Florida Senate - 2018                                    SB 1648
       
       
        
       By Senator Brandes
       
       
       
       
       
       24-01120A-18                                          20181648__
    1                        A bill to be entitled                      
    2         An act relating to chiropractic medicine; amending s.
    3         460.402, F.S.; revising applicability of provisions
    4         relating to chiropractic medicine with regard to
    5         certain chiropractic students; amending s. 460.403,
    6         F.S.; revising definitions; amending s. 460.406, F.S.;
    7         revising the educational requirements that must be
    8         satisfied by applicants before examination by the
    9         Department of Health; removing the authority of the
   10         board to require certain applicants to take a certain
   11         examination; requiring the department to issue a
   12         license by endorsement to practice chiropractic
   13         medicine to applicants who meet certain requirements,
   14         including the payment of a fee; repealing s. 460.4061,
   15         F.S., relating to a restricted license; amending s.
   16         460.4062, F.S.; revising the educational requirements
   17         that must be satisfied by applicants before the
   18         department may issue a chiropractic medicine faculty
   19         certificate; amending s. 460.413, F.S.; revising
   20         grounds for denial of a license or disciplinary action
   21         relating to failing to preserve identity of funds and
   22         property of a patient; amending s. 460.4165, F.S.;
   23         revising continuing education requirements for
   24         chiropractic physician’s assistants; amending s.
   25         460.4167, F.S.; revising provisions relating to the
   26         employment by certain clinical facilities of
   27         independent contractors who provide specified
   28         chiropractic services; providing an effective date.
   29          
   30  Be It Enacted by the Legislature of the State of Florida:
   31  
   32         Section 1. Section 460.402, Florida Statutes, is amended to
   33  read:
   34         460.402 Exceptions.—This chapter does The provisions of
   35  this chapter shall not apply to:
   36         (1) Other duly licensed health care practitioners acting
   37  within their authorized scope of practice.
   38         (2) Any person furnishing medical assistance in case of an
   39  emergency.
   40         (3) The domestic administration of recognized family
   41  remedies.
   42         (4) The practice of the religious tenets of any church.
   43         (5) Any massage therapist acting within her or his scope of
   44  practice authorized in chapter 480.
   45         (6) A chiropractic student who is enrolled in a
   46  chiropractic school, college, or program accredited by an
   47  accrediting agency recognized by the United States Secretary of
   48  Education or in an educational program leading to a degree in
   49  chiropractic medicine from an institution located outside the
   50  United States which is approved by the board or authorized to
   51  operate by the government having jurisdiction over the program
   52  chiropractic college accredited by the Council on Chiropractic
   53  Education and who is participating in either of the following:
   54         (a) A community-based internship under the direct
   55  supervision of a doctor of chiropractic medicine who is
   56  credentialed as an adjunct faculty member of a chiropractic
   57  college in which the student is enrolled.; or
   58         (b) A chiropractic college clinical internship under the
   59  direct supervision of a doctor of chiropractic medicine who is a
   60  full-time, part-time, or adjunct faculty member of a
   61  chiropractic college located in this state which is accredited
   62  by an accrediting agency recognized by the United States
   63  Secretary of Education or of an institution located outside the
   64  United States which is approved by the board or authorized to
   65  operate by the government having jurisdiction over the program
   66  and accredited by the Council on Chiropractic Education and who
   67  holds a current, active Florida chiropractor’s license.
   68         (7) A chiropractic physician who holds an active license in
   69  another state, the District of Columbia, or a possession or
   70  territory of the United States and is performing chiropractic
   71  procedures or demonstrating equipment or supplies for
   72  educational purposes at a board-approved continuing education
   73  program.
   74         Section 2. Subsection (4) and paragraph (a) of subsection
   75  (9) of section 460.403, Florida Statutes, are amended to read:
   76         460.403 Definitions.—As used in this chapter, the term:
   77         (4)(a) “Community-based internship” means a program in
   78  which a student enrolled in the last year of either a
   79  chiropractic college accredited by an accrediting agency
   80  recognized by the United States Secretary of Education or an
   81  educational program leading to a degree in chiropractic medicine
   82  from an institution located outside the United States which is
   83  approved by the board or authorized to operate by the government
   84  having jurisdiction over the program accredited by the Council
   85  on Chiropractic Education is approved to obtain required
   86  pregraduation clinical experience in a chiropractic clinic or to
   87  practice under the direct supervision of a doctor of
   88  chiropractic medicine who is approved as an adjunct faculty
   89  member of the chiropractic college in which the student is
   90  enrolled, in accordance with according to the teaching protocols
   91  for the clinical practice requirements of the college.
