Interpretation of A.R.S. § 32-3901(5)’s Definition of “Herbal Therapies”

September 28, 2022

This Substantive Policy Statement is advisory only. A Substantive Policy Statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on the regulated parties or include confidential information or rules made in accordance with the Arizona Administrative Procedures Act. If you believe that this Substantive Policy Statement does impose additional requirements or penalties on regulated parties, you may petition the State of Arizona Acupuncture Board of Examiners (the “Board”) under Arizona Revised Statutes (“A.R.S.”) Section 41-1033 for a review of the statement. See A.R.S. § 41-1091.

A.R.S. § 32-3901(5) defines “Herbal therapies” as “prescribing, administering, injecting, compounding, and dispensing herbal medicines and plant, animal, mineral, and natural substances.”   

Definitions

The Board” will review and approve at their January meeting or upon motion of the Board a list of substances it interprets as “herbal medicines and plant, animal, mineral and natural substances” under A.R.S. § 32-3901(5).  See Attachment 1

Training Requirements

A.R.S. § 32-3901(1)(b)(v) requires acupuncturists using and prescribing herbal therapies to do so only commensurate with the acupuncturist’s education and training.  The Board recognizes that many, but not all, acupuncture training programs, both American and foreign, include sufficient and extensive training in herbal therapies.  

I. This being the case, the Board approves any licensee to perform herbal therapies, not to include injections, who completed one of the following:

1. Taken and passed the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) Chinese Herbology Examination;
2. Completed sufficient education as part of their formal acupuncture training as determined by the Board after a review of official transcripts; or
3. Other training as approved by the Board. 

A Licensee is not required to receive Board approval prior to beginning practice of this modality.  Education will be reviewed on a case by case basis as instigated by the Board,  by the Executive Director or after receipt of complaint. See A.R.S. § 32-2903(A)(2); A.A.C. R4-8-602. 

II. Licensees must receive Board approval prior to injecting herbal medicines or plant, animal, mineral, or natural substances.  A licensee must have completed one of the following:

1. Acupuncture Point Injection Therapy (APIT) training of at least sixty (60) hours;
2. APIT education as part of their formal acupuncture training as determined by the Board after a review of official transcripts; or 
3. Other training as approved by the Board.

The Board will seek a statute and/or rule change to clarify the definition of “Herbal Therapies” and training requirements associated with it. 

Attachment: 1

I. The Board Interprets  “herbal medicines and plant, animal, mineral and natural substances” to include the following:

A. Non-injection substances approved for use as herbal therapies:

Individual herbs or herbal formulas found in traditional Materia Medica;  (ex. the Bensky Materia Medica or Bensky Formulas & Strategies); 

Custom compounds using individual herbs found in traditional Materia Medica  (ex. the Bensky Materia Medica or Bensky Formulas & Strategies);

Traditional Chinese Herbal formulas including modern commercially available formulas;

Publicly available vitamins, minerals, and dietary supplements;

B. (APIT) substances approved for use as herbal therapies:

Licensees may utilize Topical Vapocoolants pre or post injection;

The Intradermal Intramuscular, and Subcutaneous Injection of: Homeopathics, Dextrose, Enzymes Except Urokinase, Hyaluronic Acid, Minerals, Sarapin, Sodium Chloride, Sterile Water, Vitamins, cyanocobalamin, Marcaine (Bupivacaine Hydrochloride) with or without Epinephrine, Lidocaine, Herbs, Methylcobalamin, Engystol, Inositol, Saline, and Vitamins including but not limited to Vitamin B-6, Vitamin B-12;

The Subcutaneous or Intramuscular Injection of Epinephrine, Medical Grade Oxygen, and Additives Necessary To Stabilize, Preserve Or Balance Ph Of Approved Substances;

Non-Epidural, Non Intrathecal Injection f: Alcohol, Amino Acids, Autologous Blood And Blood Products And Appropriate Anticoagulant, Live Cell Products, Ozone, Bee Venom, Beta Glucans, Caffeine, Collagenase, Dextrose, Dimethyl Sulfoxide, Gammaglobulin, Glucose, Glucosamine, Glycerin, Hyaluronidase, Methylsulfonylmethane, Phenol, Phosphatidylcholine, Procaine, Sodium Hyaluronate, Sodium Morrhuate and Therapeutic Serum.

