Florida Senate - 2012 CS for CS for SB 470
By the Committees on Budget Subcommittee on Health and Human
Services Appropriations; and Health Regulation; and Senator
Jones
603-02262-12 2012470c2
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. 460.4167, F.S.;
25 authorizing certain sole proprietorships, group
26 practices, partnerships, corporations, limited
27 liability companies, limited partnerships,
28 professional associations, other entities, health care
29 clinics licensed under part X of ch. 400, F.S., health
30 maintenance organizations, or prepaid health clinics
31 to employ a chiropractic physician or engage a
32 chiropractic physician as an independent contractor to
33 provide services authorized by ch. 460, F.S.;
34 authorizing the spouse or adult children of a deceased
35 chiropractic physician to hold, operate, pledge, sell,
36 mortgage, assign, transfer, own, or control the
37 deceased chiropractic physician’s ownership interests
38 under certain conditions; authorizing an employer that
39 employs a chiropractic physician to exercise control
40 over the patient records of the employed chiropractic
41 physician, the policies and decisions relating to
42 pricing, credit, refunds, warranties, and advertising,
43 and the decisions relating to office personnel and
44 hours of practice; deleting an obsolete provision;
45 providing an effective date.
46
47 Be It Enacted by the Legislature of the State of Florida:
48
49 Section 1. Paragraph (e) of subsection (1) of section
50 460.4062, Florida Statutes, is amended to read:
51 460.4062 Chiropractic medicine faculty certificate.—
52 (1) The department may issue a chiropractic medicine
53 faculty certificate without examination to an individual who
54 remits a nonrefundable application fee, not to exceed $100 as
55 determined by rule of the board, and who demonstrates to the
56 board that he or she meets the following requirements:
57 (e)1. Performs research or has been offered and has
58 accepted a full-time or part-time faculty appointment to teach
59 in a program of chiropractic medicine at a publicly funded state
60 university or college or at a college of chiropractic located in
61 the state and accredited by the Council on Chiropractic
62 Education; and
63 2. Provides a certification from the dean of the appointing
64 college acknowledging the appointment.
65 Section 2. Subsection (1) of section 460.408, Florida
66 Statutes, is amended to read:
67 460.408 Continuing chiropractic education.—
68 (1) The board shall require licensees to periodically
69 demonstrate their professional competence as a condition of
70 renewal of a license by completing up to 40 contact classroom
71 hours of continuing education.
72 (a) Continuing education courses sponsored by chiropractic
73 colleges whose graduates are eligible for examination under any
74 provision of this chapter may shall be approved upon review by
75 the board if all other requirements of board rules setting forth
76 criteria for course approval are met.
77 (b) The board shall approve those courses that build upon
78 the basic courses required for the practice of chiropractic
79 medicine, and the board may also approve courses in adjunctive
80 modalities. Courses that consist of instruction in the use,
81 application, prescription, recommendation, or administration of
82 a specific company’s brand of products or services are not
83 eligible for approval.
84 Section 3. Paragraph (e) of subsection (1) of section
85 460.406, Florida Statutes, is amended to read:
86 460.406 Licensure by examination.—
87 (1) Any person desiring to be licensed as a chiropractic
88 physician must apply to the department to take the licensure
89 examination. There shall be an application fee set by the board
90 not to exceed $100 which shall be nonrefundable. There shall
91 also be an examination fee not to exceed $500 plus the actual
92 per applicant cost to the department for purchase of portions of
93 the examination from the National Board of Chiropractic
94 Examiners or a similar national organization, which may be
95 refundable if the applicant is found ineligible to take the
96 examination. The department shall examine each applicant who the
97 board certifies has:
98 (e) Successfully completed the National Board of
99 Chiropractic Examiners certification examination in parts I, II,
100 and III, and IV, and the physiotherapy examination of the
101 National Board of Chiropractic Examiners, with a score approved
102 by the board.
