The Acupuncture Society of Virginia (ASVA) is the professional membership organization of licensed acupuncturists (L.Ac.s) in Virginia. ASVA is dedicated to promoting the practice of acupuncture and Oriental medicine (AOM) within the Commonwealth.

Our mission is to uphold high professional ethics and standards by monitoring and supporting legislation regarding professional standards and public safety and to educate the general public regarding the nature and scope of acupuncture and Oriental medicine. To accomplish this mission, we support clinical research verifying the effectiveness of acupuncture and Oriental medicine. We also cooperate with national professional organizations and provide continuing education programs for licensed acupuncturists.

The following statement represents the position and public comment on the pending periodic review of the Regulations Governing the Practice of Licensed Acupuncturists. In the formulation of these comments, ASVA strived to address regulations that could meet the objectives prescribed by the Governor’s regulatory reform initiative, while continuing to account for regulations that provide for the protection of the public’s health, safety, and welfare.

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

ASVA supports the existing regulations concerning educational requirements. However, it is necessary to update these requirements as the ACAOM program requirements have increased beyond the requirements currently contained within the regulations for individuals receiving acupuncture and Oriental medicine education after July 1, 1999. The current ACAOM requirements consist of a minimum of 1905 hours of entry-level acupuncture education to include at least 1,155 didactic hours and 660 clinical hours (http://www.nccaom.org/~nccaom/wp-content/uploads/pdf/ACAOM%20Grad%20Hour%20Requirements.pdf). Updated requirements could be added to the regulations following section C.

18VAC85-110-60. Requirements of foreign graduates of nonaccredited educational programs in acupuncture and Oriental medicine.

ASVA feels that section A of this regulation contains unnecessary and redundant language. Because ACAOM only accredits schools within the United States (http://www.acaom.org/about/) and there are no other board-approved accrediting agencies, the language “or Canada that is not accredited by ACAOM or any other board-approved accrediting agency” should be stricken. This provides an opportunity to make the regulation more concise and less confusing to potential graduates of foreign programs.

18VAC85-110-80. Examination requirements for licensure.

ASVA recommends that requirement 2, “Passing the Practical Examination of Point Location Skills (PEPLS) test,” be eliminated from the regulations. Point location examination is now part of the NCCAOM acupuncture examination. Therefore, the inclusion of this requirement within the regulations is redundant and unnecessary.

18VAC85-110-90. Test of spoken English requirements.

The test of spoken English requirements is an important factor in patient care and communications. However, after a review of other health professions regulated by the Board of Medicine, ASVA would like to note that no other profession has a similar section of regulations. This section of regulations should be reviewed for how it ensures the safety of patients in cases where an individual is referred to a licensed acupuncturist who does not speak the patient’s language.

18VAC85-110-100. General requirements.

ASVA feels that the entire regulatory requirement contained in 18VAC85-110-100 should be repealed. The requirement for written documentation of or written recommendation to receive a diagnostic evaluation by physician is an unnecessary regulatory burden on licensed acupuncturists and their businesses, and is not necessary for the protection of public health, safety, or welfare.

Virginia residents often concurrently seek care with a licensed acupuncturist in addition to a licensed doctor of medicine and / or other healthcare professionals.  A patient receiving a form that notes that the state requires them to be notified of a recommendation to receive diagnostic examination by another health professional undermines the professional credibility of licensed acupuncturists, who are well aware of the limitations of the acupuncture and Oriental medicine scope of practice and their responsibility to refer patients, as necessary, to other providers. Most Insurance companies in Virginia do not currently cover acupuncture and acupuncture will not be included as an essential health benefit in Virginia. Acupuncture is an out of pocket expense for most individuals.  Therefore, this regulation should be repealed to be consistent with consumer behavior, insurance coverage, and the requirements of surrounding states.

Surrounding states do not have any similar requirements for a referral or examination.  States that previously have had this requirement have repealed it. The following surrounding states currently do not have this requirement: District of Columbia, Maryland, West Virginia, North Carolina, South Carolina, and Florida.

