Florida Senate - 2011 SB 398
By Senator Jones
13-00339A-11 2011398__
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.; prohibiting the Board of
6 Chiropractic Medicine from approving the use of
7 certain courses in continuing chiropractic education;
8 amending s. 460.4165, F.S.; providing that services
9 rendered by a certified chiropractic physician’s
10 assistant under indirect supervision may occur only at
11 the supervising chiropractic physician’s address of
12 record; deleting the length of time specified for the
13 basic program of education and training for certified
14 chiropractic physician’s assistants; amending s.
15 460.4166, F.S.; requiring a person to register as a
16 chiropractic assistant if he or she renders
17 therapeutic services or administers therapeutic agents
18 related to a chiropractic physician’s treatment of a
19 patient; providing registration requirements for such
20 persons; requiring a registered chiropractic assistant
21 to notify the board of his or her change of
22 employment; providing that a person who exclusively
23 performs nontherapeutic services is not required to
24 register as a chiropractic assistant; requiring the
25 approval of certain supervising chiropractic
26 physicians by the board; providing an effective date
27 for the board’s approval; requiring a fee for approval
28 of a supervising chiropractic physician or group of
29 chiropractic physicians; requiring the board to adopt
30 by rule an application form for the initial
31 registration of a registered chiropractic assistant, a
32 form for the approval of a supervising chiropractic
33 physician, and the notice of a change of employment
34 for a registered chiropractic assistant; amending s.
35 460.4167, F.S.; authorizing certain sole
36 proprietorships, group practices, partnerships,
37 corporations, limited liability companies, limited
38 partnerships, professional associations, other
39 entities, health care clinics licensed under part X of
40 ch. 400, F.S., health maintenance organizations, or
41 prepaid health clinics to employ a chiropractic
42 physician or engage a chiropractic physician as an
43 independent contractor to provide services authorized
44 by ch. 460, F.S.; authorizing the spouse or adult
45 children of a deceased chiropractic physician to hold,
46 operate, pledge, sell, mortgage, assign, transfer,
47 own, or control the deceased chiropractic physician’s
48 ownership interests under certain conditions;
49 authorizing an employer that employs a chiropractic
50 physician to exercise control over the patient records
51 of the employed chiropractor, policies and decisions
52 relating to pricing, credit, refunds, warranties, and
53 advertising, and decisions relating to office
54 personnel and hours of practice; deleting an obsolete
55 provision; providing an effective date.
56
57 Be It Enacted by the Legislature of the State of Florida:
58
59 Section 1. Paragraph (e) of subsection (1) of section
60 460.4062, Florida Statutes, is amended to read:
61 460.4062 Chiropractic medicine faculty certificate.—
62 (1) The department may issue a chiropractic medicine
63 faculty certificate without examination to an individual who
64 remits a nonrefundable application fee, not to exceed $100 as
65 determined by rule of the board, and who demonstrates to the
66 board that he or she meets the following requirements:
67 (e)1. Performs research or has been offered and has
68 accepted a full-time or part-time faculty appointment to teach
69 in a program of chiropractic medicine at a publicly funded state
70 university or college or at a college of chiropractic located in
71 the state and accredited by the Council on Chiropractic
72 Education; and
73 2. Provides a certification from the dean of the appointing
74 college acknowledging the appointment.
75 Section 2. Paragraph (b) of subsection (1) of section
76 460.408, Florida Statutes, is amended to read:
77 460.408 Continuing chiropractic education.—
78 (1) The board shall require licensees to periodically
79 demonstrate their professional competence as a condition of
80 renewal of a license by completing up to 40 contact classroom
81 hours of continuing education.
82 (b) The board shall approve those courses that build upon
83 the basic courses required for the practice of chiropractic
84 medicine, and the board may also approve courses in adjunctive
85 modalities. Courses that consist of instruction in the use,
86 application, prescription, recommendation, or administration of
87 a specific company’s brand of products or services are not
88 eligible for approval.
