HB 633

1
A bill to be entitled
2An act relating to chiropractic medicine; amending s.
3460.4062, F.S.; revising the requirements for obtaining a
4chiropractic medicine faculty certificate; amending s.
5460.408, F.S.; prohibiting the Board of Chiropractic
6Medicine from approving the use of certain courses in
7continuing chiropractic education; amending s. 460.4165,
8F.S.; providing that services rendered by a certified
9chiropractic physician's assistant under indirect
10supervision may occur only at the supervising chiropractic
11physician's address of record; deleting the length of time
12specified for the basic program of education and training
13for certified chiropractic physician's assistants;
14amending s. 460.4166, F.S.; requiring a person to register
15as a chiropractic assistant if he or she renders
16therapeutic services or administers therapeutic agents
17related to a chiropractic physician's treatment of a
18patient; providing registration requirements for such
19persons; requiring a registered chiropractic assistant to
20notify the board of his or her change of employment;
21providing that a person who exclusively performs
22nontherapeutic services is not required to register as a
23chiropractic assistant; requiring the approval of certain
24supervising chiropractic physicians by the board;
25providing an effective date for the board's approval;
26requiring a fee for approval of a supervising chiropractic
27physician or group of chiropractic physicians; requiring
28the board to adopt by rule an application form for the
29initial registration of a registered chiropractic
30assistant, a form for the approval of a supervising
31chiropractic physician, and the notice of a change of
32employment for a registered chiropractic assistant;
33amending s. 460.4167, F.S.; authorizing certain sole
34proprietorships, group practices, partnerships,
35corporations, limited liability companies, limited
36partnerships, professional associations, other entities,
37health care clinics licensed under part X of ch. 400,
38F.S., health maintenance organizations, or prepaid health
39clinics to employ a chiropractic physician or engage a
40chiropractic physician as an independent contractor to
41provide services authorized by ch. 460, F.S.; authorizing
42the spouse or adult children of a deceased chiropractic
43physician to hold, operate, pledge, sell, mortgage,
44assign, transfer, own, or control the deceased
45chiropractic physician's ownership interests under certain
46conditions; authorizing an employer that employs a
47chiropractic physician to exercise control over the
48patient records of the employed chiropractor, policies and
49decisions relating to pricing, credit, refunds,
50warranties, and advertising, and decisions relating to
51office personnel and hours of practice; deleting an
52obsolete provision; providing an effective date.
53
54Be It Enacted by the Legislature of the State of Florida:
55
56     Section 1.  Paragraph (e) of subsection (1) of section
57460.4062, Florida Statutes, is amended to read:
58     460.4062  Chiropractic medicine faculty certificate.-
59     (1)  The department may issue a chiropractic medicine
60faculty certificate without examination to an individual who
61remits a nonrefundable application fee, not to exceed $100 as
62determined by rule of the board, and who demonstrates to the
63board that he or she meets the following requirements:
64     (e)1.  Performs research or has been offered and has
65accepted a full-time or part-time faculty appointment to teach
66in a program of chiropractic medicine at a publicly funded state
67university or college or at a college of chiropractic located in
68the state and accredited by the Council on Chiropractic
69Education; and
70     2.  Provides a certification from the dean of the
71appointing college acknowledging the appointment.
72     Section 2.  Paragraph (b) of subsection (1) of section
73460.408, Florida Statutes, is amended to read:
74     460.408  Continuing chiropractic education.-
75     (1)  The board shall require licensees to periodically
76demonstrate their professional competence as a condition of
77renewal of a license by completing up to 40 contact classroom
78hours of continuing education.
79     (b)  The board shall approve those courses that build upon
80the basic courses required for the practice of chiropractic
81medicine, and the board may also approve courses in adjunctive
82modalities. Courses that consist of instruction in the use,
83application, prescription, recommendation, or administration of
84a specific company's brand of products or services are not
85eligible for approval.
86     Section 3.  Subsections (2) and (5) of section 460.4165,
87Florida Statutes, are amended to read:
88     460.4165  Certified chiropractic physician's assistants.-
89     (2)  PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN'S
90ASSISTANT.-Notwithstanding any other provision of law, a
91certified chiropractic physician's assistant may perform
92chiropractic services in the specialty area or areas for which
93the certified chiropractic physician's assistant is trained or
94experienced when such services are rendered under the
95supervision of a licensed chiropractic physician or group of
96chiropractic physicians certified by the board. Any certified
97chiropractic physician's assistant certified under this section
98to perform services may perform those services only:
99     (a)  In the office of the chiropractic physician to whom
100the certified chiropractic physician's assistant has been
101assigned, in which office such physician maintains her or his
102primary practice;
103     (b)  Under indirect supervision if the indirect supervision
104occurs at the supervising chiropractic physician's address of
105record or place of practice required by s. 456.035, other than
106at a clinic licensed under part X of chapter 400, of the
107chiropractic physician to whom she or he is assigned as defined
108by rule of the board;
109     (c)  In a hospital in which the chiropractic physician to
110whom she or he is assigned is a member of the staff; or
111     (d)  On calls outside of the office of the chiropractic
112physician to whom she or he is assigned, on the direct order of
113the chiropractic physician to whom she or he is assigned.