Individuals residing in localities near Virginia borders, especially those in northern Virginia, may be getting acupuncture in other states or jurisdictions (i.e. Maryland, District of Columbia) where they work. This requirement would therefore not apply to those individuals and is therefore not being applied equally to all Virginians. There have been no reported incidents of the lack of a medical examination requirement causing harm or endangering the health, safety, or welfare of these individuals.

18VAC85-110-110. Limitation of titles.

This section of regulation should be reviewed for possible amendments that would provide further clarity on the use of titles. In Virginia, the title “Lic.Ac.” is no longer commonly used by licensed acupuncturists; and most, if not all licensed acupuncturists use the title “L.Ac.” ASVA feels that the title “Lic.Ac.” can be stricken from the regulation without burden on the profession.

Additionally, ASVA is concerned that the way this regulation is currently written would allow a licensed acupuncturist to use the title of “Dr.” as there are other states (Florida, New Mexico, Rhode Island) that attribute the professional designation of doctor or physician to licensed acupuncturists, even though the acupuncturist has not obtained a clinical doctorate degree. ASVA proposes the addition of clarifying language so that the regulation would read, “and shall not use the terms "physician" or "doctor" in his name or practice unless he holds a clinical doctorate or PhD and simultaneously uses a clarifying title, initials, abbreviation or designation.”

18VAC85-110-130. Maintenance of patient records.

ASVA notes that this regulation is not contained within the regulations governing any other health profession regulated by the Board of Medicine and therefore should be repealed.

18VAC85-110-145. Registration for voluntary practice by out-of-state licensees.

ASVA recommends the subdivision of this section and the addition of an exemption to this process for organizations such as Acupuncturists Without Borders that may provide services to the public voluntarily during a state of emergency as declared by the Governor, to assist in alleviating symptoms of trauma caused by damage, loss, hardship, or suffering caused thereby. The exemption would require that any participating acupuncturist be licensed in their state of residence and comply with all applicable Virginia laws, including the Virginia acupuncture scope of practice.

I support the comments of the ASVA.  Particularly, section 18VAC85-110-100, regarding the requirement that all new patients must sign a form recommending that they see a physician, chiropractor, or osteopath if they have not brought written proof with them that they have recently seen such a provider.  As acupuncturists, we are trained well and know when it is necessary to refer to other providers.  Additionally, many patients come to acupuncturists for treatment when other methods have left them wanting, but rarely do they have written proof that they have seen such other providers.

I support the comments of the ASVA and also second the opinion of Ms. Heller of Shen Dao Clinic with regards to section 18VAC85-110-100. 

"I support the comments of the ASVA.  Particularly, section 18VAC85-110-100, regarding the requirement that all new patients must sign a form recommending that they see a physician, chiropractor, or osteopath if they have not brought written proof with them that they have recently seen such a provider.  As acupuncturists, we are trained well and know when it is necessary to refer to other providers.  Additionally, many patients come to acupuncturists for treatment when other methods have left them wanting, but rarely do they have written proof that they have seen such other providers."

~ Heller, Shen Dao Clinic

I support the recommendations submitted by the Acupuncture Society of Virginia. 

I support the statements submitted by ASVA for the review of state acupuncture regulations with one exception.  

In section 8VAC85-110-110 Limitiation of Titles,  second paragraph, last sentence "and shall not use the terms "physician or "doctor" in name or practice unless he holds a clinical doctorate or PHd and simultaneously uses a clarifying titile, initials, abbreviation, or designation.  I do not agree with this statement. 

The statement, other states (Florida, Rhode Island, and New Mexico) attribute the professional designation of doctor or physician to licensed acupuncturists, even though the acupuncturist has not obtained a clinical doctorate degree.  This statement infers that acupuncturists in this state are held to the same regulations as other states.  This inference is false. 

Florida acupuncturists use the title Doctor of Oriental Medicine or Physicians Assistant based on the scope of pracitce and duties performed.  In Florida an acupuncturist is designated a Primary Care Physician because they perform basic routine medical screenings, order  medical diagnostic and laboratory tests, and are covered by most insurance companies.  They are not required to have a clinical doctorate of PhD but as a part of the bi annual licensing renewal process they are required to complete continuing education units in medical and diagnostic findings.   

