Title of Regulation: 18VAC85-110. Regulations Governing the Practice of Licensed Acupuncturists (amending 18VAC85-110-50).

Statutory Authority: §§ 54.1-2400 and 54.1-2956.9 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: January 28, 2015.

Effective Date: February 13, 2015.

Agency Contact: William L. Harp, M.D., Executive Director, Board of Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4558, FAX (804) 527-4429, or email william.harp@dhp.virginia.gov.

Basis: Chapter 24 (§ 54.1-2400 et seq.) of Title 54.1 of the Code of Virginia establishes the general powers and duties of health regulatory boards including the responsibility to promulgate regulations. Section 54.1-2956.10 requires the board to establish a testing program to determine the training and educational achievements of acupuncturists, or the board may accept other evidence such as successful completion of a national certification examination, experience, or completion of an approved training program in lieu of testing and establish this as a prerequisite for approval of the licensee's application.

Purpose: The purpose of the amendment is to allow graduates of acupuncture programs that have candidacy status from the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) to be licensed in Virginia. In order to achieve candidacy status, a program must meet the same academic criteria as an accredited program. Accreditation is granted after a program has demonstrated a sustained level of achievement and financial stability. Graduates of candidacy status programs take the same licensing examination as accredited programs and pass the examination at a similar rate. Therefore, there is evidence that such graduates have adequate education and training to assure minimal competency for safe and effective practice as licensed acupuncturists.

Rationale for Using Fast-Track Process: The board received a recommendation from the Advisory Board on Acupuncture to amend regulations by a fast-track action to accelerate the less restrictive change to the benefit of applicants and acupuncture schools opening in Virginia. Prior to adoption, the change was vetted with representatives of the National Certification Commission for Acupuncture and Oriental Medicine and the Acupuncture Society of Virginia to ensure that it was acceptable and not controversial.

Substance: An amendment to 18VAC85-110-50 will authorize the board to license an applicant from an acupuncture program or school in candidacy status for accreditation by ACAOM if the applicant has obtained the requisite hours of didactic education and clinical training.

Issues: The primary advantage of the amendment is a very modest increase in the number of applicants who will qualify for licensure in Virginia. There are no disadvantages; there is adequate education and training to assure minimal competency for safe and effective practice. There are no advantages or disadvantages to the Commonwealth. There will be a small number of practitioners who will be able to practice in Virginia rather than going to other states.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Medicine (Board) proposes to allow graduates of acupuncture programs that have candidacy status from the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) to be licensed in Virginia.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. In order to achieve candidacy status, acupuncture educational programs must meet the same academic criteria as accredited programs. Accreditation is granted after a program has demonstrated a sustained level of achievement and financial stability. Graduates of candidacy status programs take the same licensing examination as accredited programs and pass the examination at a similar rate.¹ Therefore, there is evidence that such graduates have adequate education and training to assure minimum competency for safe and effective practice as licensed acupuncturists.

There are 72 fully ACAOM accredited acupuncture educational programs, but none are in Virginia. There are three Virginia acupuncture educational programs in candidacy status.² The proposed amendment will allow graduates of these programs (who meet the other licensing criteria) to become licensed in Virginia. This will likely increase business for these three Virginia programs and will allow their graduates to practice and gain employment in the Commonwealth. Since as described above, there is evidence that graduates of these programs are likely as competent as graduates of fully accredited programs, the proposed change will be beneficial in that it will allow additional qualified acupuncturists to practice in Virginia and will remove an unnecessary burden for three Virginia businesses.

Businesses and Entities Affected. The proposed amendment affects acupuncture educational programs with candidacy status and their graduates. There are three Virginia acupuncture educational programs in candidacy status.³

Localities Particularly Affected. Two of the three Virginia acupuncture educational programs in candidacy status are in Fairfax County. The third is in the City of Alexandria.⁴

Projected Impact on Employment. The proposed amendment will likely increase the number of acupuncturists practicing in the Commonwealth.

Effects on the Use and Value of Private Property. The proposed amendment will likely increase the value of the three Virginia acupuncture educational programs in candidacy status, since earning one of their degrees would with the amendment permit licensure in Virginia.

Small Businesses: Costs and Other Effects. The proposed amendment will not increase costs for small businesses. The three Virginia acupuncture educational programs in candidacy status, likely all small businesses, will only benefit from the proposed amendment.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed amendment will not adversely affect small businesses.

Real Estate Development Costs. The proposed amendment is unlikely to significantly affect real estate development costs.

Legal Mandate.