Training and Supervision Requirements for Acupuncture Assistants

September 28, 2022

This Substantive Policy Statement is advisory only. A Substantive Policy Statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on the regulated parties or include confidential information or rules made in accordance with the Arizona Administrative Procedures Act. If you believe that this Substantive Policy Statement does impose additional requirements or penalties on regulated parties, you may petition the State of Arizona Acupuncture Board of Examiners (the “Board”) under Arizona Revised Statutes (“A.R.S.”) Section 41-1033 for a review of the statement. See A.R.S. § 41-1091.

A.R.S. § 32-3901(1) defines "Acupuncture Assistant" (AA) as “an unlicensed person who has completed a training program approved by the board, who assists in basic health care duties in the practice of acupuncture under the supervision of a licensed acupuncturist and who performs delegated duties commensurate with the acupuncture assistant's education and training, but who does not evaluate, interpret, design or modify established treatment programs of acupuncture care.”

Training Requirements

The modalities practiced by AAs require specific training and oversight in order to protect patient safety.  The Board recognizes that an increasing number of states are recognizing AAs and hopes that national exams and educational standards will be developed.  However, without these in place, it recognizes the need to evaluate and approve programs of training on a State level.  

The Board is working with acupuncturists and other stakeholders throughout the State of Arizona to develop rules prior to the legislative deadline of January 1, 2024, as stated in Laws 2022, chapter 23, section 8.  This Substantive Policy Statement will develop temporary training guidelines until those rules can be promulgated.  

The Board approves the following programs for the training of AAs:

A. Having passed a certification exam for AAs provided by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM);

B. Having taken and passed a program of training in auricular acupuncture approved by the Board along with four (4) hours of training in moxibustion and four (4) hours of training in herbs;

C. Having taken and passed a program of training as an AA provided by an accredited college or university; 

D. Being currently enrolled in a Board-approved program of acupuncture designed to prepare the student to become a licensed acupuncturist; or

E. Having taken and passed a program of training provided by a licensed acupuncturist.

To apply for approval under item (e) above, a program of training provided by a licensed acupuncturist must meet the following criteria:
 

A training program shall be no shorter than forty (40) hours and  shall include, at a minimum, a combination of the following:

1. Sterilization procedures and techniques;
2. Preventing bruising and bleeding post needle removal;
3. Needle removal protocols including what to do with stuck, broken, or missed needles;
4. Bloodborne pathogens;
5. What to do in the event a medical emergency arises during or after treatment;
6. Cupping and scraping;
7. Moxibustion; 
8. History taking and recordkeeping; and 
9. Professional standards of conduct.

Supervision

A.R.S. § 32-3901(6) defines “Supervision” to mean “that the supervising licensed acupuncturist is present in the facility where the [AA] is performing services and is available for consultation regarding procedures that the licensed acupuncturist has authorized and for which the licensed acupuncturist remains responsible.”

An AA may not insert acupuncture needles or evaluate, interpret, design or modify established treatment programs of acupuncture care.  The Board will seek a statute and/or rule change to clarify the above supervision and training requirements

Board Approval of Alcoholism, Substance Abuse, or Chemical Dependency Programs Offering Auricular Acupuncture

March 27, 2019

This Substantive Policy Statement is advisory only. A Substantive Policy Statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on the regulated parties or include confidential information or rules made in accordance with the Arizona Administrative Procedures Act. If you believe that this Substantive Policy Statement does impose additional requirements or penalties on regulated parties, you may petition the agency under Arizona Revised Statutes (“A.R.S.”) Section 41-1033 for a review of the statement. (A.R.S. § 41-1091)