Therefore, I would like to see the statement holds a clinical doctorate or Phd not be considered in the regulations.  

I attended the Kiiko Mastumoto acupuncture education training event in Columbia Md. in mid October. The president of the Maryland Acupuncturen Society gave a lunchtime presentation and made the case of untrained physcial therapists who are performing acupuncture services called "dry needling techniques" without proper training where patient injury has occurred in these events.  I would urge the board to stay abreast of the option for  physical therapists to perform acupuncture without proper training. 

In short make the established rules for acupuncture licensure training should apply to physical therapists.  I attended a school in Florida where the training and licensure requires 1800 hours of didactic hours along with 500 clinic hours.  Currently the state of Virginia also requires N.C.C.A.O.M. license requirements as well. Ensuring the proper application and use of acupuncture services for the safety of  the public is a reflection of the medical professsion as a whole.  Being proactive and protecting the public from harm the board should use it's regulatory power to enforce complete training for the application of acupuncture services within the physical therapy realm of it's jurisdiction.

I support the comments made on behalf of the Acupuncture Society of Virginia

I support the comments submitted by ASVA regarding regulatory reform.  I would add the following.  The section dealing with the sterility and disposal of needles should be amended to include not just needles but any device that breaks the skin.  I have had patients report to me that their previous practitioner had used on them an unwrapped either plum blossom or seven star hammer that "was just laying on the desk" and then return that device to the desk, presumably to to used on another patient.  Also, physical therapists should be required to clearly and prominently make clear that their dry needling is NOT acupuncture.  Again, I have had patients who have received this treatment, who think they've had acupuncture.

VITCM supports the comments from Acupuncture Society of Virginia. In addition, VITCM's comments:

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

VITCM supports the existing regulations concerning educational requirements.The regulation should update the requirements according to ACAOM, the national accreditation agency for acupuncture and Oriental medicine education.

18VAC85-110-60. Requirements of foreign graduates of nonaccredited educational programs in acupuncture and Oriental medicine.

should be replaced by "18VAC85-110-60. Requirements of foreign graduates in acupuncture and Oriental medicine".

The reason is  ACAOM only accreditates US schools. For  whose foreign graduates, as long as they passing NCCAOM examinations, Virginia State board should treat them equally to the students who graduated from the US schools accredited by ACAOM.  NCCAOM has a very restrict procedure to evaluate/judge such foreign students, if they had equivalent education as (or higher than)  ACAOM accredited schools in USA, they are allowed to take NCCAOM examinations and get the certificates.  In the regulation doesn't need mention ".....from nonaccredited educational programs in acupuncture and Oriental medicine by ACAOM". VA regulation could match the regulations in  neighbor States, such as Maryland.

18VAC85-110-80. Examination requirements for licensure.

VITCM recommends that requirement 2, “Passing the Practical Examination of Point Location Skills (PEPLS) test,” be eliminated from the regulations. Point location examination is now part of the NCCAOM acupuncture examination. Therefore, the inclusion of this requirement within the regulations is redundant and unnecessary.

18VAC85-110-90. Test of spoken English requirements.

Not necessary to mention language requirements in VA "acupuncture" regulation, if this is not mentioned in other professions' regulation.

And, any healthcare provider (not limited to "acupuncturis") may treat the patients who only speak spanish, Chinese or Korean, or other languages, it is not necessary the "acupuncturists" should know all such languages, or English.  If the provider's patients mostly from a spanish or Korean (or other) community, the regulation should not force the provider to speak English. Interpreter may be needed if the patient could not speak the language that the provider(please notes: this is not for acupuncture profession along) speaks.

18VAC85-110-100. General requirements.

VITCM strongly disagrees that the requirement for written documentation of or written recommendation to receive a diagnostic evaluation by physician, which is an unnecessary regulatory burden on both patients and "licensed acupuncturists" and their businesses, and is not necessary for the protection of public health, safety, or welfare.

