Florida Senate - 2011 CS for SB 398
By the Committee on Health Regulation; and Senator Jones
588-02267-11 2011398c1
1 A bill to be entitled
2 An act relating to chiropractic medicine; amending s.
3 460.4062, F.S.; revising the requirements for
4 obtaining a chiropractic medicine faculty certificate;
5 amending s. 460.408, F.S.; authorizing the Board of
6 Chiropractic Medicine to approve continuing education
7 courses sponsored by chiropractic colleges under
8 certain circumstances; prohibiting the board from
9 approving the use of certain courses in continuing
10 chiropractic education; amending s. 460.413, F.S.;
11 requiring that a chiropractic physician preserve the
12 identity of funds or property of a patient in excess
13 of a specified amount; limiting the amount that may be
14 advanced to a chiropractic physician for certain costs
15 and expenses; amending s. 460.4165, F.S.; providing
16 that services rendered by a certified chiropractic
17 physician’s assistant under indirect supervision may
18 occur only at the supervising chiropractic physician’s
19 address of record; deleting the length of time
20 specified for the basic program of education and
21 training for certified chiropractic physician’s
22 assistants; amending s. 460.4166, F.S.; authorizing a
23 registered chiropractic assistant to operate
24 therapeutic office equipment; requiring a registered
25 chiropractic assistant to register with the board
26 effective April 1, 2012, and pay a fee for
27 registration; requiring a registered chiropractic
28 assistant to submit an initial application by March
29 31, 2012, or within 30 days after becoming employed,
30 whichever is later; requiring an applicant to specify
31 place of employment and supervising chiropractic
32 physicians; requiring an application to be signed by a
33 chiropractic physician who is an owner of the
34 applicant’s place of employment; providing an
35 effective date of a registered chiropractic
36 assistant’s registration; authorizing who may
37 supervise a registered chiropractic assistant;
38 requiring a registered chiropractic assistant to
39 notify to the board of his or her change of
40 employment; requiring a chiropractic physician to sign
41 the registered chiropractic assistant’s notification
42 of change in employment; requiring a registered
43 chiropractic assistant’s employer to notify the board
44 when a registered chiropractic assistant is no longer
45 employed by that employer; providing eligibility
46 conditions for registering as a registered
47 chiropractic assistant; requiring the biennial renewal
48 of a registered chiropractic assistant’s registration
49 and payment of a renewal fee; requiring the board to
50 adopt by rule forms for certain statutorily required
51 applications and notifications; providing for the
52 signature of certain forms and notices by specified
53 owners and supervisors under certain conditions;
54 amending s. 460.4167, F.S.; authorizing certain sole
55 proprietorships, group practices, partnerships,
56 corporations, limited liability companies, limited
57 partnerships, professional associations, other
58 entities, health care clinics licensed under part X of
59 ch. 400, F.S., health maintenance organizations, or
60 prepaid health clinics to employ a chiropractic
61 physician or engage a chiropractic physician as an
62 independent contractor to provide services authorized
63 by ch. 460, F.S.; authorizing the spouse or adult
64 children of a deceased chiropractic physician to hold,
65 operate, pledge, sell, mortgage, assign, transfer,
66 own, or control the deceased chiropractic physician’s
67 ownership interests under certain conditions;
68 authorizing an employer that employs a chiropractic
69 physician to exercise control over the patient records
70 of the employed chiropractor, policies and decisions
71 relating to pricing, credit, refunds, warranties, and
72 advertising, and decisions relating to office
73 personnel and hours of practice; deleting an obsolete
74 provision; providing an effective date.
75
76 Be It Enacted by the Legislature of the State of Florida:
77
78 Section 1. Paragraph (e) of subsection (1) of section
79 460.4062, Florida Statutes, is amended to read:
80 460.4062 Chiropractic medicine faculty certificate.—
81 (1) The department may issue a chiropractic medicine
82 faculty certificate without examination to an individual who
83 remits a nonrefundable application fee, not to exceed $100 as
84 determined by rule of the board, and who demonstrates to the
85 board that he or she meets the following requirements:
86 (e)1. Performs research or has been offered and has
87 accepted a full-time or part-time faculty appointment to teach
88 in a program of chiropractic medicine at a publicly funded state
89 university or college or at a college of chiropractic located in
90 the state and accredited by the Council on Chiropractic
91 Education; and
92 2. Provides a certification from the dean of the appointing
93 college acknowledging the appointment.
