Bill Text: FL S0398 | 2011 | Regular Session | Comm Sub
Bill Title: Chiropractic Medicine
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [S0398 Detail]
Download: Florida-2011-S0398-Comm_Sub.html
Florida Senate - 2011 CS for CS for SB 398 By the Committees on Budget Subcommittee on Health and Human Services Appropriations; and Health Regulation; and Senator Jones 603-04501-11 2011398c2 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 the use of certain courses in continuing 10 chiropractic education; amending s. 460.413, F.S.; 11 requiring that a chiropractic physician preserve the 12 identity of funds or property of a patient in excess 13 of a specified amount; limiting the amount that may be 14 advanced to a chiropractic physician for certain costs 15 and expenses; amending s. 460.4165, F.S.; providing 16 that services rendered by a certified chiropractic 17 physician’s assistant under indirect supervision may 18 occur only at the supervising chiropractic physician’s 19 address of record; deleting the length of time 20 specified for the basic program of education and 21 training for certified chiropractic physician’s 22 assistants; amending s. 460.4166, F.S.; authorizing a 23 registered chiropractic assistant to operate 24 therapeutic office equipment; requiring a registered 25 chiropractic assistant to register with the board 26 effective April 1, 2012, and pay a fee for 27 registration; requiring a registered chiropractic 28 assistant to submit an initial application by March 29 31, 2012, or within 30 days after becoming employed, 30 whichever is later; requiring an applicant to specify 31 place of employment and supervising chiropractic 32 physicians; requiring an application to be signed by a 33 chiropractic physician who is an owner of the 34 applicant’s place of employment; providing an 35 effective date of a registered chiropractic 36 assistant’s registration; authorizing who may 37 supervise a registered chiropractic assistant; 38 requiring a registered chiropractic assistant to 39 notify to the board of his or her change of 40 employment; requiring a chiropractic physician to sign 41 the registered chiropractic assistant’s notification 42 of change in employment; requiring a registered 43 chiropractic assistant’s employer to notify the board 44 when a registered chiropractic assistant is no longer 45 employed by that employer; providing eligibility 46 conditions for registering as a registered 47 chiropractic assistant; requiring the biennial renewal 48 of a registered chiropractic assistant’s registration 49 and payment of a renewal fee; requiring the board to 50 adopt by rule forms for certain statutorily required 51 applications and notifications; authorizing the board 52 to require and accept electronically submitted 53 applications, notifications, signatures, or 54 attestations in lieu of paper applications and actual 55 signatures; providing for the signature of certain 56 forms and notices by specified owners and supervisors 57 under certain conditions; amending s. 460.4167, F.S.; 58 authorizing certain sole proprietorships, group 59 practices, partnerships, corporations, limited 60 liability companies, limited partnerships, 61 professional associations, other entities, health care 62 clinics licensed under part X of ch. 400, F.S., health 63 maintenance organizations, or prepaid health clinics 64 to employ a chiropractic physician or engage a 65 chiropractic physician as an independent contractor to 66 provide services authorized by ch. 460, F.S.; 67 authorizing the spouse or adult children of a deceased 68 chiropractic physician to hold, operate, pledge, sell, 69 mortgage, assign, transfer, own, or control the 70 deceased chiropractic physician’s ownership interests 71 under certain conditions; authorizing an employer that 72 employs a chiropractic physician to exercise control 73 over the patient records of the employed chiropractor, 74 policies and decisions relating to pricing, credit, 75 refunds, warranties, and advertising, and decisions 76 relating to office personnel and hours of practice; 77 deleting an obsolete provision; providing an effective 78 date. 79 80 Be It Enacted by the Legislature of the State of Florida: 81 82 Section 1. Paragraph (e) of subsection (1) of section 83 460.4062, Florida Statutes, is amended to read: 84 460.4062 Chiropractic medicine faculty certificate.— 85 (1) The department may issue a chiropractic medicine 86 faculty certificate without examination to an individual who 87 remits a nonrefundable application fee, not to exceed $100 as 88 determined by rule of the board, and who demonstrates to the 89 board that he or she meets the following requirements: 90 (e)1. Performs research or has been offered and has 91 accepted a full-time or part-time faculty appointment to teach 92 in a program of chiropractic medicine at a publicly funded state 93 university or college or at a college of chiropractic located in 94 the state and accredited by the Council on Chiropractic 95 Education; and 96 2. Provides a certification from the dean of the appointing 97 college acknowledging the appointment. 