Senate Bill sb2858er

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  2         An act relating to chiropractic medicine;

  3         amending s. 460.406, F.S.; providing that the

  4         Board of Chiropractic Medicine may require

  5         certain applicants to take the National Board

  6         of Chiropractic Examiners Special Purposes

  7         Examination for Chiropractic or its equivalent;

  8         providing requirements for students relating to

  9         licensure as a chiropractic physician by

10         examination; amending s. 460.4062, F.S.;

11         revising provisions relating to chiropractic

12         medicine faculty certificates; amending s.

13         460.4165, F.S.; revising conditions under which

14         a certified chiropractic physician's assistant

15         may perform services; revising provisions

16         relating to certified chiropractic physician's

17         assistant licensure application; restricting

18         the place of practice of certified chiropractic

19         physician's assistants performing services

20         under indirect supervision; creating s.

21         460.4167, F.S.; providing requirements for

22         proprietorships owned by persons other than

23         licensed chiropractic physicians; providing

24         prohibitions; providing penalties; providing a

25         purpose; amending s. 460.408, F.S.; requiring a

26         specified number of contact classroom hours of

27         continuing education; providing effective

28         dates.

29  

30  Be It Enacted by the Legislature of the State of Florida:

31  


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 1         Section 1.  Subsection (1) of section 460.406, Florida

 2  Statutes, is amended, and subsection (5) is added to that

 3  section, to read:

 4         460.406  Licensure by examination.--

 5         (1)  Any person desiring to be licensed as a

 6  chiropractic physician must shall apply to the department to

 7  take the licensure examination. There shall be an application

 8  fee set by the board not to exceed $100 which shall be

 9  nonrefundable.  There shall also be an examination fee not to

10  exceed $500 plus the actual per applicant cost to the

11  department for purchase of portions of the examination from

12  the National Board of Chiropractic Examiners or a similar

13  national organization, which may be refundable if the

14  applicant is found ineligible to take the examination.  The

15  department shall examine each applicant who the board

16  certifies has:

17         (a)  Completed the application form and remitted the

18  appropriate fee.

19         (b)  Submitted proof satisfactory to the department

20  that he or she is not less than 18 years of age.

21         (c)  Submitted proof satisfactory to the department

22  that he or she is a graduate of a chiropractic college which

23  is accredited by or has status with the Council on

24  Chiropractic Education or its predecessor agency. However, any

25  applicant who is a graduate of a chiropractic college that was

26  initially accredited by the Council on Chiropractic Education

27  in 1995, who graduated from such college within the 4 years

28  immediately preceding such accreditation, and who is otherwise

29  qualified shall be eligible to take the examination.  No

30  application for a license to practice chiropractic medicine

31  shall be denied solely because the applicant is a graduate of


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 1  a chiropractic college that subscribes to one philosophy of

 2  chiropractic medicine as distinguished from another.

 3         (d)1.  For an applicant who has matriculated in a

 4  chiropractic college prior to July 2, 1990, completed at least

 5  2 years of residence college work, consisting of a minimum of

 6  one-half the work acceptable for a bachelor's degree granted

 7  on the basis of a 4-year period of study, in a college or

 8  university accredited by an accrediting agency recognized and

 9  approved by the United States Department of Education.

10  However, prior to being certified by the board to sit for the

11  examination, each applicant who has matriculated in a

12  chiropractic college after July 1, 1990, shall have been

13  granted a bachelor's degree, based upon 4 academic years of

14  study, by a college or university accredited by a regional

15  accrediting agency which is a member of the Commission on

16  Recognition of Postsecondary Accreditation.

17         2.  Effective July 1, 2000, completed, prior to

18  matriculation in a chiropractic college, at least 3 years of

19  residence college work, consisting of a minimum of 90 semester

20  hours leading to a bachelor's degree in a liberal arts college

21  or university accredited by an accrediting agency recognized

22  and approved by the United States Department of Education.

23  However, prior to being certified by the board to sit for the

24  examination, each applicant who has matriculated in a

25  chiropractic college after July 1, 2000, shall have been

26  granted a bachelor's degree from an institution holding

27  accreditation for that degree from a regional accrediting

28  agency which is recognized by the United States Department of

29  Education.  The applicant's chiropractic degree must consist

30  of credits earned in the chiropractic program and may not

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 1  include academic credit for courses from the bachelor's

 2  degree.

 3         (e)  Successfully completed the National Board of

 4  Chiropractic Examiners certification examination in parts I,

 5  and II, and III clinical competency, with a score approved by

 6  the board, within 10 years immediately preceding application

 7  to the department for licensure.

 8         (f)  Submitted to the department a set of fingerprints

 9  on a form and under procedures specified by the department,

10  along with payment in an amount equal to the costs incurred by

11  the Department of Health for the criminal background check of

12  the applicant.

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14  The board may require an applicant who graduated from an

15  institution accredited by the Council on Chiropractic

16  Education more than 10 years before the date of application to

17  the board to take the National Board of Chiropractic Examiners

18  Special Purposes Examination for Chiropractic, or its

19  equivalent, as determined by the board. The board shall

20  establish by rule a passing score.

