Florida Senate - 2012 SB 470
By Senator Jones
13-00243A-12 2012470__
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 certain courses in continuing chiropractic
10 education; amending s. 460.406, F.S.; revising
11 requirements for a person who desires to be licensed
12 as a chiropractic physician; amending s. 460.413,
13 F.S.; requiring that a chiropractic physician preserve
14 the identity of funds or property of a patient in
15 excess of a specified amount; limiting the amount that
16 may be advanced to a chiropractic physician for
17 certain costs and expenses; amending s. 460.4165,
18 F.S.; providing that services rendered by a certified
19 chiropractic physician’s assistant under indirect
20 supervision may occur only at the supervising
21 chiropractic physician’s address of record; deleting
22 the length of time specified for the basic program of
23 education and training for certified chiropractic
24 physician’s assistants; amending s. 460.4166, F.S.;
25 authorizing a registered chiropractic assistant to
26 operate therapeutic office equipment; requiring that a
27 registered chiropractic assistant register with the
28 board effective by a specified date and pay a fee for
29 registration under certain circumstances; requiring
30 that a registered chiropractic assistant submit an
31 initial application by a specified date, or within 30
32 days after becoming employed, whichever occurs later;
33 requiring that an applicant specify the place of
34 employment and the names of the supervising
35 chiropractic physicians; requiring that the
36 application be signed by a chiropractic physician who
37 is an owner of the applicant’s place of employment;
38 providing an effective date of a registered
39 chiropractic assistant’s registration; authorizing
40 certain chiropractic physicians or chiropractic
41 physician’s assistants to supervise a registered
42 chiropractic assistant; requiring that a registered
43 chiropractic assistant notify the board of his or her
44 change of employment within a specified time;
45 requiring that a specified chiropractic physician sign
46 the registered chiropractic assistant’s notification
47 of change of employment; requiring that the registered
48 chiropractic assistant’s employer notify the board
49 when the assistant is no longer employed by that
50 employer; providing eligibility conditions for
51 registering as a registered chiropractic assistant;
52 requiring the biennial renewal of a registered
53 chiropractic assistant’s registration and payment of a
54 renewal fee; requiring that the board adopt by rule
55 the forms for certain statutorily required
56 applications and notifications; authorizing the board
57 to accept or require electronically submitted
58 applications, notifications, signatures, or
59 attestations in lieu of paper applications and actual
60 signatures; requiring the signature of certain forms
61 and notices by specified owners and supervisors under
62 certain conditions; authorizing the board to provide
63 for electronic alternatives to signatures if an
64 application is submitted electronically; amending s.
65 460.4167, F.S.; authorizing certain sole
66 proprietorships, group practices, partnerships,
67 corporations, limited liability companies, limited
68 partnerships, professional associations, other
69 entities, health care clinics licensed under part X of
70 ch. 400, F.S., health maintenance organizations, or
71 prepaid health clinics to employ a chiropractic
72 physician or engage a chiropractic physician as an
73 independent contractor to provide services authorized
74 by ch. 460, F.S.; authorizing the spouse or adult
75 children of a deceased chiropractic physician to hold,
76 operate, pledge, sell, mortgage, assign, transfer,
77 own, or control the deceased chiropractic physician’s
78 ownership interests under certain conditions;
79 authorizing an employer that employs a chiropractic
80 physician to exercise control over the patient records
81 of the employed chiropractic physician, the policies
82 and decisions relating to pricing, credit, refunds,
83 warranties, and advertising, and the decisions
84 relating to office personnel and hours of practice;
85 deleting an obsolete provision; providing an effective
86 date.
87
88 Be It Enacted by the Legislature of the State of Florida:
89
90 Section 1. Paragraph (e) of subsection (1) of section
91 460.4062, Florida Statutes, is amended to read:
92 460.4062 Chiropractic medicine faculty certificate.—
93 (1) The department may issue a chiropractic medicine
94 faculty certificate without examination to an individual who
95 remits a nonrefundable application fee, not to exceed $100 as
96 determined by rule of the board, and who demonstrates to the
97 board that he or she meets the following requirements:
98 (e)1. Performs research or has been offered and has
99 accepted a full-time or part-time faculty appointment to teach
100 in a program of chiropractic medicine at a publicly funded state
101 university or college or at a college of chiropractic located in
102 the state and accredited by the Council on Chiropractic
103 Education; and
104 2. Provides a certification from the dean of the appointing
105 college acknowledging the appointment.
106 Section 2. Subsection (1) of section 460.408, Florida
107 Statutes, is amended to read:
108 460.408 Continuing chiropractic education.—
109 (1) The board shall require licensees to periodically
110 demonstrate their professional competence as a condition of
111 renewal of a license by completing up to 40 contact classroom
112 hours of continuing education.
