DAR File No. 38963

Commerce, Occupational and Professional Licensing

Rule R156-73

Chiropractic Physician Practice Act Rule

Notice of Proposed Rule

(Amendment)

DAR File No.: 38963
Filed: 11/20/2014 09:49:53 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division and Chiropractic Physician Licensing Board reviewed the rule and determined changes need to be made. The purpose of this filing is to clarify responsibilities concerning pre-paid services and addressing current practices which may be hazardous to the public safety or welfare. The proposed amendments also clarify certain unprofessional conduct and continuing education standards. The filing also makes corrections in examination requirements and provides new definitions.

Summary of the rule or change:

In Section R156-73-102, the proposed amendments add definitions used in reference to continuing education standards and medical retainer agreements. In Section R156-73-302b, the proposed amendments correct the examinations referenced by the National Board of Chiropractic Examiners as the exam provider and delete the Special Purposes Examination for Chiropractic (SPEC) as an examination meeting the qualifications for licensure. In Section R156-73-303b, proposed amendments add an additional sponsorship or approval organization for continuing education. The proposed amendments also make changes to uniformly reference organizations by their acronyms. In Section R156-73-501, the proposed amendments clarify unprofessional conduct relating to billing practices and specify adopted professional standards. Section R156-73-501a is new and is added to clarify standards for billing practices involving medical retainer agreements (pre-paid services).

State statutory or constitutional authorization for this rule:

• Subsection 58-1-106(1)(a)
• Section 58-73-101
• Subsection 58-1-202(1)(a)

This rule or change incorporates by reference the following material:

• Adds Professional Standards Adopted by the Utah Chiropractic Physicians Association, published by Utah Chiropractic Physicians Association, 06/13/2014

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $75 to print and distribute the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget.

local governments:

The proposed amendments apply only to licensed chiropractic physicians and to applicants for licensure in that classification. As a result, the proposed amendments do not apply to local governments.

small businesses:

The proposed amendments apply only to licensed chiropractic physicians and to applicants for licensure in that classification. A licensed chiropractic physician's office may qualify as a small business. Compliance with the billing practices may result in a cost to business. The Division is not able to determine an exact cost due to the varying circumstances or frequency involving billing practices.

persons other than small businesses, businesses, or local governmental entities:

The proposed amendments apply only to licensed chiropractic physicians and to applicants for licensure in that classification. Some of the proposed changes will clarify the licensee's financial responsibilities for the benefit and safety of the public.

Compliance costs for affected persons:

The proposed amendments apply only to licensed chiropractic physicians and to applicants for licensure in that classification. Compliance with the billing practices amendments may result in an unknown cost to a chiropractic physician's business. The Division is not able to determine an exact cost due to the varying circumstances or frequency involving billing practices. The proposed amendments may result in increased availability of qualified continuing education, thus lowering continuing education costs for chiropractic physicians. Also, no cost is associated with the association professional standards which are being incorporated by reference as the standards are available on the association's website.

Comments by the department head on the fiscal impact the rule may have on businesses:

In addition to making technical corrections, this filing approves the Accreditation Council for Continuing Medical Education (ACCME) as a continuing education provider and amends the unprofessional conduct section to reflect updated industry standards and to respond to the industry practice of accepting or requiring advance payment for treatments that are anticipated to be performed at a future date. In order to comply with the rule regarding advance payment, a business might have to alter its billing practices. Any attendant costs will vary and cannot be estimated.

Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY, UT 84111-2316

Direct questions regarding this rule to:

• Dane Ishihara at the above address, by phone at 801-530-7632, by FAX at 801-530-6511, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/14/2015

Interested persons may attend a public hearing regarding this rule:

• 01/08/2015 09:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 464, Salt Lake City, UT

This rule may become effective on:

01/21/2015

Authorized by:

Mark Steinagel, Director

R156. Commerce, Occupational and Professional Licensing.

R156-73. Chiropractic Physician Practice Act Rule.

R156-73-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 73, as used in Title 58, Chapters 1 and 73, or this rule:

(1) "ACCME" means the Accreditation Council for Continuing Medical Education.