103
104 The board may require an applicant who graduated from an
105 institution accredited by the Council on Chiropractic Education
106 more than 10 years before the date of application to the board
107 to take the National Board of Chiropractic Examiners Special
108 Purposes Examination for Chiropractic, or its equivalent, as
109 determined by the board. The board shall establish by rule a
110 passing score.
111 Section 4. Paragraph (y) of subsection (1) of section
112 460.413, Florida Statutes, is amended to read:
113 460.413 Grounds for disciplinary action; action by board or
114 department.—
115 (1) The following acts constitute grounds for denial of a
116 license or disciplinary action, as specified in s. 456.072(2):
117 (y) Failing to preserve identity of funds and property of a
118 patient, the value of which is greater than $501. As provided by
119 rule of the board, money or other property entrusted to a
120 chiropractic physician for a specific purpose, including
121 advances for costs and expenses of examination or treatment
122 which may not exceed the value of $1,500, is to be held in trust
123 and must be applied only to that purpose. Money and other
124 property of patients coming into the hands of a chiropractic
125 physician are not subject to counterclaim or setoff for
126 chiropractic physician’s fees, and a refusal to account for and
127 deliver over such money and property upon demand shall be deemed
128 a conversion. This is not to preclude the retention of money or
129 other property upon which the chiropractic physician has a valid
130 lien for services or to preclude the payment of agreed fees from
131 the proceeds of transactions for examinations or treatments.
132 Controversies as to the amount of the fees are not grounds for
133 disciplinary proceedings unless the amount demanded is clearly
134 excessive or extortionate, or the demand is fraudulent. All
135 funds of patients paid to a chiropractic physician, other than
136 advances for costs and expenses, shall be deposited into in one
137 or more identifiable bank accounts maintained in the state in
138 which the chiropractic physician’s office is situated, and no
139 funds belonging to the chiropractic physician may not shall be
140 deposited therein except as follows:
141 1. Funds reasonably sufficient to pay bank charges may be
142 deposited therein.
143 2. Funds belonging in part to a patient and in part
144 presently or potentially to the physician must be deposited
145 therein, but the portion belonging to the physician may be
146 withdrawn when due unless the right of the physician to receive
147 it is disputed by the patient, in which event the disputed
148 portion may shall not be withdrawn until the dispute is finally
149 resolved.
150
151 Every chiropractic physician shall maintain complete records of
152 all funds, securities, and other properties of a patient coming
153 into the possession of the physician and render appropriate
154 accounts to the patient regarding them. In addition, every
155 chiropractic physician shall promptly pay or deliver to the
156 patient, as requested by the patient, the funds, securities, or
157 other properties in the possession of the physician which the
158 patient is entitled to receive.
159 Section 5. Subsections (2) and (5) of section 460.4165,
160 Florida Statutes, are amended to read:
161 460.4165 Certified chiropractic physician’s assistants.—
162 (2) PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN’S
163 ASSISTANT.—Notwithstanding any other provision of law, a
164 certified chiropractic physician’s assistant may perform
165 chiropractic services in the specialty area or areas for which
166 the certified chiropractic physician’s assistant is trained or
167 experienced when such services are rendered under the
168 supervision of a licensed chiropractic physician or group of
169 chiropractic physicians certified by the board. Any certified
170 chiropractic physician’s assistant certified under this section
171 to perform services may perform those services only:
172 (a) In the office of the chiropractic physician to whom the
173 certified chiropractic physician’s assistant has been assigned,
174 in which office such physician maintains her or his primary
175 practice;
176 (b) Under indirect supervision if the indirect supervision
177 occurs at the supervising chiropractic physician’s address of
178 record or place of practice required by s. 456.035, other than
179 at a clinic licensed under part X of chapter 400, of the
180 chiropractic physician to whom she or he is assigned as defined
181 by rule of the board;
182 (c) In a hospital in which the chiropractic physician to
183 whom she or he is assigned is a member of the staff; or
184 (d) On calls outside of the office of the chiropractic
185 physician to whom she or he is assigned, on the direct order of
186 the chiropractic physician to whom she or he is assigned.