113 (a) Continuing education courses sponsored by chiropractic
114 colleges whose graduates are eligible for examination under any
115 provision of this chapter may shall be approved upon review by
116 the board if all other requirements of board rules setting forth
117 criteria for course approval are met.
118 (b) The board shall approve those courses that build upon
119 the basic courses required for the practice of chiropractic
120 medicine, and the board may also approve courses in adjunctive
121 modalities. Courses that consist of instruction in the use,
122 application, prescription, recommendation, or administration of
123 a specific company’s brand of products or services are not
124 eligible for approval.
125 Section 3. Paragraph (e) of subsection (1) of section
126 460.406, Florida Statutes, is amended to read:
127 460.406 Licensure by examination.—
128 (1) Any person desiring to be licensed as a chiropractic
129 physician must apply to the department to take the licensure
130 examination. There shall be an application fee set by the board
131 not to exceed $100 which shall be nonrefundable. There shall
132 also be an examination fee not to exceed $500 plus the actual
133 per applicant cost to the department for purchase of portions of
134 the examination from the National Board of Chiropractic
135 Examiners or a similar national organization, which may be
136 refundable if the applicant is found ineligible to take the
137 examination. The department shall examine each applicant who the
138 board certifies has:
139 (e) Successfully completed the National Board of
140 Chiropractic Examiners certification examination in parts I, II,
141 and III, and IV with a score approved by the board.
142
143 The board may require an applicant who graduated from an
144 institution accredited by the Council on Chiropractic Education
145 more than 10 years before the date of application to the board
146 to take the National Board of Chiropractic Examiners Special
147 Purposes Examination for Chiropractic, or its equivalent, as
148 determined by the board. The board shall establish by rule a
149 passing score.
150 Section 4. Paragraph (y) of subsection (1) of section
151 460.413, Florida Statutes, is amended to read:
152 460.413 Grounds for disciplinary action; action by board or
153 department.—
154 (1) The following acts constitute grounds for denial of a
155 license or disciplinary action, as specified in s. 456.072(2):
156 (y) Failing to preserve identity of funds and property of a
157 patient, the value of which is greater than $501. As provided by
158 rule of the board, money or other property entrusted to a
159 chiropractic physician for a specific purpose, including
160 advances for costs and expenses of examination or treatment
161 which may not exceed the value of $1,500, is to be held in trust
162 and must be applied only to that purpose. Money and other
163 property of patients coming into the hands of a chiropractic
164 physician are not subject to counterclaim or setoff for
165 chiropractic physician’s fees, and a refusal to account for and
166 deliver over such money and property upon demand shall be deemed
167 a conversion. This is not to preclude the retention of money or
168 other property upon which the chiropractic physician has a valid
169 lien for services or to preclude the payment of agreed fees from
170 the proceeds of transactions for examinations or treatments.
171 Controversies as to the amount of the fees are not grounds for
172 disciplinary proceedings unless the amount demanded is clearly
173 excessive or extortionate, or the demand is fraudulent. All
174 funds of patients paid to a chiropractic physician, other than
175 advances for costs and expenses, shall be deposited into in one
176 or more identifiable bank accounts maintained in the state in
177 which the chiropractic physician’s office is situated, and no
178 funds belonging to the chiropractic physician may not shall be
179 deposited therein except as follows:
180 1. Funds reasonably sufficient to pay bank charges may be
181 deposited therein.
182 2. Funds belonging in part to a patient and in part
183 presently or potentially to the physician must be deposited
184 therein, but the portion belonging to the physician may be
185 withdrawn when due unless the right of the physician to receive
186 it is disputed by the patient, in which event the disputed
187 portion may shall not be withdrawn until the dispute is finally
188 resolved.
189
190 Every chiropractic physician shall maintain complete records of
191 all funds, securities, and other properties of a patient coming
192 into the possession of the physician and render appropriate
193 accounts to the patient regarding them. In addition, every
194 chiropractic physician shall promptly pay or deliver to the
195 patient, as requested by the patient, the funds, securities, or
196 other properties in the possession of the physician which the
197 patient is entitled to receive.
