MN 146A – A piece of Health Freedom in MN you need to be aware of
(originally published in the Edge magazine, July 7, 2021)With everything going on today, people may not be aware that the practice of medicine, in all its forms, is governed mostly by each state individually. In Minnesota, we have an amazing law that our community in particular needs to know called the “Unlicensed Complementary and Alternative Health Care Practices” under MN Statute 146A1.
This law provides not just consumer protections, though also for practitioners of Complementary & Alternative Medicine (CAM), which also includes massage. As a consumer, it is important to know your rights. As a practitioner in this industry, it’s equally important to know what is legally required and expected of you.
Please note, this is not to be construed as legal advice, and I am not a lawyer, or have any legal background.
The History and Need
The practice of traditional2 and natural forms of medicine has not always been protected, and in fact, practitioners in MN previously faced the potential for fines and even imprisonment.
In 1997, a group of practitioners here in the State of MN banded together after some of them were being investigated and potentially facing fines and prison time for practicing medicine without a license, and formed the MN Natural Health Coalition and a sister organization called MN Natural Health Legal Reform Project. This was shortly after a farmer was brought up on charges of Practicing Medicine without a License for selling Immune Colostrum to the public, a common folk remedy, and went to trial twice over three years, though never convicted3. They worked with the state legislature to draft legislation to protect not just the rights of Minnesotans to practice this, but also for the public to clearly enjoy the freedom to choose this form of medicine without fear of being fined or jailed. Their efforts came to fruition with this law being passed in 2000 and going into effect on July 1, 2001. Later these organizations helped to birth the National Health Freedom Alliance and National Health Freedom Coalition.
Sadly today, some states still do not have these protections and still today practitioners have been censored and yes, even fined and jailed, often under “Practicing Medicine without a License” type laws. A recent example was in 2017 with a Certified Holistic Health Coach, CrossFit Level 2 and CrossFit Kids Trainer that lived in Florida faced over $750 in fines as well as jail time for offering dietary advice4. Her case is still in the appeals process. A Tennessee pharmacist in 2007 was fined $1 Million for offering natural medicine advice5. If these people were practicing in MN, they likely would have been covered under 146A and not feared facing fines or jail time.
What is 146A?
This law clearly makes it legal in our state to not just offer CAM therapies without licensure, but also for the public to receive them. These therapies include, but are not limited to, “acupressure; anthroposophy; aroma therapy; ayurveda; cranial sacral therapy; culturally traditional healing practices; detoxification practices and therapies; energetic healing; polarity therapy; folk practices; healing practices utilizing food, food supplements, nutrients, and the physical forces of heat, cold, water, touch, and light; Gerson therapy and colostrum therapy; healing touch; herbology or herbalism; homeopathy; nondiagnostic iridology; body work, massage, and massage therapy; meditation; mind-body healing practices; naturopathy; noninvasive instrumentalities; and traditional Oriental practices, such as Qi Gong energy healing” [sic]6. This law also lists out practices not allowed, like you can’t do x-rays, surgery, puncture the skin, Chiropractic or Dental techniques, and a few other things. Additionally, CAM practitioners may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments.
Next, under 146A.11, practitioners must provide a “Complementary and Alternative Health Care Client Bill of Rights”, as well as a copy must also be posted in a prominent location in the office (and one could argue on their website in this day-and-age). This very important consumer education document has various required verbiage that must be included in it, like the statement that there is no education or training standards set forth in the law, that the practitioner must list out their practice business information including address, list their degrees, training and education background, also the right for the client to file a complaint with the MN Department of Health/OCAP7. It must include fee structures, Right of Non-Retribution, Confidentiality, and more.
Prohibited Conduct is listed under 146A.08, and includes many things you would expect to be prohibited like no engaging in sexual contact with clients, and also things like no splitting of fees, and you cannot “use the title of “doctor”, “Dr.” or physician”, even if you have a Ph.D., amongst other prohibited things.