98 Section 2. Subsection (1) of section 460.408, Florida 99 Statutes, is amended to read: 100 460.408 Continuing chiropractic education.— 101 (1) The board shall require licensees to periodically 102 demonstrate their professional competence as a condition of 103 renewal of a license by completing up to 40 contact classroom 104 hours of continuing education. 105 (a) Continuing education courses sponsored by chiropractic 106 colleges whose graduates are eligible for examination under any 107 provision of this chapter mayshallbe approved upon review by 108 the board if all other requirements of board rules setting forth 109 criteria for course approval are met. 110 (b) The board shall approve those courses that build upon 111 the basic courses required for the practice of chiropractic 112 medicine, and the board may also approve courses in adjunctive 113 modalities. Courses that consist of instruction in the use, 114 application, prescription, recommendation, or administration of 115 a specific company’s brand of products or services are not 116 eligible for approval. 117 Section 3. Paragraph (y) of subsection (1) of section 118 460.413, Florida Statutes, is amended to read: 119 460.413 Grounds for disciplinary action; action by board or 120 department.— 121 (1) The following acts constitute grounds for denial of a 122 license or disciplinary action, as specified in s. 456.072(2): 123 (y) Failing to preserve identity of funds and property of a 124 patient, the value of which is greater than $501. As provided by 125 rule of the board, money or other property entrusted to a 126 chiropractic physician for a specific purpose, including 127 advances for costs and expenses of examination or treatment 128 which may not exceed the value of $1,500, is to be held in trust 129 and must be applied only to that purpose. Money and other 130 property of patients coming into the hands of a chiropractic 131 physician are not subject to counterclaim or setoff for 132 chiropractic physician’s fees, and a refusal to account for and 133 deliver over such money and property upon demand shall be deemed 134 a conversion. This is not to preclude the retention of money or 135 other property upon which the chiropractic physician has a valid 136 lien for services or to preclude the payment of agreed fees from 137 the proceeds of transactions for examinations or treatments. 138 Controversies as to the amount of the fees are not grounds for 139 disciplinary proceedings unless the amount demanded is clearly 140 excessive or extortionate, or the demand is fraudulent. All 141 funds of patients paid to a chiropractic physician, other than 142 advances for costs and expenses, shall be deposited in one or 143 more identifiable bank accounts maintained in the state in which 144 the chiropractic physician’s office is situated, and no funds 145 belonging to the chiropractic physician shall be deposited 146 therein except as follows: 147 1. Funds reasonably sufficient to pay bank charges may be 148 deposited therein. 149 2. Funds belonging in part to a patient and in part 150 presently or potentially to the physician must be deposited 151 therein, but the portion belonging to the physician may be 152 withdrawn when due unless the right of the physician to receive 153 it is disputed by the patient, in which event the disputed 154 portion shall not be withdrawn until the dispute is finally 155 resolved. 156 157 Every chiropractic physician shall maintain complete records of 158 all funds, securities, and other properties of a patient coming 159 into the possession of the physician and render appropriate 160 accounts to the patient regarding them. In addition, every 161 chiropractic physician shall promptly pay or deliver to the 162 patient, as requested by the patient, the funds, securities, or 163 other properties in the possession of the physician which the 164 patient is entitled to receive. 165 Section 4. Subsections (2) and (5) of section 460.4165, 166 Florida Statutes, are amended to read: 167 460.4165 Certified chiropractic physician’s assistants.— 168 (2) PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN’S 169 ASSISTANT.—Notwithstanding any other provision of law, a 170 certified chiropractic physician’s assistant may perform 171 chiropractic services in the specialty area or areas for which 172 the certified chiropractic physician’s assistant is trained or 173 experienced when such services are rendered under the 174 supervision of a licensed chiropractic physician or group of 175 chiropractic physicians certified by the board. Any certified 176 chiropractic physician’s assistant certified under this section 177 to perform services may perform those services only: 178 (a) In the office of the chiropractic physician to whom the 179 certified chiropractic physician’s assistant has been assigned, 180 in which office such physician maintains her or his primary 181 practice; 182 (b) Under indirect supervision if the indirect supervision 183 occurs at the supervising chiropractic physician’s address of 184 recordor place of practicerequired by s. 456.035, other than 185 at a clinic licensed under part X of chapter 400, of the 186 chiropractic physician to whom she or he is assigned as defined 187 by rule of the board; 188 (c) In a hospital in which the chiropractic physician to 189 whom she or he is assigned is a member of the staff; or 190 (d) On calls outside of the office of the chiropractic 191 physician to whom she or he is assigned, on the direct order of 192 the chiropractic physician to whom she or he is assigned. 