21         (5)  A student in a school or college of chiropractic

22  accredited by the Council on Chiropractic Education or its

23  successor in the final year of the program may file an

24  application pursuant to subsection (1), take all examinations

25  required for licensure, submit a set of fingerprints, and pay

26  all fees required for licensure. A chiropractic student who

27  successfully completes the licensure examinations and who

28  otherwise meets all requirements for licensure as a

29  chiropractic physician during the student's final year must

30  have graduated before being certified for licensure pursuant

31  to this section.


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 1         Section 2.  Paragraph (e) of subsection (1) and

 2  subsection (2) of section 460.4062, Florida Statutes, are

 3  amended to read:

 4         460.4062  Chiropractic medicine faculty certificate.--

 5         (1)  The department may issue a chiropractic medicine

 6  faculty certificate without examination to an individual who

 7  remits a nonrefundable application fee, not to exceed $100 as

 8  determined by rule of the board, and who demonstrates to the

 9  board that he or she meets the following requirements:

10         (e)1.  Has been offered and has accepted a full-time

11  faculty appointment to teach in a program of chiropractic

12  medicine at a publicly funded state university or college or

13  at a college of chiropractic located in the state and

14  accredited by the Council on Chiropractic Education; and

15         2.  Provides a certification from the dean of the

16  appointing college acknowledging the appointment.

17         (2)  The certificate shall authorize the holder to

18  practice only in conjunction with his or her faculty position

19  at a publicly funded state university or college and its

20  affiliated clinics that are registered with the board as sites

21  at which holders of chiropractic medicine faculty certificates

22  will be practicing. Except as provided in subsection (4), such

23  certificate shall automatically expire upon termination of the

24  holder's relationship with the university or college school or

25  after a period of 2 years, whichever occurs first.

26         Section 3.  Paragraph (b) of subsection (2) and

27  subsection (6) of section 460.4165, Florida Statutes, are

28  amended, and subsection (14) is added to that section, to

29  read:

30         460.4165  Certified chiropractic physician's

31  assistants.--


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 1         (2)  PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN'S

 2  ASSISTANT.--Notwithstanding any other provision of law, a

 3  certified chiropractic physician's assistant may perform

 4  chiropractic services in the specialty area or areas for which

 5  the certified chiropractic physician's assistant is trained or

 6  experienced when such services are rendered under the

 7  supervision of a licensed chiropractic physician or group of

 8  chiropractic physicians certified by the board. Any certified

 9  chiropractic physician's assistant certified under this

10  section to perform services may perform those services only:

11         (b)  Under indirect supervision if the indirect

12  supervision occurs at the address of record or place of

13  practice required by s. 456.035, other than at a clinic

14  licensed under part X of chapter 400, of the chiropractic

15  physician to whom she or he is assigned as defined by rule of

16  the board;

17         (6)  APPLICATION APPROVAL.--Any person desiring to be

18  licensed as a certified chiropractic physician's assistant

19  must apply to the department. The application shall include a

20  work-arrangement proposal and, as part of the application

21  process, the board shall interview the proposed supervising

22  chiropractic physician, whose license must not be encumbered

23  or restricted, and the applicant to determine whether the

24  work-arrangement proposal provides for responsible

25  supervision, as a condition of certification and approval of

26  any subsequent changes in the supervising physician. The

27  department shall issue a certificate to any person certified

28  by the board as having met the following requirements:

29         (a)  Is at least 18 years of age.

30         (b)  Is a graduate of an approved program or its

31  equivalent and is fully certified by reason of experience and


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 1  education, as defined by board rule, to perform chiropractic

 2  services under the responsible supervision of a licensed

 3  chiropractic physician and when the board is satisfied that

 4  the public will be adequately protected by the arrangement

 5  proposed in the application.

 6         (c)  Has completed the application form and remitted an

 7  application fee set by the board pursuant to this section. An

 8  application for certification made by a chiropractic

 9  physician's assistant must include:

10         1.  A certificate of completion of a physician's

11  assistant training program specified in subsection (5).

12         2.  A sworn statement of any prior felony conviction in

13  any jurisdiction.

14         3.  A sworn statement of any previous revocation or

15  denial of licensure or certification in any state or

16  jurisdiction.

17         (14)  SUPERVISION OF CERTIFIED CHIROPRACTIC PHYSICIAN'S

18  ASSISTANTS AT LICENSED CLINICS.--A certified chiropractic

19  physician's assistant certified under this section to perform

20  services at a clinic licensed under part X of chapter 400 may

21  perform those services only under direct supervision of the

22  chiropractic physician to whom she or he is assigned.

