HB 413

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. 460.4166, F.S.;
25	authorizing a registered chiropractic assistant to
26	operate therapeutic office equipment; requiring that a
27	registered chiropractic assistant register with the
28	board effective by a specified date and pay a fee for
29	registration under certain circumstances; requiring
30	that a registered chiropractic assistant submit an
31	initial application by a specified date, or within 30
32	days after becoming employed, whichever occurs later;
33	requiring that an applicant specify the place of
34	employment and the names of the supervising
35	chiropractic physicians; requiring that the
36	application be signed by a chiropractic physician who
37	is an owner of the applicant's place of employment;
38	providing an effective date of a registered
39	chiropractic assistant's registration; authorizing
40	certain chiropractic physicians or chiropractic
41	physician's assistants to supervise a registered
42	chiropractic assistant; requiring that a registered
43	chiropractic assistant notify the board of his or her
44	change of employment within a specified time;
45	requiring that a specified chiropractic physician sign
46	the registered chiropractic assistant's notification
47	of change of employment; requiring that the registered
48	chiropractic assistant's employer notify the board
49	when the assistant is no longer employed by that
50	employer; providing eligibility conditions for
51	registering as a registered chiropractic assistant;
52	requiring the biennial renewal of a registered
53	chiropractic assistant's registration and payment of a
54	renewal fee; requiring that the board adopt by rule
55	the forms for certain statutorily required
56	applications and notifications; authorizing the board
57	to accept or require electronically submitted
58	applications, notifications, signatures, or
59	attestations in lieu of paper applications and actual
60	signatures; requiring the signature of certain forms
61	and notices by specified owners and supervisors under
62	certain conditions; authorizing the board to provide
63	for electronic alternatives to signatures if an
64	application is submitted electronically; amending s.
65	460.4167, F.S.; authorizing certain sole
66	proprietorships, group practices, partnerships,
67	corporations, limited liability companies, limited
68	partnerships, professional associations, other
69	entities, health care clinics licensed under part X of
70	ch. 400, F.S., health maintenance organizations, or
71	prepaid health clinics to employ a chiropractic
72	physician or engage a chiropractic physician as an
73	independent contractor to provide services authorized
74	by ch. 460, F.S.; authorizing the spouse or adult
75	children of a deceased chiropractic physician to hold,
76	operate, pledge, sell, mortgage, assign, transfer,
77	own, or control the deceased chiropractic physician's
78	ownership interests under certain conditions;
79	authorizing an employer that employs a chiropractic
80	physician to exercise control over the patient records
81	of the employed chiropractic physician, the policies
82	and decisions relating to pricing, credit, refunds,
83	warranties, and advertising, and the decisions
84	relating to office personnel and hours of practice;
85	deleting an obsolete provision; providing an effective
86	date.
87
88	Be It Enacted by the Legislature of the State of Florida:
89
90	Section 1.  Paragraph (e) of subsection (1) of section
91	460.4062, Florida Statutes, is amended to read:
92	460.4062  Chiropractic medicine faculty certificate.-
93	(1)  The department may issue a chiropractic medicine
94	faculty certificate without examination to an individual who
95	remits a nonrefundable application fee, not to exceed $100 as
96	determined by rule of the board, and who demonstrates to the
97	board that he or she meets the following requirements:
98	(e)1.  Performs research or has been offered and has
99	accepted a full-time or part-time faculty appointment to teach
100	in a program of chiropractic medicine at a publicly funded state
101	university or college or at a college of chiropractic located in
102	the state and accredited by the Council on Chiropractic
103	Education; and
104	2.  Provides a certification from the dean of the
105	appointing college acknowledging the appointment.
106	Section 2.  Subsection (1) of section 460.408, Florida
107	Statutes, is amended to read:
108	460.408  Continuing chiropractic education.-
109	(1)  The board shall require licensees to periodically
110	demonstrate their professional competence as a condition of
111	renewal of a license by completing up to 40 contact classroom
112	hours of continuing education.