114     (5)  PROGRAM APPROVAL.-The department shall issue
115certificates of approval for programs for the education and
116training of certified chiropractic physician's assistants which
117meet board standards. Any basic program curriculum certified by
118the board shall cover a period of 24 months. The curriculum must
119consist of a curriculum of at least 200 didactic classroom hours
120during those 24 months.
121     (a)  In developing criteria for program approval, the board
122shall give consideration to, and encourage, the use utilization
123of equivalency and proficiency testing and other mechanisms
124whereby full credit is given to trainees for past education and
125experience in health fields.
126     (b)  The board shall create groups of specialty
127classifications of training for certified chiropractic
128physician's assistants. These classifications must shall reflect
129the training and experience of the certified chiropractic
130physician's assistant. The certified chiropractic physician's
131assistant may receive training in one or more such
132classifications, which shall be shown on the certificate issued.
133     (c)  The board shall adopt and publish standards to ensure
134that such programs operate in a manner which does not endanger
135the health and welfare of the patients who receive services
136within the scope of the program. The board shall review the
137quality of the curricula, faculties, and facilities of such
138programs; issue certificates of approval; and take whatever
139other action is necessary to determine that the purposes of this
140section are being met.
141     Section 4.  Subsection (3) of section 460.4166, Florida
142Statutes, is amended, and subsections (4) and (5) are added to
143that section, to read:
144     460.4166  Registered chiropractic assistants.-
145     (3)  REGISTRATION.-
146     (a)  A registered chiropractic assistant assistants may
147register with be registered by the board for a biennial fee not
148to exceed $25. Effective April 1, 2012, a person must register
149with the board as a chiropractic assistant if the person
150performs therapeutic services or administers therapeutic agents
151related to a chiropractic physician's treatment of a patient,
152unless the person is otherwise certified or licensed to perform
153those services or administer those agents.
154     (b)  A person employed as a registered chiropractic
155assistant, if required to register under this section, must
156submit to the board an initial application for registration
157within 30 days after employment. Upon the board's approval of
158the application, the effective date of the registration shall
159apply retroactively to the date of employment.
160     (c)  A registered chiropractic assistant, within 30 days
161after a change of employment, must notify the board of the new
162place of employment and the name of the chiropractic physician
163or group of chiropractic physicians under whose supervision the
164registered chiropractic assistant performs the duties described
165in subsection (2).
166     (d)  A person who exclusively performs nontherapeutic
167services is not required to register under this section.
168     (4)  APPROVAL OF SUPERVISING CHIROPRACTIC PHYSICIANS.-
169     (a)  A chiropractic physician or group of chiropractic
170physicians under whose supervision a registered chiropractic
171assistant performs the duties described in subsection (2) must
172be approved by the board. If a registered chiropractic assistant
173performs those duties under the direct supervision of a
174certified chiropractic physician's assistant, the chiropractic
175physician or group of chiropractic physicians under whose
176supervision the certified chiropractic physician's assistant
177provides direct supervision for the registered chiropractic
178assistant must be approved by the board.
179     (b)  If a registered chiropractic assistant changes
180employment, the supervising chiropractic physician or group of
181chiropractic physicians at the new place of employment must be
182approved by the board.
183     (c)  Upon approval of a supervising chiropractic physician
184or group of chiropractic physicians, the effective date of the
185board's approval applies retroactively to the date of
186employment. The board shall assess a fee for approval of a
187supervising chiropractic physician or group of chiropractic
188physicians, which may not exceed $75.
189     (5)  APPLICATION FORMS.-The board shall prescribe by rule
190application forms for the initial registration of a registered
191chiropractic assistant, the board's approval of a supervising
192chiropractic physician or group of chiropractic physicians, and
193the registered chiropractic assistant's notice of a change of
194employment.
195     Section 5.  Section 460.4167, Florida Statutes, is amended
196to read:
197     460.4167  Proprietorship by persons other than licensed
198chiropractic physicians.-
199     (1)  A No person other than a sole proprietorship, group
200practice, partnership, or corporation that is wholly owned by
201one or more chiropractic physicians licensed under this chapter
202or by a chiropractic physician licensed under this chapter and
203the spouse, parent, child, or sibling of that chiropractic
204physician may not employ a chiropractic physician licensed under
205this chapter or engage a chiropractic physician licensed under
206this chapter as an independent contractor to provide services
207authorized by this chapter to be offered by a chiropractic
208physician licensed under this chapter unless the person is any
209of the following, except for:
210     (a)  A sole proprietorship, group practice, partnership,
211corporation, limited liability company, limited partnership, any
212person, professional association, or any other entity that is
213wholly owned by:
214     1.  One or more chiropractic physicians licensed under this
215chapter;
216     2.  A chiropractic physician licensed under this chapter
217and the spouse or surviving spouse, parent, child, or sibling of
218the chiropractic physician; or
219     3.  A trust whose trustees are chiropractic physicians
220licensed under this chapter and the spouse, parent, child, or
221sibling of a chiropractic physician.