Currently, unlike many years ago, "licensed acupuncturists" have enough education (and continue education) to know which patent needs additional information from a medical doctor or other healthcare providers. In most of cases, let patient get a diagnose from other doctors, causing patient spand additional time, money and efferts. From a feasible rule, we hope delete such reuirement. Many other States already removed such unfeasible requirement for many years.

Virginia residents often concurrently seek care with a licensed acupuncturist in addition to a licensed doctor of medicine and / or other healthcare professionals.  A patient receiving a form that notes that the state requires them to be notified of a recommendation to receive diagnostic examination by another health professional undermines the professional credibility of licensed acupuncturists, who are well aware of the limitations of the acupuncture and Oriental medicine scope of practice and their responsibility to refer patients, as necessary, to other providers. Most Insurance companies in Virginia do not currently cover acupuncture and acupuncture will not be included as an essential health benefit in Virginia. Acupuncture is an out of pocket expense for most individuals.  Therefore, this regulation should be repealed to be consistent with consumer behavior, insurance coverage, and the requirements of surrounding states.

Many patients residing in localities near Virginia borders, especially those in northern Virginia, may be getting acupuncture in other states or jurisdictions (i.e. Maryland, District of Columbia) where they work. This requirement would therefore not apply to those individuals and is therefore not being applied equally to all Virginians. There have been no reported incidents of the lack of a medical examination requirement causing harm or endangering the health, safety, or welfare of these individuals.

18VAC85-110-110. Limitation of titles.

This section of regulation should be reviewed for possible amendments that would provide further clarity on the use of titles. In Virginia, the title “Lic.Ac.” is no longer commonly used by licensed acupuncturists; and most, if not all licensed acupuncturists use the title “L.Ac.” VITCM feels that the title “Lic.Ac.” can be stricken from the regulation without burden on the profession. VITCM suggests the regulation use the title of OMD (Doctor in Oriental Medicine) to replace " Lic.Ac.", which indicates the provider is for practicing Oriental medicine, includes in the evaluation/ diagnose procedure of Oriental medicine, and application of the therapies of acupuncture, Chinese herbology, dietary therapy, Tuina/Chinese therapuetic massage and Qigong, Taichi and other mind-body adjustments.

The regulation should allow a "licensed acupuncturist" to use the title of “Dr.” as there are other states (Florida, New Mexico, Rhode Island, Novada, etc.) that attribute the professional designation of doctor or physician to licensed acupuncturists, even though the "acupuncturist" has not obtained a clinical doctorate degree. As a provider in Complementary and Alternative medicine (CAM), in real clinical practice, patients treat "Lic.Ac." as a doctor.

18VAC85-110-130. Maintenance of patient records.

VITCM notes that this regulation is not contained within the regulations governing any other health profession regulated by the Board of Medicine and therefore should be repealed.

1. According to the history of Acupuncture, dry needling techneque is the other name of Acupuncture;

2. Based on the real practice of Physical Therapist(PT) who uses so called "Dry Needling Technique", acutually use acupuncture needle, and use one of acupuncture methods, the Ashi points acupuncture/needling. PT uses another "language" to replace the discription in acupuncture book, to legalizing their practice of Acupuncture(using the term of "Dry Needling Technique" and description it with other medical terms and adding their own history of development of such technique ). VITCM strongly hope board ask them to get enough training and education. Currently, our profession (Acupuncture and Oriental Medicine) needs 2000 hours (or more than that) training, MDs or DCs who practice acupuncture need 300 or more hours additional training. PT practicing so called Dry needleing technique with less than 300 hours training is not acceptable.

I support ASVA's comments.

I agree with all of the comments submitted by Janet L. Borges, MSTCM, L.Ac., on behalf of the Acupuncture Society of Virginia.

I offer the following two comments:

Regarding 18VAC85-110-90, Test of Spoken English requirements:  While I agree that such a requirement need not be enshrined in the regulations of the Code of Virginia, it is still worthwhile that all practitioners have a basic facility with the English language in order to understand what is required by government entities and what is asked by professional organizations.