(2) "CCE" means the Council on Chiropractic Education, Inc.

(3)  "Clinical acupuncture" means the application of mechanical, thermal, manual, and/or electrical stimulation of acupuncture points and meridians, including the insertion of needles, by a chiropractic physician that has demonstrated competency and training by completing a recognized course that is sponsored by an institution or organization approved to sponsor continuing education, as defined in Section R156-73-303b.

([2]4) "Distance learning" means the acquisition of knowledge and skills through information and instruction encompassing all technologies and other forms of learning at a distance, including internet, audio/visual recordings, mail or other correspondence.

([3]5) "FCLB" means the Federation of Chiropractic Licensing Boards.

([4]6) "Indirect supervision" means the supervising licensed chiropractic physician shall be available for immediate voice contact by telephone, radio, or other means and shall provide daily face to face consultation and review of cases at the chiropractic facility for the chiropractic intern, temporarily licensed or unlicensed person being supervised.

([5]7) "Joint mobilization", as used in Subsection 58-73-601(2)(c)(ii)(B) means passive movements done by another person, applied as a series of stretches or repetitive movements to individual or combinations of joints, not to exceed the end range of motion and stopping short of the articular elastic barrier.

(8) "Medical retainer agreement", as used in Section R156-73-501a, is as defined in Utah Code Annotated Section 31A-4-106.5.

([6]9) "NBCE" means the National Board of Chiropractic Examiners.

([7]10) "PACE" means Providers of Approved Continuing Education sponsored by the Federation of Chiropractic Licensing Boards.

([8]11) "Preceptor" means a licensed chiropractic physician who is a supervisor of interns and externs in the professional practice of chiropractic.

([9]12) "Preceptorship" means a supervised training program established by a written contract between a chiropractic college or university whose program or institution is accredited by the Council on Chiropractic Education, Inc., and a licensee for the purpose of providing chiropractic training to a student enrolled in the chiropractic college or university while under the supervision of a licensee.

([10]13) "Unprofessional conduct", as defined in Title 58, Chapters 1 and 73, is further defined in accordance with Subsection 58-1-203(5), in Section R156-73-501.

 

R156-73-302b. Qualifications for Licensure - Examination Requirements.

(1) In accordance with Subsection 58-73-302(1)(f)(i), the approved written clinical competency examination is the National Chiropractic Board Part [3 or the Special Purposes Examination for Chiropractic (SPEC)]III administered by the National Board of Chiropractic Examiners. The passing score shall be established by the National Board of Chiropractic Examiners.

(2) In accordance with Subsection 58-73-302(1)(f)(iii), the approved practical examination is the National Chiropractic Board Part [4]IV (practical examination) administered by the National Board of Chiropractic Examiners. The passing score shall be established by the National Board of Chiropractic Examiners.

 

R156-73-303b. Continuing Education - Standards.

(1) The standards for continuing education are as follows:

(a) [t]The content must be relevant to chiropractic practice and consistent with the laws and rules of this state[;].

(b) [t]The course must be under the sponsorship of or approved by:

(i) a chiropractic college or university whose doctor of chiropractic program is accredited by [the Council on Chiropractic Education, Inc.]CCE;

(ii) a professional or nonprofit organization or association representing a licensed profession that has open membership and election of officers whose program objectives relate to the practice of chiropractic;

(iii) the licensing agency of Utah or another state;[or]

(iv) PACE; or

(v) ACCME.

(c) [l]Learning objectives must be reasonably and clearly stated[;].

(d) [t]Teaching methods must be clearly stated and appropriate[;].

(e) [f]Faculty must be qualified, both in experience and in teaching expertise[;].

(f) [d]Documentation of attendance must be provided[;].

(g) [t]There shall be no more than four clock hours related to chiropractic practice marketing or practice building[;].

(h) [n]No more than 10 hours of continuing education, in each two year period of licensure, may be by distance learning.

(2) A licensee shall be responsible for maintaining competent records of completed continuing education for a period of two years after close of the two year period to which the records pertain.