113	(a)  Continuing education courses sponsored by chiropractic
114	colleges whose graduates are eligible for examination under any
115	provision of this chapter may shall be approved upon review by
116	the board if all other requirements of board rules setting forth
117	criteria for course approval are met.
118	(b)  The board shall approve those courses that build upon
119	the basic courses required for the practice of chiropractic
120	medicine, and the board may also approve courses in adjunctive
121	modalities. Courses that consist of instruction in the use,
122	application, prescription, recommendation, or administration of
123	a specific company's brand of products or services are not
124	eligible for approval.
125	Section 3.  Paragraph (e) of subsection (1) of section
126	460.406, Florida Statutes, is amended to read:
127	460.406  Licensure by examination.-
128	(1)  Any person desiring to be licensed as a chiropractic
129	physician must apply to the department to take the licensure
130	examination. There shall be an application fee set by the board
131	not to exceed $100 which shall be nonrefundable. There shall
132	also be an examination fee not to exceed $500 plus the actual
133	per applicant cost to the department for purchase of portions of
134	the examination from the National Board of Chiropractic
135	Examiners or a similar national organization, which may be
136	refundable if the applicant is found ineligible to take the
137	examination. The department shall examine each applicant who the
138	board certifies has:
139	(e)  Successfully completed the National Board of
140	Chiropractic Examiners certification examination in parts I, II,
141	and III, and IV with a score approved by the board.
142
143	The board may require an applicant who graduated from an
144	institution accredited by the Council on Chiropractic Education
145	more than 10 years before the date of application to the board
146	to take the National Board of Chiropractic Examiners Special
147	Purposes Examination for Chiropractic, or its equivalent, as
148	determined by the board. The board shall establish by rule a
149	passing score.
150	Section 4.  Paragraph (y) of subsection (1) of section
151	460.413, Florida Statutes, is amended to read:
152	460.413  Grounds for disciplinary action; action by board
153	or department.-
154	(1)  The following acts constitute grounds for denial of a
155	license or disciplinary action, as specified in s. 456.072(2):
156	(y)  Failing to preserve identity of funds and property of
157	a patient, the value of which is greater than $501. As provided
158	by rule of the board, money or other property entrusted to a
159	chiropractic physician for a specific purpose, including
160	advances for costs and expenses of examination or treatment
161	which may not exceed the value of $1,500, is to be held in trust
162	and must be applied only to that purpose. Money and other
163	property of patients coming into the hands of a chiropractic
164	physician are not subject to counterclaim or setoff for
165	chiropractic physician's fees, and a refusal to account for and
166	deliver over such money and property upon demand shall be deemed
167	a conversion. This is not to preclude the retention of money or
168	other property upon which the chiropractic physician has a valid
169	lien for services or to preclude the payment of agreed fees from
170	the proceeds of transactions for examinations or treatments.
171	Controversies as to the amount of the fees are not grounds for
172	disciplinary proceedings unless the amount demanded is clearly
173	excessive or extortionate, or the demand is fraudulent. All
174	funds of patients paid to a chiropractic physician, other than
175	advances for costs and expenses, shall be deposited into in one
176	or more identifiable bank accounts maintained in the state in
177	which the chiropractic physician's office is situated, and no
178	funds belonging to the chiropractic physician may not shall be
179	deposited therein except as follows:
180	1.  Funds reasonably sufficient to pay bank charges may be
181	deposited therein.
182	2.  Funds belonging in part to a patient and in part
183	presently or potentially to the physician must be deposited
184	therein, but the portion belonging to the physician may be
185	withdrawn when due unless the right of the physician to receive
186	it is disputed by the patient, in which event the disputed
187	portion may shall not be withdrawn until the dispute is finally
188	resolved.