General: The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order Number 14 (2010). Section 2.2-4007.04 requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the report should include but not be limited to:

• the projected number of businesses or other entities to whom the proposed regulatory action would apply,

• the identity of any localities and types of businesses or other entities particularly affected,

• the projected number of persons and employment positions to be affected,

• the projected costs to affected businesses or entities to implement or comply with the regulation, and

• the impact on the use and value of private property.

Small Businesses: If the proposed regulatory action will have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include:

• an identification and estimate of the number of small businesses subject to the proposed regulation,

• the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents,

• a statement of the probable effect of the proposed regulation on affected small businesses, and

• a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation.

Additionally, pursuant to § 2.2-4007.1, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules (JCAR) is notified at the time the proposed regulation is submitted to the Virginia Register of Regulations for publication. This analysis shall represent DPB's best estimate for the purposes of public review and comment on the proposed regulation.

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¹ Source: Department of Health Professions

² Data from Accreditation Commission for Acupuncture and Oriental Medicine website (http://www.acaom.org/) accessed on April 15, 2014.

³ Ibid.

⁴ Ibid.

Agency's Response to Economic Impact Analysis: The Board of Medicine concurs with the economic impact analysis prepared by the Department of Planning and Budget for 18VAC85-110.

Summary:

The amendment permits the issuance of a license to an applicant who is a graduate of an acupuncture program or school that is in candidacy status for accreditation by the Accreditation Commission for Acupuncture and Oriental Medicine if the applicant has obtained the requisite hours of didactic education and clinical training.

Part II
Requirements for Licensure

18VAC85-110-50. Educational requirements: graduates of approved institutions or programs in the United States.

A. Requirements for acupuncture education obtained prior to July 1, 1990, shall be as provided in this subsection.

1. An applicant applying for licensure to practice as an acupuncturist on the basis of successful completion of education in a school or college of acupuncture accredited by the ACAOM or other accrediting agencies approved by the Board of Medicine, which confers a degree or certificate in acupuncture in the United States, shall submit evidence of successful completion of an acupuncture course of study in an accredited school or college for acupuncture, providing evidence of not less than 1,000 hours of schooling in not less than a continuous 18-month period.

2. The studies shall include not less than 700 didactic hours and not less than 250 clinical hours. Additional hours may be in either didactic or clinical hours based upon the school or college curriculum.

B. Requirements for acupuncture education obtained after July 1, 1990, shall be as provided in this subsection.

An applicant applying for licensure to practice as a licensed acupuncturist on the basis of successful completion of education in a school or college for acupuncture accredited by ACAOM or any other accrediting agency approved by the Board of Medicine, which confers a degree or certificate in acupuncture in the United States, shall submit evidence of having a minimum of three academic years in length equivalent to 90 semester credit hours or 135 quarter credit hours.

One academic year means full-time study completed in four quarters, two semesters, or three trimesters. A full-time continuous study program shall be a concentrated educational process in acupuncture that requires individual study with assigned materials in a classroom or clinical setting.

C. Requirements for acupuncture education obtained after July 1, 1999, shall be as provided in this subsection. An applicant applying for licensure to practice as a licensed acupuncturist on the basis of successful completion of education in a school or college for acupuncture accredited by ACAOM or any other accrediting agency approved by the Board of Medicine, which confers a degree or certificate in acupuncture in the United States, shall submit evidence of having a minimum of 1,725 hours of entry-level acupuncture education to include at least 1,000 didactic hours and 500 clinical hours. Clinical hours may include observation, as well as internship or treatment hours; the remaining 225 hours may be earned as either didactic or clinical. Correspondence programs or courses in acupuncture are excluded and may not be used to meet the requirements for acupuncture education.

D. Requirements for acupuncture education obtained after February 1, 2011, shall be as provided in this subsection. An applicant applying for licensure to practice as a licensed acupuncturist on the basis of successful completion of education in a school or college for acupuncture accredited by ACAOM or any other accrediting agency approved by the Board of Medicine, which confers a degree or certificate in acupuncture in the United States, shall submit evidence of having a minimum of 1,905 hours of entry-level acupuncture education to include at least 1,155 didactic hours and 660 clinical hours. Clinical hours may include observation, as well as internship or treatment hours; the remaining 90 hours may be earned as either didactic or clinical hours. Correspondence programs or courses in acupuncture are excluded and may not be used to meet the requirements for acupuncture education.

E. An applicant from an acupuncture program in a school or college that has achieved candidacy status for accreditation by ACAOM shall be eligible for licensure provided the program has subsequently been granted accreditation within three years of the applicant's graduation meets the applicable requirements of subsection A, B, C, or D of this section, with the exception of full ACAOM accreditation.