(3) The board may, after review, waive the continuing education requirements for a licensee presenting sufficient evidence of hardship or illness or other reason making it impossible or highly impractical for the licensee to attend or have attended a sufficient number of continuing education classes.

(4) As part of the 40 continuing education hours required every two years, a chiropractic physician, who provides acupuncture services as a part of their practice, shall complete 10 hours of acupuncture related continuing education.

 

R156-73-501. Unprofessional Conduct.

"Unprofessional conduct" includes:

(1) keeping the office, instruments, laboratory, equipment, appliances or supplies in an unsafe or unsanitary condition;

(2) engaging in advertising which is misleading because of omission of necessary material information, which contains false or misleading statements, or which otherwise operates to deceive;

(3) failing to comply with the Professional Standards Adopted by the Utah Chiropractic Physicians Association, dated June 13, 2014, which is hereby incorporated by reference;

([3]4) (a)  engaging in or abetting deceptive or fraudulent billing practices; or

(b) failing to comply with Section R156-73-501a, Standards for Medical Retainer Agreements;

([4]5) engaging in sexual contact with a patient, with or without patient consent, within 12 months of last treatment;

([5]6) engaging in sexual activities or contact with a former patient, with or without consent, after 12 months of last treatment if there is a risk of exploitation or potential harm to the former patient;

([6]7) engaging in behaviors in a patient/doctor relationship, including verbal, intended to sexually arouse any person or encourage sexual activity;

([7]8) failing to keep the division informed of a current address and telephone number;

([8]9) advertising acupuncture services or practicing clinical acupuncture techniques beyond the scope of the certification held;

([9]10) advertising as an "acupuncturist" either verbally or in print;

([10]11) failing to maintain responsibility for care, billing and documentation in a group practice, multidisciplinary practice or third-party ownership practice;

([11]12) engaging in any act or practice in a professional capacity which the licensee is not competent to perform through education or training;

(13) relying solely upon the "patient records" of another physician to determine medical necessity;

([12]14) administering injections through the skin, limited to subcutaneous or intramuscular administration, of any substances other than non-prescription drugs as defined in Subsections 58-17b-102([39]37) or non-controlled substances as defined in Subsection 58-37-2(1)(f)(ii);

([13]15) administering injections of non-prescription drugs or non-controlled substances without sufficient competency and training as demonstrated by the following:

(a) completion of a recognized course on injectables and their administration, under the sponsorship of or approved by an institution, organization or association meeting the continuing education standards as defined in Section R156-73-303b; and

(b) receiving a passing score on a certifying examination; [and]or

([14]16) delegating the administration of injections to a chiropractic assistant.

 

R156-73-501a. Medical Retainer Agreement.

(1) Any medical retainer agreement shall:

(a) comply with the requirements of Section 31A-4-106.5(1);

(b) state whether a refund will be calculated according to:

(i) a discounted fee schedule; or

(ii) a non-discounted fee schedule;

(c) pursuant to Subsection 31A-4-106.5(1)(a)(ii)(B), state that a patient may terminate the agreement at any time upon written notice to the chiropractic physician; and

(d) include the written acknowledgment of the patient or the patient's legal representative that the patient or patient's representative has read, understood, and received a copy of the medical retainer agreement.

(2) Except as provided in this Subsection (5), a licensed chiropractic physician shall hold all funds tendered in advance of service in a trust account.

(3) A licensed chiropractic physician may not draw any funds from the trust account unless a service described in the associated medical retainer agreement has been fully performed.

(4) A licensed chiropractic physician shall tender a refund to a patient or the patient's legal representative within 30 days of a written request for refund from the patient or the patient's legal representative.

(5) Funds collected under a medical retainer agreement for services totaling less than $4,000 are exempt from the trust account requirement.

 

KEY: chiropractors, licensing, chiropractic physician

Date of Enactment or Last Substantive Amendment: [August 24, 2009]2015

Notice of Continuation: March 14, 2011

Authorizing, and Implemented or Interpreted Law: 58-73-101; 58-1-106(1)(a); 58-1-202(1)(a)