Florida Senate - 2025 SB 564
By Senator Gruters
22-00615B-25 2025564__
1 A bill to be entitled
2 An act relating to chiropractic medicine; amending s.
3 460.403, F.S.; revising the definition of the term
4 “practice of chiropractic medicine” to include the
5 ordering, storing, possessing, prescribing, and
6 administering of articles of natural origin under
7 certain circumstances by certain chiropractic
8 physicians; authorizing pharmacists to fill the orders
9 of such chiropractic physicians; amending s. 460.408,
10 F.S.; deleting a requirement that all chiropractic
11 continuing education be completed in a classroom
12 setting; prohibiting the Board of Chiropractic
13 Medicine from limiting the number of hours of
14 continuing education a chiropractic physician may
15 complete through distance learning; authorizing the
16 board to make exceptions to continuing education
17 requirements during a declared state of emergency in
18 this state; specifying who may teach board-approved
19 continuing education courses; requiring, rather than
20 authorizing, the board to adopt rules; amending s.
21 460.413, F.S.; revising grounds for disciplinary
22 action to conform to changes made by the act; amending
23 s. 460.4165, F.S.; revising certification requirements
24 for certified chiropractic physician’s assistants;
25 amending s. 627.736, F.S.; revising limitations on
26 medical benefits in insurance policies providing
27 personal injury protection; providing construction;
28 providing an effective date.
29
30 Be It Enacted by the Legislature of the State of Florida:
31
32 Section 1. Subsection (9) of section 460.403, Florida
33 Statutes, is amended to read:
34 460.403 Definitions.—As used in this chapter, the term:
35 (9)(a) “Practice of chiropractic medicine” means the
36 application of a noncombative principle and practice consisting
37 of the science, philosophy, and art of the adjustment,
38 manipulation, and treatment of the human body to treat any in
39 which vertebral subluxation or subluxations and other
40 malpositioned articulation or structure articulations and
41 structures that is are interfering with the normal generation,
42 transmission, and expression of nerve impulse between the brain,
43 organs, and tissue cells of the body and, thereby causing
44 disease, as applied are adjusted, manipulated, or treated, thus
45 restoring the normal flow of nerve impulse which produces normal
46 function and consequent health by chiropractic physicians using
47 specific chiropractic adjustment or manipulation techniques
48 taught in chiropractic colleges accredited by the Council on
49 Chiropractic Education to restore the normal flow of nerve
50 impulse which produces normal function and consequent health. No
51 person other than a licensed chiropractic physician may render
52 chiropractic services, chiropractic adjustments, or chiropractic
53 manipulations.
54 (b) Any chiropractic physician who has complied with the
55 provisions of this chapter may examine, analyze, and diagnose
56 the human living body and its diseases by the use of any
57 physical, chemical, electrical, or thermal method; use the X ray
58 for diagnosing; phlebotomize; and use any other general method
59 of examination for diagnosis and analysis taught in any school
60 of chiropractic.
61 (c)1. Chiropractic physicians may adjust, manipulate, or
62 treat the human body by manual, mechanical, electrical, or
63 natural methods; by the use of physical means or physiotherapy,
64 including light, heat, water, or exercise; by the use of
65 acupuncture; by the use of monofilament intramuscular
66 stimulation treatment, also known as dry needling, for trigger
67 points or myofascial pain; or by the administration of foods,
68 food concentrates, food extracts, and items for which a
69 prescription is not required and may apply first aid and
70 hygiene, but chiropractic physicians are expressly prohibited
71 from prescribing or administering to any person any legend drug
72 except as authorized under subparagraphs 2. and 3. subparagraph
73 2., from performing any surgery except as stated herein, or from
74 practicing obstetrics.
75 2. Notwithstanding the prohibition against prescribing and
76 administering legend drugs under subparagraph 1. or s.
77 499.83(2)(c), pursuant to board rule, chiropractic physicians
78 may order, store, and administer prescription medical oxygen,
79 for emergency purposes only, at the chiropractic physician’s
80 office or place of business, prescription medical oxygen and may
81 also order, store, and administer the following topical
82 anesthetics in aerosol form:
83 a. Any solution consisting of 25 percent ethylchloride and
84 75 percent dichlorodifluoromethane.