189
190	Every chiropractic physician shall maintain complete records of
191	all funds, securities, and other properties of a patient coming
192	into the possession of the physician and render appropriate
193	accounts to the patient regarding them. In addition, every
194	chiropractic physician shall promptly pay or deliver to the
195	patient, as requested by the patient, the funds, securities, or
196	other properties in the possession of the physician which the
197	patient is entitled to receive.
198	Section 5.  Subsections (2) and (5) of section 460.4165,
199	Florida Statutes, are amended to read:
200	460.4165  Certified chiropractic physician's assistants.-
201	(2)  PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN'S
202	ASSISTANT.-Notwithstanding any other provision of law, a
203	certified chiropractic physician's assistant may perform
204	chiropractic services in the specialty area or areas for which
205	the certified chiropractic physician's assistant is trained or
206	experienced when such services are rendered under the
207	supervision of a licensed chiropractic physician or group of
208	chiropractic physicians certified by the board. Any certified
209	chiropractic physician's assistant certified under this section
210	to perform services may perform those services only:
211	(a)  In the office of the chiropractic physician to whom
212	the certified chiropractic physician's assistant has been
213	assigned, in which office such physician maintains her or his
214	primary practice;
215	(b)  Under indirect supervision if the indirect supervision
216	occurs at the supervising chiropractic physician's address of
217	record or place of practice required by s. 456.035, other than
218	at a clinic licensed under part X of chapter 400, of the
219	chiropractic physician to whom she or he is assigned as defined
220	by rule of the board;
221	(c)  In a hospital in which the chiropractic physician to
222	whom she or he is assigned is a member of the staff; or
223	(d)  On calls outside of the office of the chiropractic
224	physician to whom she or he is assigned, on the direct order of
225	the chiropractic physician to whom she or he is assigned.
226	(5)  PROGRAM APPROVAL.-The department shall issue
227	certificates of approval for programs for the education and
228	training of certified chiropractic physician's assistants which
229	meet board standards. Any basic program curriculum certified by
230	the board shall cover a period of 24 months. The curriculum must
231	consist of a curriculum of at least 200 didactic classroom hours
232	during those 24 months.
233	(a)  In developing criteria for program approval, the board
234	shall give consideration to, and encourage, the use utilization
235	of equivalency and proficiency testing and other mechanisms
236	whereby full credit is given to trainees for past education and
237	experience in health fields.
238	(b)  The board shall create groups of specialty
239	classifications of training for certified chiropractic
240	physician's assistants. These classifications must shall reflect
241	the training and experience of the certified chiropractic
242	physician's assistant. The certified chiropractic physician's
243	assistant may receive training in one or more such
244	classifications, which shall be shown on the certificate issued.
245	(c)  The board shall adopt and publish standards to ensure
246	that such programs operate in a manner that which does not
247	endanger the health and welfare of the patients who receive
248	services within the scope of the program. The board shall review
249	the quality of the curricula, faculties, and facilities of such
250	programs; issue certificates of approval; and take whatever
251	other action is necessary to determine that the purposes of this
252	section are being met.
253	Section 6.  Subsections (2) and (3) of section 460.4166,
254	Florida Statutes, are amended, and subsections (4), (5), and (6)
255	are added to that section, to read:
256	460.4166  Registered chiropractic assistants.-
257	(2)  DUTIES.-Under the direct supervision and
258	responsibility of a licensed chiropractic physician or certified
259	chiropractic physician's assistant, a registered chiropractic
260	assistant may:
261	(a)  Perform clinical procedures, which include:
262	1.  Preparing patients for the chiropractic physician's
263	care.
264	2.  Taking vital signs.
265	3.  Observing and reporting patients' signs or symptoms.
266	(b)  Administer basic first aid.
267	(c)  Assist with patient examinations or treatments other
268	than manipulations or adjustments.
269	(d)  Operate therapeutic office equipment.
270	(e)  Collect routine laboratory specimens as directed by
271	the chiropractic physician or certified chiropractic physician's
272	assistant.
273	(f)  Administer nutritional supplements as directed by the
274	chiropractic physician or certified chiropractic physician's
275	assistant.