193 (5) PROGRAM APPROVAL.—The department shall issue 194 certificates of approval for programs for the education and 195 training of certified chiropractic physician’s assistants which 196 meet board standards. Any basic program curriculum certified by 197 the board shallcover a period of 24 months. The curriculum must198 consist of a curriculum of at least 200 didactic classroom hours 199during those 24 months. 200 (a) In developing criteria for program approval, the board 201 shall give consideration to, and encourage, the useutilization202 of equivalency and proficiency testing and other mechanisms 203 whereby full credit is given to trainees for past education and 204 experience in health fields. 205 (b) The board shall create groups of specialty 206 classifications of training for certified chiropractic 207 physician’s assistants. These classifications mustshallreflect 208 the training and experience of the certified chiropractic 209 physician’s assistant. The certified chiropractic physician’s 210 assistant may receive training in one or more such 211 classifications, which shall be shown on the certificate issued. 212 (c) The board shall adopt and publish standards to ensure 213 that such programs operate in a manner which does not endanger 214 the health and welfare of the patients who receive services 215 within the scope of the program. The board shall review the 216 quality of the curricula, faculties, and facilities of such 217 programs; issue certificates of approval; and take whatever 218 other action is necessary to determine that the purposes of this 219 section are being met. 220 Section 5. Subsections (2) and (3) of section 460.4166, 221 Florida Statutes, are amended, and subsections (4), (5), and (6) 222 are added to that section, to read: 223 460.4166 Registered chiropractic assistants.— 224 (2) DUTIES.—Under the direct supervision and responsibility 225 of a licensed chiropractic physician or certified chiropractic 226 physician’s assistant, a registered chiropractic assistant may: 227 (a) Perform clinical procedures, which include: 228 1. Preparing patients for the chiropractic physician’s 229 care. 230 2. Taking vital signs. 231 3. Observing and reporting patients’ signs or symptoms. 232 (b) Administer basic first aid. 233 (c) Assist with patient examinations or treatments other 234 than manipulations or adjustments. 235 (d) Operate therapeutic office equipment. 236 (e) Collect routine laboratory specimens as directed by the 237 chiropractic physician or certified chiropractic physician’s 238 assistant. 239 (f) Administer nutritional supplements as directed by the 240 chiropractic physician or certified chiropractic physician’s 241 assistant. 242 (g) Perform office procedures required by the chiropractic 243 physician or certified chiropractic physician’s assistant under 244 direct supervision of the chiropractic physician or certified 245 chiropractic physician’s assistant. 246 (3) REGISTRATION.— 247 (a) A registered chiropractic assistant shall register with 248assistants may be registered bythe board for a biennial fee not 249 to exceed $25. Effective April 1, 2012, a person must register 250 with the board as a registered chiropractic assistant if the 251 person performs any duties described in subsection (2) unless 252 the person is otherwise certified or licensed to perform those 253 duties. 254 (b) A person employed as a registered chiropractic 255 assistant shall submit to the board an initial application for 256 registration by March 31, 2012, or within 30 days after becoming 257 employed as a registered chiropractic assistant, whichever is 258 later, specifying the applicant’s place of employment and the 259 names of all chiropractic physicians under whose supervision the 260 applicant performs the duties described in subsection (2). The 261 application for registration must be signed by a chiropractic 262 physician who is an owner of the place of employment specified 263 in the application. Upon the board’s receipt of an application, 264 the effective date of the registration shall be April 1, 2012, 265 or shall apply retroactively to the applicant’s date of 266 employment as a registered chiropractic assistant, whichever is 267 later, and the registered chiropractic assistant may be 268 supervised by any licensed chiropractic physician or certified 269 chiropractic physician’s assistant who is employed by the 270 registered chiropractic assistant’s employer or listed on the 271 registration application. 