198 Section 5. Subsections (2) and (5) of section 460.4165,
199 Florida Statutes, are amended to read:
200 460.4165 Certified chiropractic physician’s assistants.—
201 (2) PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN’S
202 ASSISTANT.—Notwithstanding any other provision of law, a
203 certified chiropractic physician’s assistant may perform
204 chiropractic services in the specialty area or areas for which
205 the certified chiropractic physician’s assistant is trained or
206 experienced when such services are rendered under the
207 supervision of a licensed chiropractic physician or group of
208 chiropractic physicians certified by the board. Any certified
209 chiropractic physician’s assistant certified under this section
210 to perform services may perform those services only:
211 (a) In the office of the chiropractic physician to whom the
212 certified chiropractic physician’s assistant has been assigned,
213 in which office such physician maintains her or his primary
214 practice;
215 (b) Under indirect supervision if the indirect supervision
216 occurs at the supervising chiropractic physician’s address of
217 record or place of practice required by s. 456.035, other than
218 at a clinic licensed under part X of chapter 400, of the
219 chiropractic physician to whom she or he is assigned as defined
220 by rule of the board;
221 (c) In a hospital in which the chiropractic physician to
222 whom she or he is assigned is a member of the staff; or
223 (d) On calls outside of the office of the chiropractic
224 physician to whom she or he is assigned, on the direct order of
225 the chiropractic physician to whom she or he is assigned.
226 (5) PROGRAM APPROVAL.—The department shall issue
227 certificates of approval for programs for the education and
228 training of certified chiropractic physician’s assistants which
229 meet board standards. Any basic program curriculum certified by
230 the board shall cover a period of 24 months. The curriculum must
231 consist of a curriculum of at least 200 didactic classroom hours
232 during those 24 months.
233 (a) In developing criteria for program approval, the board
234 shall give consideration to, and encourage, the use utilization
235 of equivalency and proficiency testing and other mechanisms
236 whereby full credit is given to trainees for past education and
237 experience in health fields.
238 (b) The board shall create groups of specialty
239 classifications of training for certified chiropractic
240 physician’s assistants. These classifications must shall reflect
241 the training and experience of the certified chiropractic
242 physician’s assistant. The certified chiropractic physician’s
243 assistant may receive training in one or more such
244 classifications, which shall be shown on the certificate issued.
245 (c) The board shall adopt and publish standards to ensure
246 that such programs operate in a manner that which does not
247 endanger the health and welfare of the patients who receive
248 services within the scope of the program. The board shall review
249 the quality of the curricula, faculties, and facilities of such
250 programs; issue certificates of approval; and take whatever
251 other action is necessary to determine that the purposes of this
252 section are being met.
253 Section 6. Subsections (2) and (3) of section 460.4166,
254 Florida Statutes, are amended, and subsections (4), (5), and (6)
255 are added to that section, to read:
256 460.4166 Registered chiropractic assistants.—
257 (2) DUTIES.—Under the direct supervision and responsibility
258 of a licensed chiropractic physician or certified chiropractic
259 physician’s assistant, a registered chiropractic assistant may:
260 (a) Perform clinical procedures, which include:
261 1. Preparing patients for the chiropractic physician’s
262 care.
263 2. Taking vital signs.
264 3. Observing and reporting patients’ signs or symptoms.
265 (b) Administer basic first aid.
266 (c) Assist with patient examinations or treatments other
267 than manipulations or adjustments.
268 (d) Operate therapeutic office equipment.
269 (e) Collect routine laboratory specimens as directed by the
270 chiropractic physician or certified chiropractic physician’s
271 assistant.
272 (f) Administer nutritional supplements as directed by the
273 chiropractic physician or certified chiropractic physician’s
274 assistant.
275 (g) Perform office procedures required by the chiropractic
276 physician or certified chiropractic physician’s assistant under
277 direct supervision of the chiropractic physician or certified
278 chiropractic physician’s assistant.
279 (3) REGISTRATION.—
280 (a) A registered chiropractic assistant shall register with
281 assistants may be registered by the board for a biennial fee not
282 to exceed $25. Effective April 1, 2013, a person must register
283 with the board as a registered chiropractic assistant if the
284 person performs any duties described in subsection (2), unless
285 the person is otherwise certified or licensed to perform those
286 duties.
287 (b) A person employed as a registered chiropractic
288 assistant shall submit to the board an initial application for
289 registration by March 31, 2013, or within 30 days after becoming
290 employed as a registered chiropractic assistant, whichever
291 occurs later, specifying the applicant’s place of employment and
292 the names of all chiropractic physicians under whose supervision
293 the applicant performs the duties described in subsection (2).
294 The application for registration must be signed by a
295 chiropractic physician who is an owner of the place of
296 employment specified in the application. Upon the board’s
297 receipt of the application, the effective date of the
298 registration is April 1, 2013, or applies retroactively to the
299 applicant’s date of employment as a registered chiropractic
300 assistant, whichever occurs later, and the registered
301 chiropractic assistant may be supervised by any licensed
302 chiropractic physician or certified chiropractic physician’s
303 assistant who is employed by the registered chiropractic
304 assistant’s employer or who is listed on the registration
305 application.