   92         (b) “Chiropractic college clinical internship” means a
   93  program in which a student enrolled in either a chiropractic
   94  college accredited by an accrediting agency recognized by the
   95  United States Secretary of Education or an educational program
   96  leading to a degree in chiropractic medicine from an institution
   97  located outside the United States which is approved by the board
   98  or authorized to operate by the government having jurisdiction
   99  over the program located in this state and accredited by the
  100  Council on Chiropractic Education obtains clinical experience
  101  pursuant to the chiropractic college’s curriculum in a classroom
  102  or chiropractic clinic operated by the chiropractic college, in
  103  accordance with according to the teaching protocols for the
  104  clinical practice requirements of the college.
  105         (9)(a) “Practice of chiropractic medicine” means a
  106  noncombative principle and practice consisting of the science,
  107  philosophy, and art of the adjustment, manipulation, and
  108  treatment of the human body in which vertebral subluxations and
  109  other malpositioned articulations and structures that are
  110  interfering with the normal generation, transmission, and
  111  expression of nerve impulse between the brain, organs, and
  112  tissue cells of the body, thereby causing disease, are adjusted,
  113  manipulated, or treated, thus restoring the normal flow of nerve
  114  impulse which produces normal function and consequent health by
  115  chiropractic physicians using specific chiropractic adjustment
  116  or manipulation techniques taught in a chiropractic college
  117  accredited by an accrediting agency recognized by the United
  118  States Secretary of Education or in an educational program
  119  leading to a degree in chiropractic medicine from an institution
  120  located outside the United States which is approved by the board
  121  or authorized to operate by the government having jurisdiction
  122  over the program colleges accredited by the Council on
  123  Chiropractic Education. No person other than a licensed
  124  chiropractic physician may render chiropractic services,
  125  chiropractic adjustments, or chiropractic manipulations.
  126         Section 3. Section 460.406, Florida Statutes, is amended to
  127  read:
  128         460.406 Licensure by examination; licensure by
  129  endorsement.—
  130         (1) Any person desiring to be licensed as a chiropractic
  131  physician must apply to the department to take the licensure
  132  examination. There shall be an application fee set by the board
  133  not to exceed $100 which shall be nonrefundable. There shall
  134  also be an examination fee not to exceed $500 plus the actual
  135  per applicant cost to the department for purchase of portions of
  136  the examination from the National Board of Chiropractic
  137  Examiners or a similar national organization, which may be
  138  refundable if the applicant is found ineligible to take the
  139  examination. The department shall examine each applicant who the
  140  board certifies has:
  141         (a) Completed the application form and remitted the
  142  appropriate fee.
  143         (b) Submitted proof satisfactory to the department that he
  144  or she is not less than 18 years of age.
  145         (c) Submitted proof satisfactory to the department that he
  146  or she is a graduate of a chiropractic college accredited by an
  147  accrediting agency recognized by the United States Secretary of
  148  Education or of an educational program leading to a degree in
  149  chiropractic medicine from an institution located outside the
  150  United States which is approved by the board or authorized to
  151  operate by the government having jurisdiction over the program
  152  which is accredited by or has status with the Council on
  153  Chiropractic Education or its predecessor agency. However, any
  154  applicant who is a graduate of a chiropractic college that was
  155  initially accredited by the Council on Chiropractic Education in
  156  1995, who graduated from such college within the 4 years
  157  immediately preceding such accreditation, and who is otherwise
  158  qualified is shall be eligible to take the examination. An No
  159  application for a license to practice chiropractic medicine may
  160  not shall be denied solely because the applicant is a graduate
  161  of a chiropractic college that subscribes to one philosophy of
  162  chiropractic medicine as distinguished from another.
  163         (d)1. For an applicant who has matriculated in a
  164  chiropractic college prior to July 2, 1990, completed at least 2
  165  years of residence college work, consisting of a minimum of one
  166  half the work acceptable for a bachelor’s degree granted on the
  167  basis of a 4-year period of study, in a college or university
  168  accredited by an accrediting agency recognized and approved by
  169  the United States Department of Education. However, prior to
  170  being certified by the board to sit for the examination, each
  171  applicant who has matriculated in a chiropractic college after
  172  July 1, 1990, shall have been granted a bachelor’s degree, based
  173  upon 4 academic years of study, by a college or university
  174  accredited by a regional accrediting agency which is a member of
  175  the Commission on Recognition of Postsecondary Accreditation.