18VAC85-110-100-General requirements:  Documentation of a diagnostic evaluation by a physician was inserted into the regulations at a time when the practice of acupuncture in the Commonwealth was very new. Some in the medical profession who served on the VA Board of Medicine did not yet trust the acupuncture profession to know when to refer to a medical physician.  The language used by New York State (and long since repealed there) was adopted to assuage these concerns.  After almost 20 years, it is clear that the language is no longer necessary as there have been no cases of problems arising from physician/acupuncturist referrals.

I strongly support ASVA's comments.

Regarding 18 VAC85-110-80 -- Obtaining Diplomate status from NCCAOM now requires a variety of exams, somewhat dependent on the type of certification sought.  It is unclear from the current language which exams would count as the comprehensive written examination.  I believe the language should be revised to clarify which exam modules must be passed.

Regarding 18 VAC85-110-150 -- Requiring current active NCCAOM status adds both a financial and time burden to ongoing practice in Virginia.  Only one other profession requires ongoing approval by a third party, outside of state control, to maintain licensure.  It would ease the regulatory and financial burden to replace this requirement with a simple requirement for continuing education, the amount and type of which could be set by the board.  This would bring these regulations in line with other professions.

I strongly support the comments of the ASVA.

I strongly support the ASVA's position.

I agree with the comments of the Acupuncture Society of Virginia.

Dry needle issue

2. Based on the real practice of Physical Therapist(PT) who uses so called "Dry Needling Technique", acutually use acupuncture needles, and use one of acupuncture and chinese medicines own methods, the Ashi points acupuncture/needling, or motor point needling. PT's uses another "language" to replace the discription in acupuncture books, to legalizing their practice of Acupuncture(using the term of "Dry Needling Technique" and description it with other medical terms and adding their own history of development of such technique, but these techniques are not different or new). I strongly hope the board requires them to get enough training and education. Currently, our profession (Acupuncture and Oriental Medicine) needs 2000 hours (or more than that) training, MDs or DCs who practice acupuncture need at least 300 or more hours additional training. PT practicing so called Dry needleing technique with less than 300 hours training is not acceptable. There are more injuries due to this inexperience and new dry needling practice and because of that injures our own profession.

I support the position of the Acupuncture Society of Virginia.

I support the views and comments of ASVA

I support the comments made on behalf of the Acupuncture Society of Virginia.

I strongly support recommendations of the Acupuncture Society of Virginia.

18VAC85-110-100. General requirements.

I strongly disagree with the requirement for a written documentation of or a written recommendation to receive a diagnostic evaluation by physician. This is an unnecessary regulatory burden on both patients and licensed acupuncturists. It is not necessary for the protection of public health, safety, or welfare. 

Virginia residents often concurrently seek care with a licensed acupuncturist in addition to a licensed doctor of medicine and / or other healthcare professionals.  A patient receiving a form that notes that the state requires them to be notified of a recommendation to receive diagnostic examination by another health professional undermines the professional credibility of licensed acupuncturists, who are well aware of the limitations of the acupuncture and Oriental medicine scope of practice and their responsibility to refer patients, as necessary, to other providers. Most Insurance companies in Virginia do not currently cover acupuncture and acupuncture will not be included as an essential health benefit in Virginia. Acupuncture is an out of pocket expense for most individuals.  Therefore, this regulation should be repealed to be consistent with consumer behavior, insurance coverage, and the requirements of surrounding states.

Many patients residing in localities near Virginia borders, especially those in northern Virginia, may be getting acupuncture in other states or jurisdictions (i.e. Maryland, District of Columbia) where they work. This requirement would therefore not apply to those individuals and is therefore not being applied equally to all Virginians. There have been no reported incidents of the lack of a medical examination requirement causing harm or endangering the health, safety, or welfare of these individuals.

18VAC85-110-130. Maintenance of patient records.

This regulation is not contained within the regulations governing any other health profession regulated by the Board of Medicine and therefore should be repealed.