            A.R.S. § 32-3922 provides that the State of Arizona Acupuncture Board of Examiners (“Board”) may issue auricular acupuncture certificates for the purpose of treating alcoholism, substance abuse, or chemical dependency. A certificate issued pursuant to this statute only allows the certificate holder to practice auricular acupuncture under the supervision of a licensed Arizona acupuncturist in an alcoholism, substance abuse, or chemical dependency program (“treatment program”) approved by the Board, the state, or the federal government. Arizona Administrative Code (“A.A.C.”) R4-8-302 further elaborates that the Board automatically approves of any alcoholism, substance abuse, or chemical dependency program that is already licensed by the Arizona Department of Health Services (“DHS”) as a behavioral health agency under A.R.S. Title 36, Chapter 4.

            Currently, DHS licenses over 700 behavioral health agencies in the state of Arizona. However, DHS does not approve treatment programs and a prerequisite of licensure with DHS is that the agency must be Medicare-approved. As acupuncture is still viewed by Medicaid, Medicare, and most private insurance companies as complementary, integrative, or alternative medicine, it is generally not a covered service and so many of these agencies do not offer auricular acupuncture as a treatment option. In light of the opioid epidemic that has become a serious public health concern nationally and here in the State of Arizona, the Board has decided to set forth specific criteria for alcoholism, substance abuse, and chemical dependency programs that wish to seek approval from the Board to operate as a treatment program that can provide auricular acupuncture services through the employment of an auricular acupuncture certificate holder under the supervision of a licensed acupuncturist.

In order to seek Board approval of an alcoholism, substance abuse, and chemical dependency program, the applicant for the treatment program seeking approval shall submit the following information to the Board:

1. The treatment program’s name, physical and mailing address, phone number, fax number and email address;
2. An affidavit stating that the treatment program is for the purpose of treating alcoholism, substance abuse, or chemical dependency;
3. An affidavit stating that all auricular patients will be informed that auricular acupuncture is not a standalone cure for alcoholism, substance abuse, or chemical dependency;
4. An affidavit stating that all auricular patients will be educated about treatment program options;
5. Location of the facility where auricular acupuncture will be administered and proximity to the location of the treatment program;
6. The name of the director of the treatment program;
7. History and background of the treatment program;
8. The number and qualifications of the treatment program staff; 
9. The name and contact information for the supervising licensed acupuncturist and the certified auricular acupuncturist, if known.

While the Board seeks a rule change to clarify its position and amend the language in the existing rule regarding the requirements for Board-approval of alcoholism, substance abuse, or chemical dependency programs, the Board will continue to approve any alcoholism, substance abuse, or chemical dependency program that is approved by the State of Arizona (including DHS) or the federal government, pursuant to A.A.C. R4-8-302, and will use the above listed criteria to evaluate any other alcoholism, substance abuse, or chemical dependency program that seeks approval..

Board’s Interpretation of “Acupuncture” Definition in A.R.S. § 32-3901(1)

April 24, 2019

This Substantive Policy Statement is advisory only. A Substantive Policy Statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on the regulated parties or include confidential information or rules made in accordance with the Arizona Administrative Procedures Act. If you believe that this Substantive Policy Statement does impose additional requirements or penalties on regulated parties, you may petition the agency under Arizona Revised Statutes (“A.R.S.”) Section 41-1033 for a review of the statement. (A.R.S. § 41-1091)

            A.R.S. § 32-3901(1) defines “Acupuncture” as the “puncturing of the skin by thin, solid needles to reach subcutaneous structures, stimulating the needles to produce a positive therapeutic response at a distant site and the use of adjunctive therapies.” The State of Arizona Acupuncture Board of Examiners (“Board”) has interpreted “stimulating the needles” to include the removal of needles from a patient, as the removal of the needles is an integral part of an acupuncturist’s education and training, the patient’s treatment plan, and therapeutic effect.