  176         2. Effective July 1, 2000, completed, prior to
  177  matriculation in a chiropractic college, at least 3 years of
  178  residence college work, consisting of a minimum of 90 semester
  179  hours leading to a bachelor’s degree in a liberal arts college
  180  or university accredited by an accrediting agency recognized and
  181  approved by the United States Department of Education. However,
  182  prior to being certified by the board to sit for the
  183  examination, each applicant who has matriculated in a
  184  chiropractic college after July 1, 2000, shall have been granted
  185  a bachelor’s degree from an institution holding accreditation
  186  for that degree from a regional accrediting agency which is
  187  recognized by the United States Department of Education. The
  188  applicant’s chiropractic degree must consist of credits earned
  189  in the chiropractic program and may not include academic credit
  190  for courses from the bachelor’s degree.
  191         (d)(e) Successfully completed the National Board of
  192  Chiropractic Examiners certification examination in parts I, II,
  193  III, and IV, and the physiotherapy examination of the National
  194  Board of Chiropractic Examiners, with a score approved by the
  195  board.
  196         (e)(f) Submitted to the department a set of fingerprints on
  197  a form and under procedures specified by the department, along
  198  with payment in an amount equal to the costs incurred by the
  199  department of Health for the criminal background check of the
  200  applicant.
  201  
  202  The board may require an applicant who graduated from an
  203  institution accredited by the Council on Chiropractic Education
  204  more than 10 years before the date of application to the board
  205  to take the National Board of Chiropractic Examiners Special
  206  Purposes Examination for Chiropractic, or its equivalent, as
  207  determined by the board. The board shall establish by rule a
  208  passing score.
  209         (2) For those applicants applying for the certification
  210  examination who have matriculated before prior to July 1, 1996,
  211  in a chiropractic college, the board shall waive the provisions
  212  of paragraph (1)(c) if the applicant is a graduate of a
  213  chiropractic college that which has been denied accreditation or
  214  approval on the grounds that its curriculum does not include the
  215  training in acupuncture necessary for the completion of the
  216  certification examination or is a graduate of a chiropractic
  217  college where acupuncture is not taught or offered if the
  218  college is accredited by or has status with the Council on
  219  Chiropractic Education or its predecessor.
  220         (3) An applicant for the licensure examination may elect
  221  not to take the certification examination to use acupuncture.
  222  The department shall, in addition to the licensing exam, offer
  223  an examination for certification to use acupuncture. An
  224  applicant may elect to take the certification examination at the
  225  time of taking the licensure examination. Passage of the
  226  certification examination shall not grant any applicant the
  227  right to practice chiropractic medicine absent the passage of
  228  the licensing examination.
  229         (4) The department shall submit written notification within
  230  5 working days to applicants who have successfully completed the
  231  requirements of paragraphs (1)(a)-(d) (1)(a)-(e) and who have
  232  successfully passed the state licensure examination. An
  233  applicant who is notified in writing by the department of the
  234  successful completion of requirements in paragraphs (1)(a)-(d)
  235  (1)(a)-(e) and who has successfully passed the state licensure
  236  examination may lawfully practice pending receipt of the
  237  certificate of licensure, and the written notification shall act
  238  as evidence of licensure entitling the chiropractic physician to
  239  practice for a maximum period of 45 days or until the licensing
  240  fee is received by the department whichever is sooner.
  241         (5) A student in a school or college of chiropractic
  242  accredited by an accrediting agency recognized by the United
  243  States Secretary of Education or in an educational program
  244  leading to a degree in chiropractic medicine from an institution
  245  located outside the United States which is approved by the board
  246  or authorized to operate by the government having jurisdiction
  247  over the program by the Council on Chiropractic Education or its
  248  successor in the final year of the program may file an
  249  application pursuant to subsection (1), take all examinations
  250  required for licensure, submit a set of fingerprints, and pay
  251  all fees required for licensure. A chiropractic student who
  252  successfully completes the licensure examinations and who
  253  otherwise meets all requirements for licensure as a chiropractic
  254  physician during the student’s final year must have graduated
  255  before he or she may be being certified for licensure pursuant
  256  to this section.
  257         (6)The department shall issue a license by endorsement to
  258  practice chiropractic medicine to an applicant who submits an
  259  application to the department, pays an application fee
  260  determined by the board, which may not exceed $100, and provides
  261  proof that he or she has satisfied all of the following
  262  requirements:
  263         (a)Holds a valid license to practice chiropractic medicine
  264  in another state or territory of the United States.