272 (c) A registered chiropractic assistant, within 30 days 273 after a change of employment, must notify the board of the new 274 place of employment and the names of all chiropractic physicians 275 under whose supervision the registered chiropractic assistant 276 performs duties described in subsection (2) at the new place of 277 employment. The notification must be signed by a chiropractic 278 physician who is an owner of the new place of employment. Upon 279 the board’s receipt of the notification, the registered 280 chiropractic assistant may be supervised by any licensed 281 chiropractic physician or certified chiropractic physician’s 282 assistant who is employed by the registered chiropractic 283 assistant’s new employer or listed on the notification. 284 (d) Within 30 days after a registered chiropractic 285 assistant is no longer employed at his or her place of 286 employment as registered with the board, the registered 287 chiropractic assistant’s employer as registered with the board 288 shall notify the board that the registered chiropractic 289 assistant is no longer employed by that employer. 290 (e) An employee who performs none of the duties described 291 in subsection (2) is not eligible to register under this 292 subsection. 293 (4) REGISTERED CHIROPRACTIC ASSISTANT REGISTRATION 294 RENEWAL.— 295 (a) A registered chiropractic assistant’s registration must 296 be renewed biennially. Each renewal must include: 297 1. A renewal fee as set by the board not to exceed $25. 298 2. The registered chiropractic assistant’s current place of 299 employment and the names of all chiropractic physicians under 300 whose supervision the applicant performs duties described in 301 subsection (2). The application for registration renewal must be 302 signed by a chiropractic physician who is an owner of the place 303 of employment specified in the application. 304 (b) Upon registration renewal, the registered chiropractic 305 assistant may be supervised by any licensed chiropractic 306 physician or certified chiropractic physician’s assistant who is 307 employed by the registered chiropractic assistant’s employer or 308 listed on the registration renewal. 309 (5) APPLICATION AND NOTIFICATION FORMS.—The board shall 310 prescribe, by rule, forms for the applications and notifications 311 required under subsections (3) and (4). The board may require 312 and accept electronically submitted applications, notifications, 313 signatures, or attestations in lieu of paper applications and 314 actual signatures. 315 (6) SIGNATURE REQUIREMENTS.—If a person employed as a 316 registered chiropractic assistant is employed by an entity not 317 owned in whole or in part by a licensed chiropractic physician 318 under s. 460.4167, the documents requiring signatures under this 319 section must be signed by a person having an ownership interest 320 in the entity that employs the registered chiropractic assistant 321 and a licensed chiropractic physician who supervises the 322 registered chiropractic assistant. 323 Section 6. Section 460.4167, Florida Statutes, is amended 324 to read: 325 460.4167 Proprietorship by persons other than licensed 326 chiropractic physicians.— 327 (1) ANopersonother than a sole proprietorship, group328practice, partnership, or corporation that is wholly owned by329one or more chiropractic physicians licensed under this chapter330or by a chiropractic physician licensed under this chapter and331the spouse, parent, child, or sibling of that chiropractic332physicianmay not employ a chiropractic physician licensed under 333 this chapter or engage a chiropractic physician licensed under 334 this chapter as an independent contractor to provide services 335 authorized by this chapter to be offered by a chiropractic 336 physician licensed under this chapter unless the person is any 337 of the following,except for: 338 (a) A sole proprietorship, group practice, partnership, 339 corporation, limited liability company, limited partnership, any 340 person, professional association, or any other entity that is 341 wholly owned by: 342 1. One or more chiropractic physicians licensed under this 343 chapter; 344 2. A chiropractic physician licensed under this chapter and 345 the spouse or surviving spouse, parent, child, or sibling of the 346 chiropractic physician; or 347 3. A trust whose trustees are chiropractic physicians 348 licensed under this chapter and the spouse, parent, child, or 349 sibling of a chiropractic physician. 350 (b)(a)A sole proprietorship, group practice, partnership, 351orcorporation, limited liability company, limited partnership, 352 professional association, or any other entity that is wholly 353 owned by a physician or physicians licensed under this chapter, 354 chapter 458, chapter 459, or chapter 461. 355 (c)(b)An entityEntitiesthat is whollyareowned, 356 directly or indirectly, by an entity licensed or registered by 357 the state under chapter 395. 358 (d)(c)A clinical facility that isfacilitiesaffiliated 359 with a college of chiropractic accredited by the Council on 360 Chiropractic Education at which training is provided for 361 chiropractic students. 