89 Section 3. Subsections (2) and (5) of section 460.4165,
90 Florida Statutes, are amended to read:
91 460.4165 Certified chiropractic physician’s assistants.—
92 (2) PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN’S
93 ASSISTANT.—Notwithstanding any other provision of law, a
94 certified chiropractic physician’s assistant may perform
95 chiropractic services in the specialty area or areas for which
96 the certified chiropractic physician’s assistant is trained or
97 experienced when such services are rendered under the
98 supervision of a licensed chiropractic physician or group of
99 chiropractic physicians certified by the board. Any certified
100 chiropractic physician’s assistant certified under this section
101 to perform services may perform those services only:
102 (a) In the office of the chiropractic physician to whom the
103 certified chiropractic physician’s assistant has been assigned,
104 in which office such physician maintains her or his primary
105 practice;
106 (b) Under indirect supervision if the indirect supervision
107 occurs at the supervising chiropractic physician’s address of
108 record or place of practice required by s. 456.035, other than
109 at a clinic licensed under part X of chapter 400, of the
110 chiropractic physician to whom she or he is assigned as defined
111 by rule of the board;
112 (c) In a hospital in which the chiropractic physician to
113 whom she or he is assigned is a member of the staff; or
114 (d) On calls outside of the office of the chiropractic
115 physician to whom she or he is assigned, on the direct order of
116 the chiropractic physician to whom she or he is assigned.
117 (5) PROGRAM APPROVAL.—The department shall issue
118 certificates of approval for programs for the education and
119 training of certified chiropractic physician’s assistants which
120 meet board standards. Any basic program curriculum certified by
121 the board shall cover a period of 24 months. The curriculum must
122 consist of a curriculum of at least 200 didactic classroom hours
123 during those 24 months.
124 (a) In developing criteria for program approval, the board
125 shall give consideration to, and encourage, the use utilization
126 of equivalency and proficiency testing and other mechanisms
127 whereby full credit is given to trainees for past education and
128 experience in health fields.
129 (b) The board shall create groups of specialty
130 classifications of training for certified chiropractic
131 physician’s assistants. These classifications must shall reflect
132 the training and experience of the certified chiropractic
133 physician’s assistant. The certified chiropractic physician’s
134 assistant may receive training in one or more such
135 classifications, which shall be shown on the certificate issued.
136 (c) The board shall adopt and publish standards to ensure
137 that such programs operate in a manner which does not endanger
138 the health and welfare of the patients who receive services
139 within the scope of the program. The board shall review the
140 quality of the curricula, faculties, and facilities of such
141 programs; issue certificates of approval; and take whatever
142 other action is necessary to determine that the purposes of this
143 section are being met.
144 Section 4. Subsection (3) of section 460.4166, Florida
145 Statutes, is amended, and subsections (4) and (5) are added to
146 that section, to read:
147 460.4166 Registered chiropractic assistants.—
148 (3) REGISTRATION.—
149 (a) A registered chiropractic assistant assistants may
150 register with be registered by the board for a biennial fee not
151 to exceed $25. Effective April 1, 2012, a person must register
152 with the board as a chiropractic assistant if the person
153 performs therapeutic services or administers therapeutic agents
154 related to a chiropractic physician’s treatment of a patient,
155 unless the person is otherwise certified or licensed to perform
156 those services or administer those agents.
157 (b) A person employed as a registered chiropractic
158 assistant, if required to register under this section, must
159 submit to the board an initial application for registration
160 within 30 days after employment. Upon the board’s approval of
161 the application, the effective date of the registration shall
162 apply retroactively to the date of employment.
163 (c) A registered chiropractic assistant, within 30 days
164 after a change of employment, must notify the board of the new
165 place of employment and the name of the chiropractic physician
166 or group of chiropractic physicians under whose supervision the
167 registered chiropractic assistant performs the duties described
168 in subsection (2).