222     (b)(a)  A sole proprietorship, group practice, partnership,
223or corporation, limited liability company, limited partnership,
224professional association, or any other entity that is wholly
225owned by a physician or physicians licensed under this chapter,
226chapter 458, chapter 459, or chapter 461.
227     (c)(b)  An entity Entities that is wholly are owned,
228directly or indirectly, by an entity licensed or registered by
229the state under chapter 395.
230     (d)(c)  A clinical facility that is facilities affiliated
231with a college of chiropractic accredited by the Council on
232Chiropractic Education at which training is provided for
233chiropractic students.
234     (e)(d)  A public or private university or college.
235     (f)(e)  An entity wholly owned and operated by an
236organization that is exempt from federal taxation under s.
237501(c)(3) or (4) of the Internal Revenue Code, a any community
238college or university clinic, and any entity owned or operated
239by the Federal Government or by state government, including any
240agency, county, municipality, or other political subdivision
241thereof.
242     (g)(f)  An entity owned by a corporation the stock of which
243is publicly traded.
244     (h)(g)  A clinic licensed under part X of chapter 400 which
245that provides chiropractic services by a chiropractic physician
246licensed under chapter 460 and other health care services by
247physicians licensed under chapter 458 or, chapter 459, or
248chapter 460, the medical director of which is licensed under
249chapter 458 or chapter 459.
250     (i)(h)  A state-licensed insurer.
251     (j)  A health maintenance organization or prepaid health
252clinic regulated under chapter 641.
253
254If a chiropractic physician described in subparagraph (a)2.
255dies, notwithstanding part X of chapter 400, the deceased
256chiropractic physician's surviving spouse or adult children may
257hold, operate, pledge, sell, mortgage, assign, transfer, own, or
258control the deceased chiropractic physician's ownership
259interests for so long as the surviving spouse or adult children
260remain the sole proprietor of the chiropractic practice.
261     (2)  A No person other than a chiropractic physician
262licensed under this chapter may not shall direct, control, or
263interfere with a chiropractic physician's clinical judgment
264regarding the medical necessity of chiropractic treatment. For
265purposes of this subsection, a chiropractic physician's clinical
266judgment does not apply to chiropractic services contractually
267excluded, the application of alternative services that may be
268appropriate given the chiropractic physician's prescribed course
269of treatment, or determinations comparing contractual provisions
270and scope of coverage with a chiropractic physician's prescribed
271treatment on behalf of a covered person by an insurer, health
272maintenance organization, or prepaid limited health service
273organization.
274     (3)  Any lease agreement, rental agreement, or other
275arrangement between a person other than a licensed chiropractic
276physician and a chiropractic physician whereby the person other
277than a licensed chiropractic physician provides the chiropractic
278physician with chiropractic equipment or chiropractic materials
279must shall contain a provision whereby the chiropractic
280physician expressly maintains complete care, custody, and
281control of the equipment or practice.
282     (4)  The purpose of this section is to prevent a person
283other than the a licensed chiropractic physician from
284influencing or otherwise interfering with the exercise of the a
285chiropractic physician's independent professional judgment. In
286addition to the acts specified in subsection (2) (1), a person
287or entity other than an employer or entity authorized in
288subsection (1) a licensed chiropractic physician and any entity
289other than a sole proprietorship, group practice, partnership,
290or corporation that is wholly owned by one or more chiropractic
291physicians licensed under this chapter or by a chiropractic
292physician licensed under this chapter and the spouse, parent,
293child, or sibling of that physician, may not employ or engage a
294chiropractic physician licensed under this chapter. A person or
295entity may not or enter into a contract or arrangement with a
296chiropractic physician pursuant to which such unlicensed person
297or such entity exercises control over the following:
298     (a)  The selection of a course of treatment for a patient,
299the procedures or materials to be used as part of such course of
300treatment, and the manner in which such course of treatment is
301carried out by the licensee;
302     (b)  The patient records of a chiropractor;
303     (c)  Policies and decisions relating to pricing, credit,
304refunds, warranties, and advertising; or
305     (d)  Decisions relating to office personnel and hours of
306practice. However, an employer authorized to employ a
307chiropractic physician under subsection (1) may exercise control
308over the patient records of the employed chiropractor; policies
309and decisions relating to pricing, credit, refunds, warranties,
310and advertising; and decisions relating to office personnel and
311hours of practice.
312     (5)  Any person who violates this section commits a felony
313of the third degree, punishable as provided in s. 775.082 s.
314775.081, s. 775.083, or s. 775.084 s. 775.035.
315     (6)  Any contract or arrangement entered into or undertaken
316in violation of this section is shall be void as contrary to
317public policy. This section applies to contracts entered into or
318renewed on or after July 1, 2008.
319     Section 6.  This act shall take effect July 1, 2011.


CODING: Words stricken are deletions; words underlined are additions.