  265         (b)Has actively practiced chiropractic medicine in another
  266  state or territory of the United States for the preceding 10
  267  years without having his or her license acted against by the
  268  licensing authority of any jurisdiction.
  269         (c)Meets the requirements in paragraphs (1)(a), (b), (c),
  270  and (e).
  271         Section 4. Section 460.4061, Florida Statutes, is repealed.
  272         Section 5. Subsection (1) of section 460.4062, Florida
  273  Statutes, is amended to read:
  274         460.4062 Chiropractic medicine faculty certificate.—
  275         (1) The department may issue a chiropractic medicine
  276  faculty certificate without examination to an individual who
  277  remits a nonrefundable application fee, not to exceed $100 as
  278  determined by board rule of the board, and who demonstrates to
  279  the board that he or she meets the following requirements:
  280         (a) Is a graduate of a an accredited school or college of
  281  chiropractic accredited by an accrediting agency recognized by
  282  the United States Secretary of Education or of an educational
  283  program leading to a degree in chiropractic medicine from an
  284  institution located outside the United States which is approved
  285  by the board or authorized to operate by the government having
  286  jurisdiction over the school or college by the Council on
  287  Chiropractic Education.
  288         (b) Holds a valid current license to practice chiropractic
  289  medicine in another jurisdiction in the United States.
  290         (c) Is at least 21 years of age and of good moral
  291  character.
  292         (d) Has not committed any act or offense in any
  293  jurisdiction which would constitute the basis for discipline
  294  under this chapter or chapter 456.
  295         (e)1. Performs research or has been offered and has
  296  accepted a full-time or part-time faculty appointment to teach
  297  in a program of chiropractic medicine at a publicly funded state
  298  university or college or at a college of chiropractic located in
  299  the state and accredited by an accrediting agency recognized by
  300  the United States Secretary of Education the Council on
  301  Chiropractic Education; and
  302         2. Provides a certification from the dean of the appointing
  303  college acknowledging the appointment.
  304         Section 6. Present paragraphs (z) through (ff) of
  305  subsection (1) of section 460.413, Florida Statutes, are
  306  redesignated as paragraphs (y) through (ee), respectively, and
  307  present paragraph (y) of that subsection is amended, to read:
  308         460.413 Grounds for disciplinary action; action by board or
  309  department.—
  310         (1) The following acts constitute grounds for denial of a
  311  license or disciplinary action, as specified in s. 456.072(2):
  312         (y)Failing to preserve identity of funds and property of a
  313  patient, the value of which is greater than $501. As provided by
  314  rule of the board, money or other property entrusted to a
  315  chiropractic physician for a specific purpose, including
  316  advances for costs and expenses of examination or treatment
  317  which may not exceed the value of $1,500, is to be held in trust
  318  and must be applied only to that purpose. Money and other
  319  property of patients coming into the hands of a chiropractic
  320  physician are not subject to counterclaim or setoff for
  321  chiropractic physician’s fees, and a refusal to account for and
  322  deliver over such money and property upon demand shall be deemed
  323  a conversion. This is not to preclude the retention of money or
  324  other property upon which the chiropractic physician has a valid
  325  lien for services or to preclude the payment of agreed fees from
  326  the proceeds of transactions for examinations or treatments.
  327  Controversies as to the amount of the fees are not grounds for
  328  disciplinary proceedings unless the amount demanded is clearly
  329  excessive or extortionate, or the demand is fraudulent. All
  330  funds of patients paid to a chiropractic physician, other than
  331  advances for costs and expenses, shall be deposited into one or
  332  more identifiable bank accounts maintained in the state in which
  333  the chiropractic physician’s office is situated, and funds
  334  belonging to the chiropractic physician may not be deposited
  335  therein except as follows:
  336         1. Funds reasonably sufficient to pay bank charges may be
  337  deposited therein.
  338         2. Funds belonging in part to a patient and in part
  339  presently or potentially to the physician must be deposited
  340  therein, but the portion belonging to the physician may be
  341  withdrawn when due unless the right of the physician to receive
  342  it is disputed by the patient, in which event the disputed
  343  portion may not be withdrawn until the dispute is finally
  344  resolved.
  345  
  346  Every chiropractic physician shall maintain complete records of
  347  all funds, securities, and other properties of a patient coming
  348  into the possession of the physician and render appropriate
  349  accounts to the patient regarding them. In addition, every
  350  chiropractic physician shall promptly pay or deliver to the
  351  patient, as requested by the patient, the funds, securities, or
  352  other properties in the possession of the physician which the
  353  patient is entitled to receive.
