LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6721 NOTE PREPARED: Dec 28, 2023
BILL NUMBER: SB 262 BILL AMENDED:
SUBJECT: Licensure of Naturopathic Physicians.
FIRST AUTHOR: Sen. Goode BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: Naturopathic Physician License– The bill provides for the licensure of
naturopathic physicians. The bill specifies certain individuals who are not required to be licensed. The bill
establishes the Board of Naturopathic Medicine (Board). The bill establishes license requirements. The bill
requires licensed naturopathic physicians to obtain continuing education for license renewal.
Naturopathic Formulary Council– The bill establishes the Naturopathic Formulary Council (Council) to
establish a formulary for naturopathic physicians.
CAAC– The bill establishes the Childbirth Attendance Advisory Commission (CAAC) to provide
recommendations concerning the practice of naturopathic childbirth.
Prohibitions– The bill provides that an individual who is not licensed may not use certain descriptions, titles,
or initials to indicate or imply that the individual is a licensed naturopathic physician.
Penalty Provision– The bill establishes criminal penalties for certain violations.
Effective Date: July 1, 2024.
Explanation of State Expenditures: Naturopathic Physician License– The bill would establish the state
Board of Naturopathic Medicine. The board would have five members, none of which would be eligible for
per diem or travel reimbursement for their service. The following table presents the development and ongoing
costs necessary to establish and maintain the proposed board.
SB 262 1 Estimated Initial and Ongoing Costs for Proposed Board
Expenditure Type Explanation Estimated Cost
Initial License
Development*
Salary cost to the Professional Licensing Agency (PLA)
to develop new license
$76,300
Ongoing Administration
Costs**
License administration and staff support to the board $17,600
*One-time startup expenditures, which equate to the salary cost of PLA staff to develop the proposed license. If existing
PLA staff is insufficient to develop the license, then additional staffing could be met through funded vacancies or hiring
of a new staff member(s). Hiring of new staff outside the PLA’s budget could be accomplished through reallocation of
existing funds not currently used for staff or new appropriations made by the General Assembly.
** Ongoing opportunity cost to existing staff to devote approximately 100 hours to the Board annually.
The Governor must appoint the five members to the board. This is a routine administrative functions of the
Governor.
CAAC– Given that members are not eligible for per diem or travel reimbursement, this provision is not likely
to generate additional state expenditures, but may increase workload for the PLA or other executive agency
to provide administrative support, if needed. The Governor must appoint the five members to the CAAC.
This is a routine administrative functions of the Governor.
Penalty Provision– An unlicensed person that knowingly and intentionally practices naturopathic medicine
under bill would commit a Level 5 felony. A Level 5 felony is punishable by a prison term ranging from 1
to 6 years, with an advisory sentence of three years. The sentence depends on mitigating and aggravating
circumstances. The average expenditure to house an adult offender was $28,110 annually, or $76.96 daily,
in FY 2023. (This does not include the cost of new construction.) If offenders can be housed in existing
facilities with no additional staff, the marginal cost for medical care, food, and clothing is approximately
$4,456 annually, or $12.21 daily, per prisoner. These marginal cost estimates are based on contractual
agreements with food and medical vendors and projections based on prior years for clothing and hygiene.
The estimated average cost of housing a juvenile in a state juvenile facility was $112,655, or $308.43 daily,
in FY 2023. The marginal cost for juvenile facilities was $6,325 annually or $17.33 daily.
The entire Level 5 sentence may be suspended and the person placed on either probation or community
corrections. If no time is suspended, the offender can receive good time credit of 25% and educational credit
time. After adjusting for credit time, the offender can be released from prison and placed on parole.
Explanation of State Revenues: Naturopathic Physician License– It is estimated that, at most, 20 to 22
candidates (3 to 5 within Indiana) and 17 within a 250 mile radius of Indianapolis would be the most likely
to apply for the license in the first year of establishment. However, the unknown number of persons licensed
in jurisdictions further away that may also apply for a reciprocity license makes estimation of the annual
revenue this bill could generate indeterminable. Generally, professional license fees are set to breakeven with
the PLA’s ongoing license administration costs. Assuming that 20 persons apply every two years (to include
potential out-of-state applicants), an approximate fee of $2,000 would breakeven with the total estimated
ongoing costs to administer the license.
SB 262 2 Penalty Provision– If additional court cases occur and fines are collected, revenue to both the Common
School Fund (from fines) and the state General Fund (from court fees) would increase. The maximum fine
for a Class A misdemeanor is $5,000. The maximum fine for a Level 5 felony is $10,000. The total fee
revenue per case would range between $113 and $135. The amount of court fees deposited will vary
depending on whether the case is filed in a court of record or a municipal court. The following linked
document describes the fees and distribution of the revenue: Court fees imposed in criminal, juvenile, and
civil violation cases.
Additional Information- Based on a search of state and national naturopathic doctor organizations, there may
be 3 to 5 persons practicing in Indiana that might qualify immediately for a license under the bill’s
requirements. A 2018 journal article suggests there are approximately 6,000 licensed persons in 23 U.S.
states and territories that practice naturopathic medicine.
Explanation of Local Expenditures: Penalty Provision– A Class A misdemeanor is punishable by up to
one year in jail.
Explanation of Local Revenues: Penalty Provision– If additional court actions occur and a guilty verdict
is entered, more revenue will be collected by certain local units. If the case is filed in a court of record, the
county general fund will receive $47.40 and qualifying municipalities will receive a share of $3.60. If the
case is filed in a municipal court, the county receives $30, and the municipality will receive $46. The
following linked document describes the fees and distribution of the revenue: Court fees imposed in
criminal, juvenile, and civil violation cases.
State Agencies Affected: Department of Correction; Professional Licensing Agency; Governor’s Office.
Local Agencies Affected: Trial courts, local law enforcement agencies.
Information Sources: https://naturopathic.org/search/newsearch.asp; Indiana Supreme Court, Indiana Trial
Court Fee Manual; http://apps.who.int/medicinedocs/en/d/Jh2943e/5.18.html;
LSA’s professional license cost estimator, FY 2023 version; https://naturemed.org/about-us/anniversary/;
https://www.prnewswire.com/news-releases/naturopathic-medicine-is-growing-in-us-medical-centers-of-
excellence-300601605.html.
Fiscal Analyst: Chris Baker, 317-232-9851.
SB 262 3