85 b. Any solution consisting of 15 percent
86 dichlorodifluoromethane and 85 percent
87 trichloromonofluoromethane.
88 3. Notwithstanding the prohibition against prescribing and
89 administering legend drugs under subparagraph 1. or s.
90 499.83(2)(c), pursuant to board rule, chiropractic physicians
91 who have completed a board-approved minimum of a 36-hour
92 training course may order, store, possess, prescribe, and
93 administer articles of natural origin, including vitamins,
94 minerals, amino acids, fatty acids, hyaluronic acid, enzymes,
95 saline, antioxidants, dextrose, glandulars, cellular components,
96 extracts, water, botanicals, phytonutrients, and homeopathics,
97 and may administer medical oxygen as defined in s. 499.82.
98 Pharmacists licensed under chapter 465 may fill the orders of
99 chiropractic physicians authorized to prescribe and administer
100 articles of natural origin necessary for the practice of
101 chiropractic medicine.
102
103 However, this paragraph does not authorize a chiropractic
104 physician to prescribe medical oxygen as defined in s.
105 499.82(10).
106 (d) Chiropractic physicians shall have the privileges of
107 services from the department’s laboratories.
108 (e) The term “chiropractic medicine,” “chiropractic,”
109 “doctor of chiropractic,” or “chiropractor” is shall be
110 synonymous with “chiropractic physician,” and each term must
111 shall be construed to mean a practitioner of chiropractic
112 medicine as the same has been defined herein. Chiropractic
113 physicians may analyze and diagnose the physical conditions of
114 the human body to determine the abnormal functions of the human
115 organism and to determine whether such functions as are
116 abnormally expressed and the cause of such abnormal expression.
117 (f) Any chiropractic physician who has complied with the
118 provisions of this chapter is authorized to analyze and diagnose
119 abnormal bodily functions and to adjust the physical
120 representative of the primary cause of disease as is herein
121 defined and provided. As an incident to the care of the sick,
122 chiropractic physicians may advise and instruct patients in all
123 matters pertaining to hygiene and sanitary measures as taught
124 and approved by recognized chiropractic schools and colleges. A
125 chiropractic physician may not use acupuncture until certified
126 by the board. Certification must shall be granted to
127 chiropractic physicians who have satisfactorily completed the
128 required coursework in acupuncture and successfully passed after
129 successful passage of an appropriate examination as administered
130 by the department. The required coursework must shall have been
131 provided by a college or university which is recognized by an
132 accrediting agency approved by the United States Department of
133 Education.
134 Section 2. Section 460.408, Florida Statutes, is amended to
135 read:
136 460.408 Continuing chiropractic education.—
137 (1) The board shall require licensees to periodically
138 demonstrate their professional competence periodically as a
139 condition of renewal of a license by completing up to 40 contact
140 classroom hours of continuing education.
141 (a) Continuing education courses sponsored by board
142 approved continuing education providers, or by chiropractic
143 colleges whose graduates are eligible for examination under any
144 provision of this chapter, may be approved upon review by the
145 board if all other requirements of board rules setting forth
146 criteria for course approval are met.
147 (b) The board shall approve those courses that build upon
148 the basic courses required for the practice of chiropractic
149 medicine, and the board may also approve courses in adjunctive
150 modalities. Courses that include consist of instruction in the
151 use, application, prescription, recommendation, or
152 administration of a specific company’s brand of products or
153 services are not eligible for approval.
154 (c) The board may not limit the number of approved
155 continuing education hours that may be completed through
156 distance learning.
157 (2) The board may provide exceptions to make exception from
158 the requirements of this section in emergency or hardship cases
159 and during a declared state of emergency in this state.
160 (3) Continuing education courses must be taught by a person
161 who has at least one of the following qualifications:
162 (a) Has a postgraduate degree, or a bachelor’s degree with
163 at least 2 years of experience in the subject matter being
164 taught;
165 (b) Is a current faculty member of a chiropractic college
166 or school maintaining standards approved by the board or is a
167 current faculty member at a medical or osteopathic college or a
168 university accredited by, or having status with, an accrediting
169 agency, or its successor, recognized and approved by the United
170 States Department of Education or by the Council for Higher
171 Education Accreditation or its successor; or
172 (c) Is a postgraduate-level instructor at a chiropractic
173 college or school maintaining standards approved by the board or
174 is a postgraduate-level instructor at a medical or osteopathic
175 college or a university accredited by, or having status with, an
176 accrediting agency, or its successor, recognized and approved by
177 the United States Department of Education or by the Council for
178 Higher Education Accreditation or its successor.
179 (4) The board shall may adopt rules necessary to implement
180 within the requirements of this section that are necessary for
181 its implementation.