  354         Section 7. Paragraph (b) of subsection (13) of section
  355  460.4165, Florida Statutes, is amended to read:
  356         460.4165 Certified chiropractic physician’s assistants.—
  357         (13) CERTIFIED CHIROPRACTIC ASSISTANT CERTIFICATION
  358  RENEWAL.—The certification must be renewed biennially.
  359         (b) Each certified chiropractic physician’s assistant shall
  360  biennially complete 24 hours of continuing education courses
  361  approved by the board and sponsored by a chiropractic college
  362  colleges accredited by an accrediting agency recognized by the
  363  United States Secretary of Education or by an institution
  364  located outside the United States which is approved by the board
  365  or authorized to operate by the government having jurisdiction
  366  over the college or institution the Council on Chiropractic
  367  Education and approved by the board. The board shall approve
  368  those courses that build upon the basic courses required for the
  369  practice of chiropractic medicine, and the board may also
  370  approve courses in adjunctive modalities. The board may exempt a
  371  chiropractic physician’s assistant make exception from the
  372  requirements of this section in the case of an emergency or
  373  hardship cases. The board may adopt rules within the
  374  requirements of this section which are necessary for its
  375  implementation.
  376         Section 8. Subsection (1) of section 460.4167, Florida
  377  Statutes, is amended to read:
  378         460.4167 Proprietorship by persons other than licensed
  379  chiropractic physicians.—
  380         (1) A person may not employ a chiropractic physician
  381  licensed under this chapter or engage a chiropractic physician
  382  licensed under this chapter as an independent contractor to
  383  provide services that chiropractic physicians are authorized to
  384  offer under this chapter, unless the person is any of the
  385  following:
  386         (a) A sole proprietorship, group practice, partnership,
  387  corporation, limited liability company, limited partnership,
  388  professional association, or any other entity that is wholly
  389  owned by:
  390         1. One or more chiropractic physicians licensed under this
  391  chapter;
  392         2. A chiropractic physician licensed under this chapter and
  393  the spouse or surviving spouse, parent, child, or sibling of the
  394  chiropractic physician; or
  395         3. A trust whose trustees are chiropractic physicians
  396  licensed under this chapter and the spouse, parent, child, or
  397  sibling of a chiropractic physician.
  398  
  399  If the chiropractic physician described in subparagraph 2. dies,
  400  notwithstanding part X of chapter 400, the surviving spouse or
  401  adult children may hold, operate, pledge, sell, mortgage,
  402  assign, transfer, own, or control the chiropractic physician’s
  403  ownership interests for so long as the surviving spouse or adult
  404  children remain the sole proprietors of the chiropractic
  405  practice.
  406         (b) A sole proprietorship, group practice, partnership,
  407  corporation, limited liability company, limited partnership,
  408  professional association, or any other entity that is wholly
  409  owned by a physician or physicians licensed under this chapter,
  410  chapter 458, chapter 459, or chapter 461.
  411         (c) An entity that is wholly owned, directly or indirectly,
  412  by an entity licensed or registered by the state under chapter
  413  395.
  414         (d) A clinical facility that is affiliated with a college
  415  of chiropractic accredited by an accrediting agency recognized
  416  by the United States Secretary of Education or with an
  417  institution located outside the United States which is approved
  418  by the board or authorized to operate by the government having
  419  jurisdiction over the college or institution by the Council on
  420  Chiropractic Education at which training is provided for
  421  chiropractic students.
  422         (e) A public or private university or college.
  423         (f) An entity wholly owned and operated by an organization
  424  that is exempt from federal taxation under s. 501(c)(3) or (4)
  425  of the Internal Revenue Code, a community college or university
  426  clinic, or an entity owned or operated by the Federal Government
  427  or by state government, including any agency, county,
  428  municipality, or other political subdivision thereof.
  429         (g) An entity owned by a corporation whose the stock of
  430  which is publicly traded.
  431         (h) A clinic licensed under part X of chapter 400 which
  432  provides chiropractic services by a chiropractic physician
  433  licensed under this chapter and other health care services by
  434  physicians licensed under chapter 458 or chapter 459, the
  435  medical director of which is licensed under chapter 458 or
  436  chapter 459.
  437         (i) A state-licensed insurer.
  438         (j) A health maintenance organization or prepaid health
  439  clinic regulated under chapter 641.
  440         Section 9. This act shall take effect upon becoming a law.