94 Section 2. Subsection (1) of section 460.408, Florida
95 Statutes, is amended to read:
96 460.408 Continuing chiropractic education.—
97 (1) The board shall require licensees to periodically
98 demonstrate their professional competence as a condition of
99 renewal of a license by completing up to 40 contact classroom
100 hours of continuing education.
101 (a) Continuing education courses sponsored by chiropractic
102 colleges whose graduates are eligible for examination under any
103 provision of this chapter may shall be approved upon review by
104 the board if all other requirements of board rules setting forth
105 criteria for course approval are met.
106 (b) The board shall approve those courses that build upon
107 the basic courses required for the practice of chiropractic
108 medicine, and the board may also approve courses in adjunctive
109 modalities. Courses that consist of instruction in the use,
110 application, prescription, recommendation, or administration of
111 a specific company’s brand of products or services are not
112 eligible for approval.
113 Section 3. Paragraph (y) of subsection (1) of section
114 460.413, Florida Statutes, is amended to read:
115 460.413 Grounds for disciplinary action; action by board or
116 department.—
117 (1) The following acts constitute grounds for denial of a
118 license or disciplinary action, as specified in s. 456.072(2):
119 (y) Failing to preserve identity of funds and property of a
120 patient, the value of which is greater than $501. As provided by
121 rule of the board, money or other property entrusted to a
122 chiropractic physician for a specific purpose, including
123 advances for costs and expenses of examination or treatment
124 which may not exceed the value of $1,500, is to be held in trust
125 and must be applied only to that purpose. Money and other
126 property of patients coming into the hands of a chiropractic
127 physician are not subject to counterclaim or setoff for
128 chiropractic physician’s fees, and a refusal to account for and
129 deliver over such money and property upon demand shall be deemed
130 a conversion. This is not to preclude the retention of money or
131 other property upon which the chiropractic physician has a valid
132 lien for services or to preclude the payment of agreed fees from
133 the proceeds of transactions for examinations or treatments.
134 Controversies as to the amount of the fees are not grounds for
135 disciplinary proceedings unless the amount demanded is clearly
136 excessive or extortionate, or the demand is fraudulent. All
137 funds of patients paid to a chiropractic physician, other than
138 advances for costs and expenses, shall be deposited in one or
139 more identifiable bank accounts maintained in the state in which
140 the chiropractic physician’s office is situated, and no funds
141 belonging to the chiropractic physician shall be deposited
142 therein except as follows:
143 1. Funds reasonably sufficient to pay bank charges may be
144 deposited therein.
145 2. Funds belonging in part to a patient and in part
146 presently or potentially to the physician must be deposited
147 therein, but the portion belonging to the physician may be
148 withdrawn when due unless the right of the physician to receive
149 it is disputed by the patient, in which event the disputed
150 portion shall not be withdrawn until the dispute is finally
151 resolved.
152
153 Every chiropractic physician shall maintain complete records of
154 all funds, securities, and other properties of a patient coming
155 into the possession of the physician and render appropriate
156 accounts to the patient regarding them. In addition, every
157 chiropractic physician shall promptly pay or deliver to the
158 patient, as requested by the patient, the funds, securities, or
159 other properties in the possession of the physician which the
160 patient is entitled to receive.
161 Section 4. Subsections (2) and (5) of section 460.4165,
162 Florida Statutes, are amended to read:
163 460.4165 Certified chiropractic physician’s assistants.—
164 (2) PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN’S
165 ASSISTANT.—Notwithstanding any other provision of law, a
166 certified chiropractic physician’s assistant may perform
167 chiropractic services in the specialty area or areas for which
168 the certified chiropractic physician’s assistant is trained or
169 experienced when such services are rendered under the
170 supervision of a licensed chiropractic physician or group of
171 chiropractic physicians certified by the board. Any certified
172 chiropractic physician’s assistant certified under this section
173 to perform services may perform those services only:
174 (a) In the office of the chiropractic physician to whom the
175 certified chiropractic physician’s assistant has been assigned,
176 in which office such physician maintains her or his primary
177 practice;
178 (b) Under indirect supervision if the indirect supervision
179 occurs at the supervising chiropractic physician’s address of
180 record or place of practice required by s. 456.035, other than
181 at a clinic licensed under part X of chapter 400, of the
182 chiropractic physician to whom she or he is assigned as defined
183 by rule of the board;
184 (c) In a hospital in which the chiropractic physician to
185 whom she or he is assigned is a member of the staff; or
186 (d) On calls outside of the office of the chiropractic
187 physician to whom she or he is assigned, on the direct order of
188 the chiropractic physician to whom she or he is assigned.