A more recent addition to the law is that licensed medical providers may now also offer CAM therapies and services, and clarifies they must provide a separate Client Bill of Rights for those services not governed under their license. As an example, if you are a licensed provider, and suggest to your client or patient to try Lavender essential oil for stress, you likely need to provide them with a 146A Client Bill of Rights so the client can judge if you actually have the background to make such a suggestion.
Unlicensed?
In recent years, some have been asking why this industry is unlicensed, and giving the connotation that it is hence unregulated without licensure and pushing for licensure for certain aspects of practice. As you found out earlier in this article, the practice of CAM, including massage, is actually regulated in MN and has stiff penalties for not following this law. While yes, some local municipalities in MN do license the practice of massage, and even Reiki in one area of MN from my understanding, and some with insane fees upwards of $3,000 or more a year, they do not supersede the state law governing these practices.
So, what does licensure actually do? For some it creates barriers with being able to practice through increased mandates, fees, and a massive increase in costs through mandated education, education that doesn’t necessarily produce better practitioners. Studies have also shown that occupational licensure creates undue burdens on low to moderate-income workers8. For others, it creates a “leg up” by decreasing competition. In some states, even to do traditional forms of energy or spiritual healing passed down from one generation to the next – you must first be a licensed massage therapist that has done hundreds of hours of schooling and often paying exorbitant fees.
Further, licensure gives a false impression that the practitioner is actually skilled in what you are wanting or needing to have done, and with the wide breadth of what is out there that could be learned (there are literally thousands of different styles and techniques that fall under CAM) – training from one organization or place is often not equivalent or to the same standards as another. In my own experience, some of the least effective practitioners came from a school that only taught the “basics” and hadn’t done further educational study after graduating. It could be argued that, when following MN 146A, the consumer is more likely to obtain the services they are seeking because they are able to compare education backgrounds, and hence receive better outcomes in care.
If there was one thing I personally would change with this law, it would be that municipalities would not be able to create occupational licensing, and only allow for reasonable fees with business licensing.
What to expect when visiting a practitioner
One of the very first things any practitioner must do before engaging in practice with a client is to give the client the Client Bill of Rights and have them sign acknowledging they received it. In my practice, I actually go through this with the client, pointing out each area of the document; my practice information, educational background, that the state hasn’t adopted any education or training standards, if they would like to make a complaint, my fee structures, insurance, confidentiality, non-retribution, right to refuse service, etc. Even with my very long list of training and education, this takes me maybe 1-minute to go through the document with them, shows transparency and helps them to build trust in me and my practice. It also gives them an opportunity to ask me questions and start partnering with me in their healing journey.
So, what do you do if the practitioner doesn’t have a Client Bill of Rights? Personally, I would walk out. Why? I’ve worked with a wide variety of practitioners over the years, some stating they had some sort of training, though later found out it was only an intro course into that subject. If I would have had the Client Bill of Rights as required, I would have been able to make an educated decision before making the appointment. Also realize, you are completely within your rights to refuse service at any time, as stated in the law.
We are very fortunate here in MN to have a law that clearly protects the use and practice of the wide and diverse spectrum of what is traditional and natural medicine. If you have any questions, always feel free to reach out to the MN OCAP office, or the organizations like the non-profits listed previously.
1 https://www.revisor.mn.gov/statutes/cite/146A
2 https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1
3 Miller JD, Diane. Health Freedom The Greatest Freedom of All. iUniverse, 2021
4 https://morningchalkup.com/2019/08/18/for-one-health-coach-her-advice-cost-her-freedom-of-speech/
5 https://educate-yourself.org/cn/pharmacistfinedonemillion14jun07.shtml
6 https://www.revisor.mn.gov/statutes/cite/146A.01
7 https://www.health.state.mn.us/facilities/providers/compalt/
8 https://ij.org/issues/economic-liberty/occupational-licensing/
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