362 (e)(d)A public or private university or college. 363 (f)(e)An entity wholly owned and operated by an 364 organization that is exempt from federal taxation under s. 365 501(c)(3) or (4) of the Internal Revenue Code, aanycommunity 366 college or university clinic, and any entity owned or operated 367 by the Federal Government or by state government, including any 368 agency, county, municipality, or other political subdivision 369 thereof. 370 (g)(f)An entity owned by a corporation the stock of which 371 is publicly traded. 372 (h)(g)A clinic licensed under part X of chapter 400 which 373thatprovides chiropractic services by a chiropractic physician 374 licensed under chapter 460 and other health care services by 375 physicians licensed under chapter 458 or,chapter 459,or376chapter 460,the medical director of which is licensed under 377 chapter 458 or chapter 459. 378 (i)(h)A state-licensed insurer. 379 (j) A health maintenance organization or prepaid health 380 clinic regulated under chapter 641. 381 382 If a chiropractic physician described in subparagraph (a)2. 383 dies, notwithstanding part X of chapter 400, the deceased 384 chiropractic physician’s surviving spouse or adult children may 385 hold, operate, pledge, sell, mortgage, assign, transfer, own, or 386 control the deceased chiropractic physician’s ownership 387 interests for so long as the surviving spouse or adult children 388 remain the sole proprietor of the chiropractic practice. 389 (2) ANoperson other than a chiropractic physician 390 licensed under this chapter may notshalldirect, control, or 391 interfere with a chiropractic physician’s clinical judgment 392 regarding the medical necessity of chiropractic treatment. For 393 purposes of this subsection, a chiropractic physician’s clinical 394 judgment does not apply to chiropractic services contractually 395 excluded, the application of alternative services that may be 396 appropriate given the chiropractic physician’s prescribed course 397 of treatment, or determinations comparing contractual provisions 398 and scope of coverage with a chiropractic physician’s prescribed 399 treatment on behalf of a covered person by an insurer, health 400 maintenance organization, or prepaid limited health service 401 organization. 402 (3) Any lease agreement, rental agreement, or other 403 arrangement between a person other than a licensed chiropractic 404 physician and a chiropractic physician whereby the person other 405 than a licensed chiropractic physician provides the chiropractic 406 physician with chiropractic equipment or chiropractic materials 407 mustshallcontain a provision whereby the chiropractic 408 physician expressly maintains complete care, custody, and 409 control of the equipment or practice. 410 (4) The purpose of this section is to prevent a person 411 other than thealicensed chiropractic physician from 412 influencing or otherwise interfering with the exercise of thea413 chiropractic physician’s independent professional judgment. In 414 addition to the acts specified in subsection (2)(1), a person 415 or entity other than an employer or entity authorized in 416 subsection (1)a licensed chiropractic physician and any entity417other than a sole proprietorship, group practice, partnership,418or corporation that is wholly owned by one or more chiropractic419physicians licensed under this chapter or by a chiropractic420physician licensed under this chapter and the spouse, parent,421child, or sibling of that physician,may not employ or engage a 422 chiropractic physician licensed under this chapter. A person or 423 entity may notorenter into a contract or arrangement with a 424 chiropractic physician pursuant to which suchunlicensedperson 425 or such entity exercises control over the following: 426 (a) The selection of a course of treatment for a patient, 427 the procedures or materials to be used as part of such course of 428 treatment, and the manner in which such course of treatment is 429 carried out by the licensee; 430 (b) The patient records of a chiropractor; 431 (c) Policies and decisions relating to pricing, credit, 432 refunds, warranties, and advertising; or 433 (d) Decisions relating to office personnel and hours of 434 practice. However, an employer authorized to employ a 435 chiropractic physician under subsection (1) may exercise control 436 over the patient records of the employed chiropractor; policies 437 and decisions relating to pricing, credit, refunds, warranties, 438 and advertising; and decisions relating to office personnel and 439 hours of practice. 440 (5) Any person who violates this section commits a felony 441 of the third degree, punishable as provided in s. 775.082s.442775.081, s. 775.083, or s. 775.084s.775.035. 443 (6) Any contract or arrangement entered into or undertaken 444 in violation of this section isshall bevoid as contrary to 445 public policy.This section applies to contracts entered into or446renewed on or after July 1, 2008.447 Section 7. This act shall take effect July 1, 2011.