169 (d) A person who exclusively performs nontherapeutic
170 services is not required to register under this section.
171 (4) APPROVAL OF SUPERVISING CHIROPRACTIC PHYSICIANS.—
172 (a) A chiropractic physician or group of chiropractic
173 physicians under whose supervision a registered chiropractic
174 assistant performs the duties described in subsection (2) must
175 be approved by the board. If a registered chiropractic assistant
176 performs those duties under the direct supervision of a
177 certified chiropractic physician’s assistant, the chiropractic
178 physician or group of chiropractic physicians under whose
179 supervision the certified chiropractic physician’s assistant
180 provides direct supervision for the registered chiropractic
181 assistant must be approved by the board.
182 (b) If a registered chiropractic assistant changes
183 employment, the supervising chiropractic physician or group of
184 chiropractic physicians at the new place of employment must be
185 approved by the board.
186 (c) Upon approval of a supervising chiropractic physician
187 or group of chiropractic physicians, the effective date of the
188 board’s approval applies retroactively to the date of
189 employment. The board shall assess a fee for approval of a
190 supervising chiropractic physician or group of chiropractic
191 physicians, which may not exceed $75.
192 (5) APPLICATION FORMS.—The board shall prescribe by rule
193 application forms for the initial registration of a registered
194 chiropractic assistant, the board’s approval of a supervising
195 chiropractic physician or group of chiropractic physicians, and
196 the registered chiropractic assistant’s notice of a change of
197 employment.
198 Section 5. Section 460.4167, Florida Statutes, is amended
199 to read:
200 460.4167 Proprietorship by persons other than licensed
201 chiropractic physicians.—
202 (1) A No person other than a sole proprietorship, group
203 practice, partnership, or corporation that is wholly owned by
204 one or more chiropractic physicians licensed under this chapter
205 or by a chiropractic physician licensed under this chapter and
206 the spouse, parent, child, or sibling of that chiropractic
207 physician may not employ a chiropractic physician licensed under
208 this chapter or engage a chiropractic physician licensed under
209 this chapter as an independent contractor to provide services
210 authorized by this chapter to be offered by a chiropractic
211 physician licensed under this chapter unless the person is any
212 of the following, except for:
213 (a) A sole proprietorship, group practice, partnership,
214 corporation, limited liability company, limited partnership, any
215 person, professional association, or any other entity that is
216 wholly owned by:
217 1. One or more chiropractic physicians licensed under this
218 chapter;
219 2. A chiropractic physician licensed under this chapter and
220 the spouse or surviving spouse, parent, child, or sibling of the
221 chiropractic physician; or
222 3. A trust whose trustees are chiropractic physicians
223 licensed under this chapter and the spouse, parent, child, or
224 sibling of a chiropractic physician.
225 (b)(a) A sole proprietorship, group practice, partnership,
226 or corporation, limited liability company, limited partnership,
227 professional association, or any other entity that is wholly
228 owned by a physician or physicians licensed under this chapter,
229 chapter 458, chapter 459, or chapter 461.
230 (c)(b) An entity Entities that is wholly are owned,
231 directly or indirectly, by an entity licensed or registered by
232 the state under chapter 395.
233 (d)(c) A clinical facility that is facilities affiliated
234 with a college of chiropractic accredited by the Council on
235 Chiropractic Education at which training is provided for
236 chiropractic students.
237 (e)(d) A public or private university or college.
238 (f)(e) An entity wholly owned and operated by an
239 organization that is exempt from federal taxation under s.
240 501(c)(3) or (4) of the Internal Revenue Code, a any community
241 college or university clinic, and any entity owned or operated
242 by the Federal Government or by state government, including any
243 agency, county, municipality, or other political subdivision
244 thereof.
245 (g)(f) An entity owned by a corporation the stock of which
246 is publicly traded.