182 Section 3. Paragraph (p) of subsection (1) of section
183 460.413, Florida Statutes, is amended to read:
184 460.413 Grounds for disciplinary action; action by board or
185 department.—
186 (1) The following acts constitute grounds for denial of a
187 license or disciplinary action, as specified in s. 456.072(2):
188 (p) Prescribing, dispensing, or administering any medicinal
189 drug except as authorized by s. 460.403(9)(c)2. or 3. s.
190 460.403(9)(c)2., performing any surgery, or practicing
191 obstetrics.
192 Section 4. Paragraph (b) of subsection (13) of section
193 460.4165, Florida Statutes, is amended to read:
194 460.4165 Certified chiropractic physician’s assistants.—
195 (13) CERTIFIED CHIROPRACTIC ASSISTANT CERTIFICATION
196 RENEWAL.—The certification must be renewed biennially.
197 (b) Each certified chiropractic physician’s assistant shall
198 biennially complete 24 hours of continuing education courses
199 sponsored by chiropractic colleges accredited by the Council on
200 Chiropractic Education and approved by the board. The board
201 shall approve those courses that build upon the basic courses
202 required for the practice of chiropractic medicine, and the
203 board may also approve courses in adjunctive modalities. The
204 board may make exception from the requirements of this section
205 in emergency or hardship cases. The board may adopt rules
206 necessary to implement within the requirements of this section
207 which are necessary for its implementation.
208 Section 5. Paragraph (a) of subsection (1) of section
209 627.736, Florida Statutes, is amended to read:
210 627.736 Required personal injury protection benefits;
211 exclusions; priority; claims.—
212 (1) REQUIRED BENEFITS.—An insurance policy complying with
213 the security requirements of s. 627.733 must provide personal
214 injury protection to the named insured, relatives residing in
215 the same household unless excluded under s. 627.747, persons
216 operating the insured motor vehicle, passengers in the motor
217 vehicle, and other persons struck by the motor vehicle and
218 suffering bodily injury while not an occupant of a self
219 propelled vehicle, subject to subsection (2) and paragraph
220 (4)(e), to a limit of $10,000 in medical and disability benefits
221 and $5,000 in death benefits resulting from bodily injury,
222 sickness, disease, or death arising out of the ownership,
223 maintenance, or use of a motor vehicle as follows:
224 (a) Medical benefits.—Eighty percent of all reasonable
225 expenses for medically necessary medical, surgical, X-ray,
226 dental, and rehabilitative services, including prosthetic
227 devices and medically necessary ambulance, hospital, and nursing
228 services if the individual receives initial services and care
229 pursuant to subparagraph 1. within 14 days after the motor
230 vehicle accident. The medical benefits provide reimbursement
231 only for:
232 1. Initial services and care that are lawfully provided,
233 supervised, ordered, or prescribed by a physician licensed under
234 chapter 458 or chapter 459, a dentist licensed under chapter
235 466, a chiropractic physician licensed under chapter 460, or an
236 advanced practice registered nurse registered under s. 464.0123
237 or that are provided in a hospital or in a facility that owns,
238 or is wholly owned by, a hospital. Initial services and care may
239 also be provided by a person or entity licensed under part III
240 of chapter 401 which provides emergency transportation and
241 treatment.
242 2. Upon referral by a provider described in subparagraph
243 1., follow-up followup services and care consistent with the
244 underlying medical diagnosis rendered pursuant to subparagraph
245 1. which may be provided, supervised, ordered, or prescribed
246 only by a physician licensed under chapter 458 or chapter 459, a
247 chiropractic physician licensed under chapter 460, a dentist
248 licensed under chapter 466, or an advanced practice registered
249 nurse registered under s. 464.0123, or, to the extent permitted
250 by applicable law and under the supervision of such physician,
251 osteopathic physician, chiropractic physician, or dentist, by a
252 physician assistant licensed under chapter 458 or chapter 459 or
253 an advanced practice registered nurse licensed under chapter
254 464. Follow-up Followup services and care may also be provided
255 by the following persons or entities:
256 a. A hospital or ambulatory surgical center licensed under
257 chapter 395.