23         Section 4.  Effective July 1, 2008, section 460.4167,

24  Florida Statutes, is created to read:

25         460.4167  Proprietorship by persons other than licensed

26  chiropractic physicians.--

27         (1)  No person other than a sole proprietorship, group

28  practice, partnership, or corporation that is wholly owned by

29  one or more chiropractic physicians licensed under this

30  chapter or by a chiropractic physician licensed under this

31  chapter and the spouse, parent, child, or sibling of that


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 1  chiropractic physician may employ a chiropractic physician

 2  licensed under this chapter or engage a chiropractic physician

 3  licensed under this chapter as an independent contractor to

 4  provide services authorized by this chapter to be offered by a

 5  chiropractic physician licensed under this chapter, except

 6  for:

 7         (a)  A sole proprietorship, group practice,

 8  partnership, or corporation that is wholly owned by a

 9  physician or physicians licensed under this chapter, chapter

10  458, chapter 459, or chapter 461.

11         (b)  Entities that are owned, directly or indirectly,

12  by an entity licensed or registered by the state under chapter

13  395.

14         (c)  Clinical facilities affiliated with a college of

15  chiropractic accredited by the Council on Chiropractic

16  Education at which training is provided for chiropractic

17  students.

18         (d)  A public or private university or college.

19         (e)  An entity that is exempt from federal taxation

20  under s. 501(c)(3) or (4) of the Internal Revenue Code, any

21  community college or university clinic, and any entity owned

22  or operated by the Federal Government or by state government,

23  including any agency, county, municipality, or other political

24  subdivision thereof.

25         (f)  An entity owned by a corporation the stock of

26  which is publicly traded.

27         (g)  A clinic licensed under part X of chapter 400 that

28  provides health care services by physicians licensed under

29  chapter 458, chapter 459, or chapter 460, the medical director

30  of which is licensed under chapter 458 or chapter 459.

31         (h)  A state-licensed insurer.


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 1         (2)  No person other than a chiropractic physician

 2  licensed under this chapter shall direct, control, or

 3  interfere with a chiropractic physician's clinical judgment

 4  regarding the medical necessity of chiropractic treatment. For

 5  purposes of this subsection, a chiropractic physician's

 6  clinical judgment does not apply to chiropractic services

 7  contractually excluded, the application of alternative

 8  services that may be appropriate given the chiropractic

 9  physician's prescribed course of treatment, or determinations

10  comparing contractual provisions and scope of coverage with a

11  chiropractic physician's prescribed treatment on behalf of a

12  covered person by an insurer, health maintenance organization,

13  or prepaid limited health service organization.

14         (3)  Any lease agreement, rental agreement, or other

15  arrangement between a person other than a licensed

16  chiropractic physician and a chiropractic physician whereby

17  the person other than a licensed chiropractic physician

18  provides the chiropractic physician with chiropractic

19  equipment or chiropractic materials shall contain a provision

20  whereby the chiropractic physician expressly maintains

21  complete care, custody, and control of the equipment or

22  practice.

23         (4)  The purpose of this section is to prevent a person

24  other than a licensed chiropractic physician from influencing

25  or otherwise interfering with the exercise of a chiropractic

26  physician's independent professional judgment. In addition to

27  the acts specified in subsection (1), a person other than a

28  licensed chiropractic physician and any entity other than a

29  sole proprietorship, group practice, partnership, or

30  corporation that is wholly owned by one or more chiropractic

31  physicians licensed under this chapter or by a chiropractic


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 1  physician licensed under this chapter and the spouse, parent,

 2  child, or sibling of that physician, may not employ a

 3  chiropractic physician licensed under this chapter or enter

 4  into a contract or arrangement with a chiropractic physician

 5  pursuant to which such unlicensed person or such entity

 6  exercises control over the following:

 7         (a)  The selection of a course of treatment for a

 8  patient, the procedures or materials to be used as part of

 9  such course of treatment, and the manner in which such course

10  of treatment is carried out by the licensee;

11         (b)  The patient records of a chiropractor;

12         (c)  Policies and decisions relating to pricing,

13  credit, refunds, warranties, and advertising; or

14         (d)  Decisions relating to office personnel and hours

15  of practice.

16         (5)  Any person who violates this section commits a

17  felony of the third degree, punishable as provided in s.

18  775.081, s. 775.083, or s. 775.035.

19         (6)  Any contract or arrangement entered into or

20  undertaken in violation of this section shall be void as

21  contrary to public policy. This section applies to contracts

22  entered into or renewed on or after July 1, 2008.

23         Section 5.  Subsection (1) of section 460.408, Florida

24  Statutes, is amended to read:

25         460.408  Continuing chiropractic education.--

26         (1)  The board shall require licensees to periodically

27  demonstrate their professional competence as a condition of

28  renewal of a license by completing up to 40 contact classroom

29  hours of continuing education.

30         (a)  Continuing education courses sponsored by

31  chiropractic colleges whose graduates are eligible for


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 1  examination under any provision of this chapter shall be

 2  approved by the board if all other requirements of board rules

 3  setting forth criteria for course approval are met.

 4         (b)  The board shall approve those courses that build

 5  upon the basic courses required for the practice of

 6  chiropractic medicine, and the board may also approve courses

 7  in adjunctive modalities.

 8         Section 6.  Except as otherwise expressly provided in

 9  this act, this act shall take effect July 1, 2007.

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