247 (h)(g) A clinic licensed under part X of chapter 400 which
248 that provides chiropractic services by a chiropractic physician
249 licensed under chapter 460 and other health care services by
250 physicians licensed under chapter 458 or, chapter 459, or
251 chapter 460, the medical director of which is licensed under
252 chapter 458 or chapter 459.
253 (i)(h) A state-licensed insurer.
254 (j) A health maintenance organization or prepaid health
255 clinic regulated under chapter 641.
256
257 If a chiropractic physician described in subparagraph (a)2.
258 dies, notwithstanding part X of chapter 400, the deceased
259 chiropractic physician’s surviving spouse or adult children may
260 hold, operate, pledge, sell, mortgage, assign, transfer, own, or
261 control the deceased chiropractic physician’s ownership
262 interests for so long as the surviving spouse or adult children
263 remain the sole proprietor of the chiropractic practice.
264 (2) A No person other than a chiropractic physician
265 licensed under this chapter may not shall direct, control, or
266 interfere with a chiropractic physician’s clinical judgment
267 regarding the medical necessity of chiropractic treatment. For
268 purposes of this subsection, a chiropractic physician’s clinical
269 judgment does not apply to chiropractic services contractually
270 excluded, the application of alternative services that may be
271 appropriate given the chiropractic physician’s prescribed course
272 of treatment, or determinations comparing contractual provisions
273 and scope of coverage with a chiropractic physician’s prescribed
274 treatment on behalf of a covered person by an insurer, health
275 maintenance organization, or prepaid limited health service
276 organization.
277 (3) Any lease agreement, rental agreement, or other
278 arrangement between a person other than a licensed chiropractic
279 physician and a chiropractic physician whereby the person other
280 than a licensed chiropractic physician provides the chiropractic
281 physician with chiropractic equipment or chiropractic materials
282 must shall contain a provision whereby the chiropractic
283 physician expressly maintains complete care, custody, and
284 control of the equipment or practice.
285 (4) The purpose of this section is to prevent a person
286 other than the a licensed chiropractic physician from
287 influencing or otherwise interfering with the exercise of the a
288 chiropractic physician’s independent professional judgment. In
289 addition to the acts specified in subsection (2) (1), a person
290 or entity other than an employer or entity authorized in
291 subsection (1) a licensed chiropractic physician and any entity
292 other than a sole proprietorship, group practice, partnership,
293 or corporation that is wholly owned by one or more chiropractic
294 physicians licensed under this chapter or by a chiropractic
295 physician licensed under this chapter and the spouse, parent,
296 child, or sibling of that physician, may not employ or engage a
297 chiropractic physician licensed under this chapter. A person or
298 entity may not or enter into a contract or arrangement with a
299 chiropractic physician pursuant to which such unlicensed person
300 or such entity exercises control over the following:
301 (a) The selection of a course of treatment for a patient,
302 the procedures or materials to be used as part of such course of
303 treatment, and the manner in which such course of treatment is
304 carried out by the licensee;
305 (b) The patient records of a chiropractor;
306 (c) Policies and decisions relating to pricing, credit,
307 refunds, warranties, and advertising; or
308 (d) Decisions relating to office personnel and hours of
309 practice. However, an employer authorized to employ a
310 chiropractic physician under subsection (1) may exercise control
311 over the patient records of the employed chiropractor; policies
312 and decisions relating to pricing, credit, refunds, warranties,
313 and advertising; and decisions relating to office personnel and
314 hours of practice.
315 (5) Any person who violates this section commits a felony
316 of the third degree, punishable as provided in s. 775.082 s.
317 775.081, s. 775.083, or s. 775.084 s. 775.035.
318 (6) Any contract or arrangement entered into or undertaken
319 in violation of this section is shall be void as contrary to
320 public policy. This section applies to contracts entered into or
321 renewed on or after July 1, 2008.
322 Section 6. This act shall take effect July 1, 2011.