187 (5) PROGRAM APPROVAL.—The department shall issue
188 certificates of approval for programs for the education and
189 training of certified chiropractic physician’s assistants which
190 meet board standards. Any basic program curriculum certified by
191 the board shall cover a period of 24 months. The curriculum must
192 consist of a curriculum of at least 200 didactic classroom hours
193 during those 24 months.
194 (a) In developing criteria for program approval, the board
195 shall give consideration to, and encourage, the use utilization
196 of equivalency and proficiency testing and other mechanisms
197 whereby full credit is given to trainees for past education and
198 experience in health fields.
199 (b) The board shall create groups of specialty
200 classifications of training for certified chiropractic
201 physician’s assistants. These classifications must shall reflect
202 the training and experience of the certified chiropractic
203 physician’s assistant. The certified chiropractic physician’s
204 assistant may receive training in one or more such
205 classifications, which shall be shown on the certificate issued.
206 (c) The board shall adopt and publish standards to ensure
207 that such programs operate in a manner that which does not
208 endanger the health and welfare of the patients who receive
209 services within the scope of the program. The board shall review
210 the quality of the curricula, faculties, and facilities of such
211 programs; issue certificates of approval; and take whatever
212 other action is necessary to determine that the purposes of this
213 section are being met.
214 Section 6. Section 460.4167, Florida Statutes, is amended
215 to read:
216 460.4167 Proprietorship by persons other than licensed
217 chiropractic physicians.—
218 (1) A No person other than a sole proprietorship, group
219 practice, partnership, or corporation that is wholly owned by
220 one or more chiropractic physicians licensed under this chapter
221 or by a chiropractic physician licensed under this chapter and
222 the spouse, parent, child, or sibling of that chiropractic
223 physician may not employ a chiropractic physician licensed under
224 this chapter or engage a chiropractic physician licensed under
225 this chapter as an independent contractor to provide services
226 that chiropractic physicians are authorized to offer by this
227 chapter to be offered by a chiropractic physician licensed under
228 this chapter, unless the person is any of the following, except
229 for:
230 (a) A sole proprietorship, group practice, partnership,
231 corporation, limited liability company, limited partnership,
232 professional association, or any other entity that is wholly
233 owned by:
234 1. One or more chiropractic physicians licensed under this
235 chapter;
236 2. A chiropractic physician licensed under this chapter and
237 the spouse or surviving spouse, parent, child, or sibling of the
238 chiropractic physician; or
239 3. A trust whose trustees are chiropractic physicians
240 licensed under this chapter and the spouse, parent, child, or
241 sibling of a chiropractic physician.
242
243 If the chiropractic physician described in subparagraph (a)2.
244 dies, notwithstanding part X of chapter 400, the surviving
245 spouse or adult children may hold, operate, pledge, sell,
246 mortgage, assign, transfer, own, or control the chiropractic
247 physician’s ownership interests for so long as the surviving
248 spouse or adult children remain the sole proprietors of the
249 chiropractic practice.
250 (b)(a) A sole proprietorship, group practice, partnership,
251 or corporation, limited liability company, limited partnership,
252 professional association, or any other entity that is wholly
253 owned by a physician or physicians licensed under this chapter,
254 chapter 458, chapter 459, or chapter 461.
255 (c)(b) An entity Entities that is wholly are owned,
256 directly or indirectly, by an entity licensed or registered by
257 the state under chapter 395.
258 (d)(c) A clinical facility that is facilities affiliated
259 with a college of chiropractic accredited by the Council on
260 Chiropractic Education at which training is provided for
261 chiropractic students.
262 (e)(d) A public or private university or college.
263 (f)(e) An entity wholly owned and operated by an
264 organization that is exempt from federal taxation under s.