258 b. An entity wholly owned by one or more physicians
259 licensed under chapter 458 or chapter 459, chiropractic
260 physicians licensed under chapter 460, advanced practice
261 registered nurses registered under s. 464.0123, or dentists
262 licensed under chapter 466 or by such practitioners and the
263 spouse, parent, child, or sibling of such practitioners.
264 c. An entity that owns or is wholly owned, directly or
265 indirectly, by a hospital or hospitals.
266 d. A physical therapist licensed under chapter 486, based
267 upon a referral by a provider described in this subparagraph.
268 e. A health care clinic licensed under part X of chapter
269 400 which is accredited by an accrediting organization whose
270 standards incorporate comparable regulations required by this
271 state, or
272 (I) Has a medical director licensed under chapter 458,
273 chapter 459, or chapter 460;
274 (II) Has been continuously licensed for more than 3 years
275 or is a publicly traded corporation that issues securities
276 traded on an exchange registered with the United States
277 Securities and Exchange Commission as a national securities
278 exchange; and
279 (III) Provides at least four of the following medical
280 specialties:
281 (A) General medicine.
282 (B) Radiography.
283 (C) Orthopedic medicine.
284 (D) Physical medicine.
285 (E) Physical therapy.
286 (F) Physical rehabilitation.
287 (G) Prescribing or dispensing outpatient prescription
288 medication.
289 (H) Laboratory services.
290 3. Reimbursement for services and care provided in
291 subparagraph 1. or subparagraph 2. up to $10,000 if a physician
292 licensed under chapter 458 or chapter 459, a dentist licensed
293 under chapter 466, a physician assistant licensed under chapter
294 458 or chapter 459, or an advanced practice registered nurse
295 licensed under chapter 464 has determined that the injured
296 person had an emergency medical condition.
297 4. Reimbursement for services and care provided in
298 subparagraph 1. or subparagraph 2. is limited to $2,500 if a
299 provider listed in subparagraph 1. or subparagraph 2. determines
300 that the injured person did not have an emergency medical
301 condition.
302 5. Medical benefits do not include massage therapy as
303 defined in s. 480.033 or acupuncture as defined in s. 457.102,
304 regardless of the person, entity, or licensee providing massage
305 therapy or acupuncture, and a licensed massage therapist or
306 licensed acupuncturist may not be reimbursed for medical
307 benefits in such licensed capacities under this section. A
308 person licensed as a massage therapist under chapter 480 or as
309 an acupuncturist under chapter 457 may be reimbursed for medical
310 benefits under this section only if he or she holds
311 qualifications or licensure, other than as a massage therapist
312 or an acupuncturist, which independently authorizes his or her
313 services or care to be eligible for reimbursement as specified
314 in subparagraph 1. or subparagraph 2.
315 6. The Financial Services Commission shall adopt by rule
316 the form that must be used by an insurer and a health care
317 provider specified in sub-subparagraph 2.b., sub-subparagraph
318 2.c., or sub-subparagraph 2.e. to document that the health care
319 provider meets the criteria of this paragraph. Such rule must
320 include a requirement for a sworn statement or affidavit.
321
322 Only insurers writing motor vehicle liability insurance in this
323 state may provide the required benefits of this section, and
324 such insurer may not require the purchase of any other motor
325 vehicle coverage other than the purchase of property damage
326 liability coverage as required by s. 627.7275 as a condition for
327 providing such benefits. Insurers may not require that property
328 damage liability insurance in an amount greater than $10,000 be
329 purchased in conjunction with personal injury protection. Such
330 insurers shall make benefits and required property damage
331 liability insurance coverage available through normal marketing
332 channels. An insurer writing motor vehicle liability insurance
333 in this state who fails to comply with such availability
334 requirement as a general business practice violates part IX of
335 chapter 626, and such violation constitutes an unfair method of
336 competition or an unfair or deceptive act or practice involving
337 the business of insurance. An insurer committing such violation
338 is subject to the penalties provided under that part, as well as
339 those provided elsewhere in the insurance code.
340 Section 6. This act shall take effect July 1, 2025.