189 (5) PROGRAM APPROVAL.—The department shall issue
190 certificates of approval for programs for the education and
191 training of certified chiropractic physician’s assistants which
192 meet board standards. Any basic program curriculum certified by
193 the board shall cover a period of 24 months. The curriculum must
194 consist of a curriculum of at least 200 didactic classroom hours
195 during those 24 months.
196 (a) In developing criteria for program approval, the board
197 shall give consideration to, and encourage, the use utilization
198 of equivalency and proficiency testing and other mechanisms
199 whereby full credit is given to trainees for past education and
200 experience in health fields.
201 (b) The board shall create groups of specialty
202 classifications of training for certified chiropractic
203 physician’s assistants. These classifications must shall reflect
204 the training and experience of the certified chiropractic
205 physician’s assistant. The certified chiropractic physician’s
206 assistant may receive training in one or more such
207 classifications, which shall be shown on the certificate issued.
208 (c) The board shall adopt and publish standards to ensure
209 that such programs operate in a manner which does not endanger
210 the health and welfare of the patients who receive services
211 within the scope of the program. The board shall review the
212 quality of the curricula, faculties, and facilities of such
213 programs; issue certificates of approval; and take whatever
214 other action is necessary to determine that the purposes of this
215 section are being met.
216 Section 5. Subsections (2) and (3) of section 460.4166,
217 Florida Statutes, are amended, and subsections (4), (5), and (6)
218 are added to that section, to read:
219 460.4166 Registered chiropractic assistants.—
220 (2) DUTIES.—Under the direct supervision and responsibility
221 of a licensed chiropractic physician or certified chiropractic
222 physician’s assistant, a registered chiropractic assistant may:
223 (a) Perform clinical procedures, which include:
224 1. Preparing patients for the chiropractic physician’s
225 care.
226 2. Taking vital signs.
227 3. Observing and reporting patients’ signs or symptoms.
228 (b) Administer basic first aid.
229 (c) Assist with patient examinations or treatments other
230 than manipulations or adjustments.
231 (d) Operate therapeutic office equipment.
232 (e) Collect routine laboratory specimens as directed by the
233 chiropractic physician or certified chiropractic physician’s
234 assistant.
235 (f) Administer nutritional supplements as directed by the
236 chiropractic physician or certified chiropractic physician’s
237 assistant.
238 (g) Perform office procedures required by the chiropractic
239 physician or certified chiropractic physician’s assistant under
240 direct supervision of the chiropractic physician or certified
241 chiropractic physician’s assistant.
242 (3) REGISTRATION.—
243 (a) A registered chiropractic assistant shall register with
244 assistants may be registered by the board for a biennial fee not
245 to exceed $25. Effective April 1, 2012, a person must register
246 with the board as a registered chiropractic assistant if the
247 person performs any duties described in subsection (2) unless
248 the person is otherwise certified or licensed to perform those
249 duties.
250 (b) A person employed as a registered chiropractic
251 assistant shall submit to the board an initial application for
252 registration by March 31, 2012, or within 30 days after becoming
253 employed as a registered chiropractic assistant, whichever is
254 later, specifying the applicant’s place of employment and the
255 names of all chiropractic physicians under whose supervision the
256 applicant performs the duties described in subsection (2). The
257 application for registration must be signed by a chiropractic
258 physician who is an owner of the place of employment specified
259 in the application. Upon the board’s receipt of an application,
260 the effective date of the registration shall be April 1, 2012,
261 or shall apply retroactively to the applicant’s date of
262 employment as a registered chiropractic assistant, whichever is
263 later, and the registered chiropractic assistant may be
264 supervised by any licensed chiropractic physician or certified
265 chiropractic physician’s assistant who is employed by the
266 registered chiropractic assistant’s employer or listed on the
267 registration application.