306 (c) A registered chiropractic assistant, within 30 days
307 after a change of employment, shall notify the board of the new
308 place of employment and the names of all chiropractic physicians
309 under whose supervision the registered chiropractic assistant
310 performs duties described in subsection (2) at the new place of
311 employment. The notification must be signed by a chiropractic
312 physician who is an owner of the new place of employment. Upon
313 the board’s receipt of the notification, the registered
314 chiropractic assistant may be supervised by any licensed
315 chiropractic physician or certified chiropractic physician’s
316 assistant who is employed by the registered chiropractic
317 assistant’s new employer or who is listed on the notification.
318 (d) Within 30 days after a registered chiropractic
319 assistant is no longer employed at his or her place of
320 employment as registered with the board, the registered
321 chiropractic assistant’s employer as registered with the board
322 shall notify the board that the registered chiropractic
323 assistant is no longer employed by that employer.
324 (e) An employee who performs none of the duties described
325 in subsection (2) is not eligible to register under this
326 subsection.
327 (4) REGISTERED CHIROPRACTIC ASSISTANT REGISTRATION
328 RENEWAL.—
329 (a) A registered chiropractic assistant’s registration must
330 be renewed biennially. Each renewal must include:
331 1. A renewal fee as set by the board, not to exceed $25.
332 2. The registered chiropractic assistant’s current place of
333 employment and the names of all chiropractic physicians under
334 whose supervision the applicant performs duties described in
335 subsection (2). The application for registration renewal must be
336 signed by a chiropractic physician who is an owner of the place
337 of employment specified in the application.
338 (b) Upon registration renewal, the registered chiropractic
339 assistant may be supervised by any licensed chiropractic
340 physician or certified chiropractic physician’s assistant who is
341 employed by the registered chiropractic assistant’s employer or
342 who is listed on the registration renewal.
343 (5) APPLICATION AND NOTIFICATION FORMS.—The board shall
344 prescribe by rule the forms for the registration application,
345 notification, and registration renewal that are required under
346 subsections (3) and (4). The board may accept or may require
347 electronically submitted registration applications,
348 notifications, registration renewals, attestations, or
349 signatures in lieu of paper applications, notifications,
350 renewals, or attestations or actual signatures.
351 (6) SIGNATURE REQUIREMENTS.—If a registered chiropractic
352 assistant is employed by an entity that is not owned in whole or
353 in part by a licensed chiropractic physician under s. 460.4167,
354 the documents requiring signatures under this section must be
355 signed by a person having an ownership interest in the entity
356 that employs the assistant and by the licensed chiropractic
357 physician who supervises the assistant. In lieu of written
358 signatures, the board may provide for electronic alternatives to
359 signatures if an application is submitted electronically, in
360 which instance all other requirements in this section apply.
361 Section 7. Section 460.4167, Florida Statutes, is amended
362 to read:
363 460.4167 Proprietorship by persons other than licensed
364 chiropractic physicians.—
365 (1) A No person other than a sole proprietorship, group
366 practice, partnership, or corporation that is wholly owned by
367 one or more chiropractic physicians licensed under this chapter
368 or by a chiropractic physician licensed under this chapter and
369 the spouse, parent, child, or sibling of that chiropractic
370 physician may not employ a chiropractic physician licensed under
371 this chapter or engage a chiropractic physician licensed under
372 this chapter as an independent contractor to provide services
373 that chiropractic physicians are authorized to offer by this
374 chapter to be offered by a chiropractic physician licensed under
375 this chapter, unless the person is any of the following, except
376 for:
377 (a) A sole proprietorship, group practice, partnership,
378 corporation, limited liability company, limited partnership,
379 professional association, or any other entity that is wholly
380 owned by:
381 1. One or more chiropractic physicians licensed under this
382 chapter;
383 2. A chiropractic physician licensed under this chapter and
384 the spouse or surviving spouse, parent, child, or sibling of the
385 chiropractic physician; or
386 3. A trust whose trustees are chiropractic physicians
387 licensed under this chapter and the spouse, parent, child, or
388 sibling of a chiropractic physician.
389
390 If the chiropractic physician described in subparagraph (a)2.
391 dies, notwithstanding part X of chapter 400, the surviving
392 spouse or adult children may hold, operate, pledge, sell,
393 mortgage, assign, transfer, own, or control the chiropractic
394 physician’s ownership interests for so long as the surviving
395 spouse or adult children remain the sole proprietors of the
396 chiropractic practice.