Dry needle issue

2. Based on the real practice of Physical Therapist(PT) who uses so called "Dry Needling Technique", acutually use acupuncture needles, and use one of acupuncture and chinese medicines own methods, the Ashi points acupuncture/needling, or motor point needling. PT's uses another "language" to replace the discription in acupuncture books, to legalizing their practice of Acupuncture(using the term of "Dry Needling Technique" and description it with other medical terms and adding their own history of development of such technique, but these techniques are not different or new). I strongly hope the board requires them to get enough training and education. Currently, our profession (Acupuncture and Oriental Medicine) needs 2000 hours (or more than that) training, MDs or DCs who practice acupuncture need at least 300 or more hours additional training. PT practicing so called Dry needleing technique with less than 300 hours training is not acceptable. There are more injuries due to this inexperience and new dry needling practice and because of that injures our own profession.

 Thank you for your consideration of these recommendations.

I strongly support the comments made by Janet Borges of ASVA.

I support ASVA's position on regulations for Acupuncturists

Hello,

My name is Sarah Shupe and I am a licensed acupuncturist working in Northern VA.  I fully support ASVA's position on the review of state acupuncture regulations.  

Thanks for you time,

Sarah Shupe L.Ac.

703-217-7124

Regarding 18 VAC85-110-150, requiring licensed acupuncturists to maintain active NCCAOM certification in order to continue to practice in VA: It is the position of the Acupuncture Society of Virginia (ASVA) that this requirement does not cause burden to the profession.  States that require NCCAOM certification put the cost and responsibility of ensuring competency maintenance for licensed acupunctuists on the NCCAOM. If this requirement were eliminated, it would put the burden for ensuring competency and verifying continuing education requirements on the VA Board of Medicine. ASVA believes that maintenance of NCCAOM certification provides protection to the public, and that the requirement should be retained in its current form.

As a Virginia citizen, acupuncture consumer and the Deputy Director of the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), I would like to express my support for maintaining 18 VAC85-110-150, which requires licensed acupuncturists to maintain active NCCAOM certification in order to continue to practice in Virginia. The mission of the NCCAOM is to establish, assess, and promote recognized standards of competence and safety in acupuncture and Oriental medicine for the protection and benefit of the public. It is with this mission that the NCCAOM sets national standards for maintaining continued competency in the field of acupuncture and Oriental medicine. States that require active NCCAOM certification, can be reassured that every practitioner has meet NCCAOM’s robust professional development activity (PDA) program requirements which includes completing safety/ethics courses as well as documenting of CPR course certificate. States who require NCCAOM active certification place the burden and cost of recertification verification and professional development activity program development to the NCCAOM.  Therefore, this requirement does not cause burden to the state or the profession. 

Most importantly, the NCCAOM also oversees the practice of the acupuncture and Oriental profession as stated in our mission through its Professional Ethics and Disciplinary Review process. NCCAOM partners with states that require active certification to ensure that practitioners who have violated the NCCAOM Code of Ethics and have been disciplined are prevented from obtaining a license in those states. States such as Virginia that require active certification have the reassurance that disciplined practitioners will not go undetected through the requirement of active certification. A recent example took place this year when a practitioner in California whose certification was revoked moved to the state of Virginia and the state was immediately informed by the NCCAOM that his certification was revoked due to fraud. This person was prevented from practicing acupuncture in Virginia and causing harm to consumers.

The trend in healthcare throughout the nation is to raise standards for licensure, not to lower or eliminate them. States are increasing their requirements for certification maintenance as these changes are based on the premise of improving the quality of healthcare for the citizens of these states. The NCCAOM is proud of its reputation and recognizes the value of our nationally recognized status. The unprecedented growth and acceptance of acupuncture is due in no small part to the existence of a legitimate certification and professional development activity program based upon national standards.

As a citizen of this great state, I strongly believe that the requirement for the maintenance of NCCAOM certification for licensed acupuncturists provides protection to the consumers of this state. It would be a step backwards as well as  potential harm to the public to change this requirement.