265 501(c)(3) or (4) of the Internal Revenue Code, a any community
266 college or university clinic, or an and any entity owned or
267 operated by the Federal Government or by state government,
268 including any agency, county, municipality, or other political
269 subdivision thereof.
270 (g)(f) An entity owned by a corporation the stock of which
271 is publicly traded.
272 (h)(g) A clinic licensed under part X of chapter 400 which
273 that provides chiropractic services by a chiropractic physician
274 licensed under this chapter and other health care services by
275 physicians licensed under chapter 458 or, chapter 459, or
276 chapter 460, the medical director of which is licensed under
277 chapter 458 or chapter 459.
278 (i)(h) A state-licensed insurer.
279 (j) A health maintenance organization or prepaid health
280 clinic regulated under chapter 641.
281 (2) A No person other than a chiropractic physician
282 licensed under this chapter may not shall direct, control, or
283 interfere with a chiropractic physician’s clinical judgment
284 regarding the medical necessity of chiropractic treatment. For
285 purposes of this subsection, a chiropractic physician’s clinical
286 judgment does not apply to chiropractic services that are
287 contractually excluded, the application of alternative services
288 that may be appropriate given the chiropractic physician’s
289 prescribed course of treatment, or determinations that compare
290 comparing contractual provisions and scope of coverage with a
291 chiropractic physician’s prescribed treatment on behalf of a
292 covered person by an insurer, health maintenance organization,
293 or prepaid limited health service organization.
294 (3) Any lease agreement, rental agreement, or other
295 arrangement between a person other than a licensed chiropractic
296 physician and a chiropractic physician whereby the person other
297 than a licensed chiropractic physician provides the chiropractic
298 physician with chiropractic equipment or chiropractic materials
299 must shall contain a provision whereby the chiropractic
300 physician expressly maintains complete care, custody, and
301 control of the equipment or practice.
302 (4) The purpose of this section is to prevent a person
303 other than the a licensed chiropractic physician from
304 influencing or otherwise interfering with the exercise of the a
305 chiropractic physician’s independent professional judgment. In
306 addition to the acts specified in subsection (2) (1), a person
307 or entity other than an employer or entity authorized in
308 subsection (1) a licensed chiropractic physician and any entity
309 other than a sole proprietorship, group practice, partnership,
310 or corporation that is wholly owned by one or more chiropractic
311 physicians licensed under this chapter or by a chiropractic
312 physician licensed under this chapter and the spouse, parent,
313 child, or sibling of that physician, may not employ or engage a
314 chiropractic physician licensed under this chapter. A person or
315 entity may not or enter into a contract or arrangement with a
316 chiropractic physician pursuant to which such unlicensed person
317 or such entity exercises control over the following:
318 (a) The selection of a course of treatment for a patient,
319 the procedures or materials to be used as part of the such
320 course of treatment, and the manner in which the such course of
321 treatment is carried out by the chiropractic physician licensee;
322 (b) The patient records of the chiropractic physician a
323 chiropractor;
324 (c) The policies and decisions relating to pricing, credit,
325 refunds, warranties, and advertising; or
326 (d) The decisions relating to office personnel and hours of
327 practice.
328
329 However, a person or entity that is authorized to employ a
330 chiropractic physician under subsection (1) may exercise control
331 over the patient records of the employed chiropractic physician;
332 the policies and decisions relating to pricing, credit, refunds,
333 warranties, and advertising; and the decisions relating to
334 office personnel and hours of practice.
335 (5) Any person who violates this section commits a felony
336 of the third degree, punishable as provided in s. 775.082 s.
337 775.081, s. 775.083, or s. 775.084 s. 775.035.
338 (6) Any contract or arrangement entered into or undertaken
339 in violation of this section is shall be void as contrary to
340 public policy. This section applies to contracts entered into or
341 renewed on or after July 1, 2008.
342 Section 7. This act shall take effect July 1, 2012.