397 (b)(a) A sole proprietorship, group practice, partnership,
398 or corporation, limited liability company, limited partnership,
399 professional association, or any other entity that is wholly
400 owned by a physician or physicians licensed under this chapter,
401 chapter 458, chapter 459, or chapter 461.
402 (c)(b) An entity Entities that is wholly are owned,
403 directly or indirectly, by an entity licensed or registered by
404 the state under chapter 395.
405 (d)(c) A clinical facility that is facilities affiliated
406 with a college of chiropractic accredited by the Council on
407 Chiropractic Education at which training is provided for
408 chiropractic students.
409 (e)(d) A public or private university or college.
410 (f)(e) An entity wholly owned and operated by an
411 organization that is exempt from federal taxation under s.
412 501(c)(3) or (4) of the Internal Revenue Code, a any community
413 college or university clinic, or an and any entity owned or
414 operated by the Federal Government or by state government,
415 including any agency, county, municipality, or other political
416 subdivision thereof.
417 (g)(f) An entity owned by a corporation the stock of which
418 is publicly traded.
419 (h)(g) A clinic licensed under part X of chapter 400 which
420 that provides chiropractic services by a chiropractic physician
421 licensed under this chapter and other health care services by
422 physicians licensed under chapter 458 or, chapter 459, or
423 chapter 460, the medical director of which is licensed under
424 chapter 458 or chapter 459.
425 (i)(h) A state-licensed insurer.
426 (j) A health maintenance organization or prepaid health
427 clinic regulated under chapter 641.
428 (2) A No person other than a chiropractic physician
429 licensed under this chapter may not shall direct, control, or
430 interfere with a chiropractic physician’s clinical judgment
431 regarding the medical necessity of chiropractic treatment. For
432 purposes of this subsection, a chiropractic physician’s clinical
433 judgment does not apply to chiropractic services that are
434 contractually excluded, the application of alternative services
435 that may be appropriate given the chiropractic physician’s
436 prescribed course of treatment, or determinations that compare
437 comparing contractual provisions and scope of coverage with a
438 chiropractic physician’s prescribed treatment on behalf of a
439 covered person by an insurer, health maintenance organization,
440 or prepaid limited health service organization.
441 (3) Any lease agreement, rental agreement, or other
442 arrangement between a person other than a licensed chiropractic
443 physician and a chiropractic physician whereby the person other
444 than a licensed chiropractic physician provides the chiropractic
445 physician with chiropractic equipment or chiropractic materials
446 must shall contain a provision whereby the chiropractic
447 physician expressly maintains complete care, custody, and
448 control of the equipment or practice.
449 (4) The purpose of this section is to prevent a person
450 other than the a licensed chiropractic physician from
451 influencing or otherwise interfering with the exercise of the a
452 chiropractic physician’s independent professional judgment. In
453 addition to the acts specified in subsection (2) (1), a person
454 or entity other than an employer or entity authorized in
455 subsection (1) a licensed chiropractic physician and any entity
456 other than a sole proprietorship, group practice, partnership,
457 or corporation that is wholly owned by one or more chiropractic
458 physicians licensed under this chapter or by a chiropractic
459 physician licensed under this chapter and the spouse, parent,
460 child, or sibling of that physician, may not employ or engage a
461 chiropractic physician licensed under this chapter. A person or
462 entity may not or enter into a contract or arrangement with a
463 chiropractic physician pursuant to which such unlicensed person
464 or such entity exercises control over the following:
465 (a) The selection of a course of treatment for a patient,
466 the procedures or materials to be used as part of the such
467 course of treatment, and the manner in which the such course of
468 treatment is carried out by the chiropractic physician licensee;
469 (b) The patient records of the chiropractic physician a
470 chiropractor;
471 (c) The policies and decisions relating to pricing, credit,
472 refunds, warranties, and advertising; or
473 (d) The decisions relating to office personnel and hours of
474 practice.
475
476 However, a person or entity that is authorized to employ a
477 chiropractic physician under subsection (1) may exercise control
478 over the patient records of the employed chiropractic physician;
479 the policies and decisions relating to pricing, credit, refunds,
480 warranties, and advertising; and the decisions relating to
481 office personnel and hours of practice.
482 (5) Any person who violates this section commits a felony
483 of the third degree, punishable as provided in s. 775.082 s.
484 775.081, s. 775.083, or s. 775.084 s. 775.035.
485 (6) Any contract or arrangement entered into or undertaken
486 in violation of this section is shall be void as contrary to
487 public policy. This section applies to contracts entered into or
488 renewed on or after July 1, 2008.
489 Section 8. This act shall take effect July 1, 2012.