13 June 2024
We are sad to report that - despite our significant efforts over the last 9 months - the Department of Health has finalized the proposed changes to WAC 246-338-020 to remove naturopathic physicians and midwives from the list of health care providers that can obtain a license to perform Provider-Performed Microscopic Procedures (PPMP). This change was required by the federal government in order for Washington State to maintain its CLIA exempt status. The WANP submitted both written and oral comments opposing this rule change, but the Department was not able to keep us in rule. While the rule officially takes effect today, the Department will not be revoking any currently issued PPMP licenses. As of today, no new PPMP licenses will be issued to naturopathic physicians or midwives, and naturopathic physicians and midwives will not be able to renew their current PPMP licenses when they expire on June 30, 2025. You can find the final notice HERE.
While this rule has unfortunately moved forward and our doctors have lost the ability to use microscopy in office, the WANP will not stop our efforts to fight this. We have submitted numerous public records requests and have received information disclosing that the Washington State Department of Health DID fight to maintain us in rule, explaining to the federal government that Washington-licensed naturopathic physicians are sufficiently trained and that we are licensed as primary care physicians in our state. We are incredibly grateful for the efforts of our local DOH staff to educate the federal government on our behalf. Unfortunately, the Office of General Counsel (OGC) for the federal CMS program had the final say, which was: "CMS cannot make a subjective determination that the state curriculum for Naturopathic Medicine (ND) licensure is sufficient to meet the 'physician' or 'midlevel practitioner' definitions under the regulations. OGC has determined that Naturopaths do not meet the definition of physician, midlevel practitioner, or dentist, therefore, Naturopaths cannot qualify as a Laboratory Director (LD) or testing personnel under a Certificate for PPM." We are working with the American Association of Naturopathic Physicians (AANP) to strategize best next steps to get in front of the Clinical Laboratory Improvement Advisory Committee (CLIAC), the CMS CLIA Office of General Counsel (OGC), and our Washington Congressional delegation to make the case for expanding the CMS CLIA definition of "physician" to include licensed naturopathic physicians. This is and will be a lengthy process and a heavy lift, but know we are still working on it.