within one month of the change.

17.8(6) Delegation of responsibilities. A licensee shall perform all aspects of acupuncture treatment that involve penetration of the skin of a patient. The licensee may delegate other aspects of treatment to staff and patients who are properly trained by the licensee. It is permissible for appropriately trained staff and patients to remove acupuncture needles from the patient’s body. The licensee is responsible for establishing and maintaining written training standards for staff.

17.8(7) Change of full legal name. A licensee shall notify the board of any change in the licensee’s full legal name within one month of making the name change. Notification requires a notarized copy of a marriage license or a notarized copy of court documents.

17.8(8) Deceased. A licensee’s file will be closed and labeled “deceased” when the board receives a copy of the licensee’s death certificate or other reliable information of the licensee’s death.

These rules are intended to implement Iowa Code chapter 148E and sections 17A.10 through 17A.20, 147.55, 272C.3 through 272C.6, 272C.8 and 272C.9.