<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08" citation="COMAR 10.26.02.08" title_num="10" subtitle_num="26" chapter_num="02" heading="Acupoint Injection Therapy.">
  <paragraph num="A.">
    <text>Registration. To obtain the required registration from the Board as qualified to practice acupoint injection therapy, an applicant shall:</text>
    <paragraph num="(1)">
      <text>Possess an active license in good standing to practice acupuncture and East Asian medicine in the State;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Successfully complete an NCCAOM, or other appropriate accreditation body endorsed specialty training program and assessment in acupoint injection therapy that consists of at least 60 hours including:</text>
      <paragraph num="(a)">
        <text>A minimum of 40 hours of theoretical training in the required topics;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A minimum of 20 hours of live face-to-face clinical practical experience; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Instruction that meets the requirements of §C of this regulation;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Possess a current certification by the American Heart Association or approved equivalent in basic life support;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Hold a current Clean Needle Technique Certificate through CCAHM or NCCAOM;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If licensed in the State for less than 2 years, possess a valid license in good standing to practice acupuncture and East Asian medicine, in any state, for at least 2 years before applying to perform acupoint injection therapy in the State; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Complete and submit an application in the format provided by the Board.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Board shall accept the documentation from a licensee that has completed the training required to perform acupoint injection therapy prior to the effective date of this regulation if:</text>
    <paragraph num="(1)">
      <text>The licensee provides a certificate, or other valid documentation, confirming successful completion of 60 hours of acupoint injection therapy training that complies with this regulation; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The previously completed training does not meet the requirements of this regulation, but the licensee provides documentation of completion of supplemental training that, together with the initial training, fulfills the coursework requirements of §C of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Training Program Curriculum. The curriculum for the acupoint injection therapy program shall include:</text>
    <paragraph num="(1)">
      <text>20 hours of clinical practice on a patient or patients;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>History and development of acupuncture injection therapy;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Differential diagnosis;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Definitions, concepts, and pathophysiology;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The nature, function, channels entered, and contraindications of the substances stated in §F(2) of this regulation;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Diseases amenable to treatment with acupuncture injection therapy and the substances appropriate to treat them;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Identification of appropriate points for treatment, including palpatory diagnosis;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>A review of physical examination, anatomy, and referral zones;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Universal precautions including management of blood borne pathogens and hazardous waste;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Procedures for injections, including preparing the substances, contraindications, and precautions;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Administration techniques and equipment required;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Administration of the prepackaged substances authorized for acupoint injection therapy, including aseptic technique, recordkeeping and storage of substances prepared and authorized for use in acupoint injection therapy;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Safety and emergency procedures; and</text>
    </paragraph>
    <paragraph num="(14)">
      <text>2 hours of training in the use of intramuscular epinephrine and emergency oxygen which count toward the required theoretical and clinical training hours.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Clinical Instructors. In addition to the requirements of NCCAOM, or other appropriate accreditation body, an instructor for acupoint injection therapy shall:</text>
    <paragraph num="(1)">
      <text>Ensure that the curriculum meets the training requirements set forth under §C of this regulation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be a licensed practitioner in acupuncture in good standing in the State and be registered to practice acupoint injection therapy in the State;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Possess at least 5 years of experience in the practice of acupuncture that includes acupoint injection therapy;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Retain proof of compliance as set forth under this section for as long as they provide acupoint injection therapy training; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Provide proof of compliance to the Board upon request.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Training Programs. All training programs shall provide each successful student with:</text>
    <paragraph num="(1)">
      <text>A certificate of successful completion of the program;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A course syllabus outlining the schedule and curriculum of the program; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Testing requirements and the performance measure for successful completion.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Practice.</text>
    <paragraph num="(1)">
      <text>To practice acupoint injection therapy, the licensed acupuncturist shall:</text>
      <paragraph num="(a)">
        <text>Possess a registration for acupoint injection therapy from the Board;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Explain acupoint injection therapy to the patient in advance of treatment;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Obtain written informed consent specific to acupoint injection therapy that shall be included in the patient’s medical record;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Only perform subcutaneous, intradermal, or intramuscular injection in accordance with the principles of acupuncture;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Have an adverse event or emergency plan in place for allergic reactions to injected substances;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Maintain professional liability coverage for this procedure; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Only use prepackaged and sterile acupoint injectable therapeutic substances that are:</text>
        <paragraph num="(i)">
          <text>Acquired from an appropriately licensed entity in compliance with federal and State law; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Stored securely and in accordance with manufacturer's specifications.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>In the practice of acupoint injection therapy, the licensed acupuncturist, provided they have been trained on utilization of the specific therapeutic substance, may only use the following therapeutic substances for acupoint injection therapy:</text>
      <paragraph num="(a)">
        <text>Sterile and bacteriostatic water;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Saline solution;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Alkalizing agents such as sodium bicarbonate;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Nutritional or dietary substances;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Vitamins and minerals including B-12, B-complex, C, cyanocobalamin, hydroxocobalamin, and methylcobalamin;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Proteins, enzymes, and amino acids including methionine, choline, inositol, and glutathione;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Sugars including dextrose and glucose;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Ozone;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Procaine and lidocaine;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Herbal and botanical extracts including astragalus and Sarapin;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Biological products including hyaluronic acid and epinephrine; and</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Homeopathic substances including Traumeel and Zeel.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A licensed acupuncturist in the practice of acupoint injection therapy may not:</text>
      <paragraph num="(a)">
        <text>Administer substances other than those specified under §F(2) of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Administer substances that the licensed acupuncturist has not been appropriately trained in accordance with this regulation;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Give an injectable substance to a patient for self-injection; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Administer intravenous injections.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>The Board shall maintain a list of all:</text>
    <paragraph num="(1)">
      <text>Licensed acupuncturists registered by the Board as qualified to practice acupoint injection therapy; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Acupoint injection therapy training programs endorsed by the NCCAOM, or other appropriate accreditation body updated at least annually.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>On or after the effective date of this regulation, unless the person is registered by the Board as qualified to practice acupoint injection therapy, an individual may not:</text>
    <paragraph num="(1)">
      <text>Practice acupoint injection therapy; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Represent to the public that the individual is an acupoint injection therapy registered acupuncturist.</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Violation of this regulation constitutes unprofessional conduct and may result in disciplinary action as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland.</text>
  </paragraph>
</regulation>