July 2024 Update: The Colorado Department of Regulatory Agencies Concludes Facilitator Rulemaking for Implementation of the Natural Medicine Health Act
As Colorado continues to lead in progressive health legislation, the Department of Regulatory Agencies (DORA), in charge of regulating the education, licensing, and conduct of facilitators, is at the forefront of implementing the Natural Medicine Health Act. The process has involved rigorous rulemaking to ensure the safe and effective administration of natural medicine services, including regulations on licensing, training, and professional conduct.
Throughout the past year, DORA has published separate permanent rulemaking notices for three sets of rules, each addressing different aspects of licensing and operational standards for natural medicine facilitators. Sections one through five address licensing and training standards for facilitators and Facilitator Training Programs; sections six and seven cover standards of practice and advertising; and section eight addresses disciplinary standards. Sections one through five have closed for public comment, culminating in a final rulemaking hearing on May 3, 2024. The rules devised in this round have been finalized and were approved by the Attorney General on May 30, 2024. On June 30, 2024, the rules went into effect.
Pursuant to these newly adopted DORA regulations, there are two primary types of facilitator applicants. The first is “Facilitators,” which is defined as an individual licensed to provide natural medicine services to qualifying participants and who do not need to have any special or underlying independent licensure. The second is “Clinical Facilitator” which is defined as a licensed professional who provides natural medicine services to treat diagnosed conditions. Clinical Facilitators must be licensed to diagnose and treat physical or behavioral health conditions and hold a secondary license allowing to engage in those practices (e.g., MD, DO, APN). The State chose to distinguish between the two so that Clinical Facilitators can integrate natural medicine services into their current independently licensed practices.
All facilitator applicants must be at least 21 years of age and provide proof of basic life support training. Unless an exception applies, both Facilitators and Clinical Facilitators are required to engage in 150 hours of didactic instruction (i.e., passive teacher-led classroom learning), 40 hours of supervised practicum training (i.e., supervised direct experience and hands-on practice), and 50 hours of consultation (i.e., formally discussing treatment with the participant). The adopted rules also permit prospective facilitators licensed in other states like Oregon to apply for licensure by endorsement via the occupational credential portal.
In addition to Facilitator and Clinical Facilitator, DORA created “Training Licensee” and “Distinguished Educator” classifications. A Training Licensee is an individual undergoing training to become a licensed Facilitator or Clinical Facilitator. To be deemed eligible for classification as a Training Licensee, an individual must have successfully completed basic life support training and an approved Facilitator Training Program. Individuals with a Training License have completed the necessary education and basic life support training but have not yet finished all of their practical training requirements. Training Licensees may practice under specific conditions as part of their path to licensure as a Facilitator or Clinical Facilitator. They are allowed to provide natural medicine services while completing the required 40 hours of supervised practicum and 50 hours of consultation.
A Distinguished Educator is a professional recognized for their extensive experience and significant professional achievements in natural medicine services that is invited by a state-licensed Facilitator Training Program in Colorado to serve as a member of its academic faculty. To qualify as a Distinguished Educator, an individual must hold a current facilitator license in good standing from another jurisdiction or have demonstrated significant professional achievement as determined by the Director of the Division of Professions and Occupations within DORA.
On July 3, 2024, DORA opened applications for Facilitator Training Programs to apply for state licensure. The application requires a completed Facilitator Training Program Director Affidavit, job descriptions for each faculty position, and a very detailed curriculum. The curriculum must meet the minimum requirement of 150 hours of coursework covering various topics such as facilitator best practices, ethics and Colorado Natural Medicine Rules and Regulations, physical and mental health, trauma-informed care, suicide risk, as well as indigenous and cultural considerations. The education organization applicant must also present an organizational chart, a mission statement, the purpose and outcome competencies for the training program, as well as standards for recruitment, advertising, and tuition refunds. Student policies and plans supporting behavioral and physical health, learning, equitable access, career advice, and disability accommodations must also be provided. The initial certification (application) fee for a Facilitator Training Program applicant is $10,000, which is based on DORA’s cost of providing services and is adjusted annually. This certification must be renewed every year to maintain the program’s approval status.
As introduced above, sections six and seven of DORA rules address standard practices and advertisement. The final rulemaking hearing for these regulations was held on June 20, 2024, and public comment came to a close the following day.
Pursuant to section six, all facilitators are required to maintain detailed records for each participant, including demographic information, informed consent, communication preferences, transportation plans, fee agreements, physical touch contracts, safety and support plans, session details, product details, adverse reactions, and other documentation as mandated by regulatory bodies. Confidentiality of participant information is paramount, with records considered medical data and protected unless consent for disclosure is provided by the participant or required by law.
The primary focus of section seven is to prevent facilitators from making false, deceptive, or misleading statements about their services. Facilitators must represent their qualifications truthfully, ensuring that all public statements, whether in person, in print, or online are based on their training, experience, and current scientific literature. Facilitators are allowed to collect and display testimonials from participants to showcase their work. However, they are strictly prohibited from soliciting these testimonials. This means facilitators cannot actively ask participants to provide positive feedback or endorsements, ensuring that any testimonials are given voluntarily and reflect genuine participant feedback. Section seven also stipulates that only licensed facilitators can use the terms “sitter,” “guide,” or “facilitator” in the context of regulated natural medicine services to prevent unlicensed individuals from misleading the public by using these titles. Rules six and seven are set to go into effect August 14, 2024.
Section eight establishes disciplinary procedures to maintain the integrity and professionalism of licensed facilitators. Public comment on this set of rules concluded on July 8, 2024, in a permanent rulemaking hearing. Section eight will become effective August 30, 2024.
Pursuant to section eight, all licensees, including Facilitators, Clinical Facilitators, Distinguished Educators, and Training Licensees, are required to report any criminal charges, convictions, and instances of unprofessional conduct within specified time frames. These reports must be made in writing within 45 days of the occurrence of the event. Grounds for disciplinary action include felony charges and convictions (excluding legally protected cannabis convictions), misstatements or omissions on license applications, and excessive or habitual use or abuse of alcohol or controlled substances. Additionally, unprofessional or dishonest conduct, unlicensed facilitation or aiding and abetting such practices, and failure to meet required reporting duties, including incidents of unprofessional conduct or convictions, are all grounds for discipline pursuant to section eight. The Director of DORA has the authority to issue cease and desist orders against individuals found to be engaged in the unlicensed practice of natural medicine. Lastly, section eight includes specific exemptions for religious, cultural, or spiritual ceremonies. Individuals conducting such ceremonies are permitted to do so without a license, provided they clearly inform participants that they are not licensed facilitators and that the ceremonies are not commercial or for-profit.
As the final stages of DORA-led rulemaking conclude, with sections six and seven set to become effective on August 14, 2024, and section eight on August 30, 2024, Colorado continues to lead the way in integrating natural medicine into its healthcare framework. The collaborative efforts of DORA, the Natural Medicine Advisory Board, and public stakeholders highlight a shared vision of creating a regulated environment that prioritizes the well-being of participants while fostering ethical and transparent practices.
For more information on Colorado’s implementation of the Natural Medicine Health Act or if you’d like to apply for licensure, contact info@feldmanlegaladvisors.com.