268 (c) A registered chiropractic assistant, within 30 days
269 after a change of employment, must notify the board of the new
270 place of employment and the names of all chiropractic physicians
271 under whose supervision the registered chiropractic assistant
272 performs duties described in subsection (2) at the new place of
273 employment. The notification must be signed by a chiropractic
274 physician who is an owner of the new place of employment. Upon
275 the board’s receipt of the notification, the registered
276 chiropractic assistant may be supervised by any licensed
277 chiropractic physician or certified chiropractic physician’s
278 assistant who is employed by the registered chiropractic
279 assistant’s new employer or listed on the notification.
280 (d) Within 30 days after a registered chiropractic
281 assistant is no longer employed at his or her place of
282 employment as registered with the board, the registered
283 chiropractic assistant’s employer as registered with the board
284 shall notify the board that the registered chiropractic
285 assistant is no longer employed by that employer.
286 (e) An employee who performs none of the duties described
287 in subsection (2) is not eligible to register under this
288 subsection.
289 (4) REGISTERED CHIROPRACTIC ASSISTANT REGISTRATION
290 RENEWAL.—
291 (a) A registered chiropractic assistant’s registration must
292 be renewed biennially. Each renewal must include:
293 1. A renewal fee as set by the board not to exceed $25.
294 2. The registered chiropractic assistant’s current place of
295 employment and the names of all chiropractic physicians under
296 whose supervision the applicant performs duties described in
297 subsection (2). The application for registration renewal must be
298 signed by a chiropractic physician who is an owner of the place
299 of employment specified in the application.
300 (b) Upon registration renewal, the registered chiropractic
301 assistant may be supervised by any licensed chiropractic
302 physician or certified chiropractic physician’s assistant who is
303 employed by the registered chiropractic assistant’s employer or
304 listed on the registration renewal.
305 (5) APPLICATION AND NOTIFICATION FORMS.—The board shall
306 prescribe, by rule, forms for the applications and notifications
307 required under subsections (3) and (4).
308 (6) SIGNATURE REQUIREMENTS.—If a person employed as a
309 registered chiropractic assistant is employed by an entity not
310 owned in whole or in part by a licensed chiropractic physician
311 under s. 460.4167, the documents requiring signatures under this
312 section must be signed by a person having an ownership interest
313 in the entity that employs the registered chiropractic assistant
314 and a licensed chiropractic physician who supervises the
315 registered chiropractic assistant.
316 Section 6. Section 460.4167, Florida Statutes, is amended
317 to read:
318 460.4167 Proprietorship by persons other than licensed
319 chiropractic physicians.—
320 (1) A No person other than a sole proprietorship, group
321 practice, partnership, or corporation that is wholly owned by
322 one or more chiropractic physicians licensed under this chapter
323 or by a chiropractic physician licensed under this chapter and
324 the spouse, parent, child, or sibling of that chiropractic
325 physician may not employ a chiropractic physician licensed under
326 this chapter or engage a chiropractic physician licensed under
327 this chapter as an independent contractor to provide services
328 authorized by this chapter to be offered by a chiropractic
329 physician licensed under this chapter unless the person is any
330 of the following, except for:
331 (a) A sole proprietorship, group practice, partnership,
332 corporation, limited liability company, limited partnership, any
333 person, professional association, or any other entity that is
334 wholly owned by:
335 1. One or more chiropractic physicians licensed under this
336 chapter;
337 2. A chiropractic physician licensed under this chapter and
338 the spouse or surviving spouse, parent, child, or sibling of the
339 chiropractic physician; or
340 3. A trust whose trustees are chiropractic physicians
341 licensed under this chapter and the spouse, parent, child, or
342 sibling of a chiropractic physician.
343 (b)(a) A sole proprietorship, group practice, partnership,
344 or corporation, limited liability company, limited partnership,
345 professional association, or any other entity that is wholly
346 owned by a physician or physicians licensed under this chapter,
347 chapter 458, chapter 459, or chapter 461.
348 (c)(b) An entity Entities that is wholly are owned,
349 directly or indirectly, by an entity licensed or registered by
350 the state under chapter 395.
351 (d)(c) A clinical facility that is facilities affiliated
352 with a college of chiropractic accredited by the Council on
353 Chiropractic Education at which training is provided for
354 chiropractic students.
355 (e)(d) A public or private university or college.
