California naturopathic board weighs fee increases, scope changes and legislative steps to shore up fund

The California Board of Naturopathic Medicine discussed a mix of short- and long-term options on Jan. 23 to address fiscal pressures in the board’s fund, including a fee increase that took effect Jan. 1, 2025, and possible legislative changes during sunset review to broaden scope of practice and open new fee streams.

Board President Dara Thompson said the recent fee change “is going to extend the period of time that we are functional” while the board explores broader reforms to avoid insolvency. Rebecca Mitchell, the board’s executive officer, told members the Jan. 1 change is already being collected and staff will re-run fund projections with the new receipts.

Why it matters: The board projects that short-term fee changes will buy time, but several members warned that raising fees alone may further shrink the licensee population if the state’s restrictive scope of practice remains unchanged. Dr. Bruce Davidson and other members said the board likely will need both raising statutorily allowed fee caps and scope modernization to attract and retain licensees.

Key numbers and projected balances: Kirsten Cox of the Department of Consumer Affairs (DCA) budget office told the board the board’s beginning base budget for the year was $763,000 with projected expenditures around $734,000, leaving an estimated reversion of about $29,000 (3.86%). For fiscal year 2024–25 the board projects $550,000 in revenue and $765,000 in expenditures under current projections, leaving an estimated fund balance of approximately $613,000 — about 10 months of reserve, down from roughly 13 months at the end of 2023–24.

Board discussion and options: Members and staff reviewed several potential revenue options beyond across‑the‑board fee increases: - Permits for specific services: Regulation counsel and staff raised the idea of permitting specialty services (e.g., IV injection therapy certificates, drug‑furnishing numbers, fictitious name permits) that could carry application and renewal fees. Staff said existing workloads already include review of drug‑furnishing numbers and IV certificates but the board currently does not charge for those reviews. - Continuing education or certification fees: Board members discussed whether a mandatory board‑created ethics or certification course could carry a fee and periodic recertification requirement; staff noted developing such courses requires funding and may itself increase workload. - Legislative action at sunset: Several members emphasized the need to press scope modernization during the upcoming sunset review, including examples from other states (Arizona, Washington, Oregon) where broader prescribing and minor office procedure authority helped create more robust licensee bases.

Constraints and risks: Staff and board counsel cautioned that including contentious scope changes directly in a sunset reauthorization bill can risk the board’s reauthorization if strong opposition surfaces. The Department of Consumer Affairs recommended raising the issues in sunset background materials to signal need while pursuing separate sponsored legislation for contentious scope expansions.

Next steps: The board asked staff to prepare high‑level workload and revenue estimates for potential new permit fees (IV/administration certificates, drug‑furnishing numbers and fictitious name permits) and to include the scope modernization topic on the May agenda and as part of the board’s sunset planning. Members said they want to pursue legislative outreach and stakeholder education in parallel.