            A.R.S. § 32-3924(2) requires every applicant for licensure to provide evidence that he or she has graduated from or completed training in a board-approved program of acupuncture with a minimum of one thousand eight-hundred fifty hours of training that includes at least eight hundred hours of board-approved clinical training. Board-approved programs of acupuncture spend a significant amount of time teaching students about the risks and complications associated with acupuncture and the removal of needles: specifically, preventing bruising and bleeding post needle removal and what to do with stuck, broken needles, or missed needles, as well as what to do in the event a medical emergency arises during or after treatment. In light of the possibility that unlicensed and unqualified individuals may be removing needles from patients at the direction and without the supervision of a licensed acupuncturist, the Board has decided to clarify that it views removal of needles as “stimulation” of a needle and a practice exclusively within the scope of practice of a licensed acupuncturist or individuals exempted from Board regulation pursuant to A.R.S. § 32-3921(B).

The Board will seek a statute and/or rule change to clarify the definition of “Acupuncture” to specifically include the removal of needles in a licensee’s scope of practice. While the Board seeks this change to clarify its position, the Board will continue to recognize removal of needles as practicing acupuncture in the State of Arizona under its current law. Only individuals licensed by this Board and exempt pursuant to A.R.S. § 32-3921(B) are authorized to remove needles from patients being treated with acupuncture. Any unlicensed persons removing needles without a license, certificate, or statutory exemption may be subject to legal action pursuant to A.R.S. § 32-3953 and any licensed acupuncturist directing or supervising an unlicensed person in the removal of needles may also be subject to discipline by the Board for unprofessional conduct.

Acupuncture Board of Examiners

Substantive Policy Statement Regarding Board Policy on Examinations Recognized by the Board for Meeting Statutory License Requirements.

SPS 2008-001

  This substantive policy statement is advisory only.  A substantive policy statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on regulated parties or include confidential information or rules made in accordance with the Arizona administrative procedure act.  If you believe that this substantive policy statement does impose additional requirements or penalties on regulated parties you may petition the agency under Arizona Revised Statues §41-1033 for a review of the document.
            Whereas in A.R.S § 32-3924 (1). Qualifications for licensure, it outlines and states the requirements on how to acquire a license to practice acupuncture.  This statutory cite states the board may approve an applicant for licensure by recognizing the examination provided by the National Commission for the Certification of Acupuncture and Oriental Medicine or examination that is recognized by the board.
            Whereas, the Board in the interest of issuing an acupuncture license, the board will accept documentation from an applicant that demonstrates the applicant has taken and passed all four of the exam modules: Point Location Module, Foundations of Oriental Medicine Module, Biomedicine Module and the Acupuncture Module as provided by the National Commission for the Certification of Acupuncture and Oriental Medicine.
            Whereas, the Board in the interest of issuing an acupuncture license, the board will recognize documentation from an applicant that demonstrates the applicant has taken and passed the California Acupuncture Licensing Examination.
            (Adopted at the Board meeting of October 22, 2008)

Acupuncture Board of Examiners

Substantive Policy Statement Regarding Board Policy on Acupuncture License and Auricular Acupuncture Certificate Renewal Date Requirements.

SPS 2009-001

This substantive policy statement is advisory only.  A substantive policy statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on regulated parties or include confidential information or rules made in accordance with the Arizona administrative procedure act.  If you believe that this substantive policy statement does impose additional requirements or penalties on regulated parties you may petition the agency under Arizona Revised Statues §41-1033 for a review of the document.
            Whereas, pursuant to A.A.C. R4-8-204(A) and A.A.C. R4-8-303(A) an acupuncture  license and auricular acupuncture certificate expire 12 months after the date issued.
            Whereas, the Board interprets “12 months after the date issued” to include the full renewal month.  Meaning, that an applicant must submit their renewal application, and any other documentation required under A.A.C. R4-8-204 and A.A.C. R4-8-303, prior to the close of business on the last business day of the renewal month in order to avoid the expiration of their acupuncture license pursuant to A.A.C. R4-8-204(A) and A.A.C. R4-8-303(A0.
 
            (Adopted at the Board meeting of April 22, 2009)