356 (f)(e) An entity wholly owned and operated by an
357 organization that is exempt from federal taxation under s.
358 501(c)(3) or (4) of the Internal Revenue Code, a any community
359 college or university clinic, and any entity owned or operated
360 by the Federal Government or by state government, including any
361 agency, county, municipality, or other political subdivision
362 thereof.
363 (g)(f) An entity owned by a corporation the stock of which
364 is publicly traded.
365 (h)(g) A clinic licensed under part X of chapter 400 which
366 that provides chiropractic services by a chiropractic physician
367 licensed under chapter 460 and other health care services by
368 physicians licensed under chapter 458 or, chapter 459, or
369 chapter 460, the medical director of which is licensed under
370 chapter 458 or chapter 459.
371 (i)(h) A state-licensed insurer.
372 (j) A health maintenance organization or prepaid health
373 clinic regulated under chapter 641.
374
375 If a chiropractic physician described in subparagraph (a)2.
376 dies, notwithstanding part X of chapter 400, the deceased
377 chiropractic physician’s surviving spouse or adult children may
378 hold, operate, pledge, sell, mortgage, assign, transfer, own, or
379 control the deceased chiropractic physician’s ownership
380 interests for so long as the surviving spouse or adult children
381 remain the sole proprietor of the chiropractic practice.
382 (2) A No person other than a chiropractic physician
383 licensed under this chapter may not shall direct, control, or
384 interfere with a chiropractic physician’s clinical judgment
385 regarding the medical necessity of chiropractic treatment. For
386 purposes of this subsection, a chiropractic physician’s clinical
387 judgment does not apply to chiropractic services contractually
388 excluded, the application of alternative services that may be
389 appropriate given the chiropractic physician’s prescribed course
390 of treatment, or determinations comparing contractual provisions
391 and scope of coverage with a chiropractic physician’s prescribed
392 treatment on behalf of a covered person by an insurer, health
393 maintenance organization, or prepaid limited health service
394 organization.
395 (3) Any lease agreement, rental agreement, or other
396 arrangement between a person other than a licensed chiropractic
397 physician and a chiropractic physician whereby the person other
398 than a licensed chiropractic physician provides the chiropractic
399 physician with chiropractic equipment or chiropractic materials
400 must shall contain a provision whereby the chiropractic
401 physician expressly maintains complete care, custody, and
402 control of the equipment or practice.
403 (4) The purpose of this section is to prevent a person
404 other than the a licensed chiropractic physician from
405 influencing or otherwise interfering with the exercise of the a
406 chiropractic physician’s independent professional judgment. In
407 addition to the acts specified in subsection (2) (1), a person
408 or entity other than an employer or entity authorized in
409 subsection (1) a licensed chiropractic physician and any entity
410 other than a sole proprietorship, group practice, partnership,
411 or corporation that is wholly owned by one or more chiropractic
412 physicians licensed under this chapter or by a chiropractic
413 physician licensed under this chapter and the spouse, parent,
414 child, or sibling of that physician, may not employ or engage a
415 chiropractic physician licensed under this chapter. A person or
416 entity may not or enter into a contract or arrangement with a
417 chiropractic physician pursuant to which such unlicensed person
418 or such entity exercises control over the following:
419 (a) The selection of a course of treatment for a patient,
420 the procedures or materials to be used as part of such course of
421 treatment, and the manner in which such course of treatment is
422 carried out by the licensee;
423 (b) The patient records of a chiropractor;
424 (c) Policies and decisions relating to pricing, credit,
425 refunds, warranties, and advertising; or
426 (d) Decisions relating to office personnel and hours of
427 practice. However, an employer authorized to employ a
428 chiropractic physician under subsection (1) may exercise control
429 over the patient records of the employed chiropractor; policies
430 and decisions relating to pricing, credit, refunds, warranties,
431 and advertising; and decisions relating to office personnel and
432 hours of practice.
433 (5) Any person who violates this section commits a felony
434 of the third degree, punishable as provided in s. 775.082 s.
435 775.081, s. 775.083, or s. 775.084 s. 775.035.
436 (6) Any contract or arrangement entered into or undertaken
437 in violation of this section is shall be void as contrary to
438 public policy. This section applies to contracts entered into or
439 renewed on or after July 1, 2008.
440 Section 7. This act shall take effect July 1, 2011.