276	(g)  Perform office procedures required by the chiropractic
277	physician or certified chiropractic physician's assistant under
278	direct supervision of the chiropractic physician or certified
279	chiropractic physician's assistant.
280	(3)  REGISTRATION.-
281	(a)  A registered chiropractic assistant shall register
282	with assistants may be registered by the board for a biennial
283	fee not to exceed $25. Effective April 1, 2013, a person must
284	register with the board as a registered chiropractic assistant
285	if the person performs any duties described in subsection (2),
286	unless the person is otherwise certified or licensed to perform
287	those duties.
288	(b)  A person employed as a registered chiropractic
289	assistant shall submit to the board an initial application for
290	registration by March 31, 2013, or within 30 days after becoming
291	employed as a registered chiropractic assistant, whichever
292	occurs later, specifying the applicant's place of employment and
293	the names of all chiropractic physicians under whose supervision
294	the applicant performs the duties described in subsection (2).
295	The application for registration must be signed by a
296	chiropractic physician who is an owner of the place of
297	employment specified in the application. Upon the board's
298	receipt of the application, the effective date of the
299	registration is April 1, 2013, or applies retroactively to the
300	applicant's date of employment as a registered chiropractic
301	assistant, whichever occurs later, and the registered
302	chiropractic assistant may be supervised by any licensed
303	chiropractic physician or certified chiropractic physician's
304	assistant who is employed by the registered chiropractic
305	assistant's employer or who is listed on the registration
306	application.
307	(c)  A registered chiropractic assistant, within 30 days
308	after a change of employment, shall notify the board of the new
309	place of employment and the names of all chiropractic physicians
310	under whose supervision the registered chiropractic assistant
311	performs duties described in subsection (2) at the new place of
312	employment. The notification must be signed by a chiropractic
313	physician who is an owner of the new place of employment. Upon
314	the board's receipt of the notification, the registered
315	chiropractic assistant may be supervised by any licensed
316	chiropractic physician or certified chiropractic physician's
317	assistant who is employed by the registered chiropractic
318	assistant's new employer or who is listed on the notification.
319	(d)  Within 30 days after a registered chiropractic
320	assistant is no longer employed at his or her place of
321	employment as registered with the board, the registered
322	chiropractic assistant's employer as registered with the board
323	shall notify the board that the registered chiropractic
324	assistant is no longer employed by that employer.
325	(e)  An employee who performs none of the duties described
326	in subsection (2) is not eligible to register under this
327	subsection.
328	(4)  REGISTERED CHIROPRACTIC ASSISTANT REGISTRATION
329	RENEWAL.-
330	(a)  A registered chiropractic assistant's registration
331	must be renewed biennially. Each renewal must include:
332	1.  A renewal fee as set by the board, not to exceed $25.
333	2.  The registered chiropractic assistant's current place
334	of employment and the names of all chiropractic physicians under
335	whose supervision the applicant performs duties described in
336	subsection (2). The application for registration renewal must be
337	signed by a chiropractic physician who is an owner of the place
338	of employment specified in the application.
339	(b)  Upon registration renewal, the registered chiropractic
340	assistant may be supervised by any licensed chiropractic
341	physician or certified chiropractic physician's assistant who is
342	employed by the registered chiropractic assistant's employer or
343	who is listed on the registration renewal.
344	(5)  APPLICATION AND NOTIFICATION FORMS.-The board shall
345	prescribe by rule the forms for the registration application,
346	notification, and registration renewal that are required under
347	subsections (3) and (4). The board may accept or may require
348	electronically submitted registration applications,
349	notifications, registration renewals, attestations, or
350	signatures in lieu of paper applications, notifications,
351	renewals, or attestations or actual signatures.
352	(6)  SIGNATURE REQUIREMENTS.-If a registered chiropractic
353	assistant is employed by an entity that is not owned in whole or
354	in part by a licensed chiropractic physician under s. 460.4167,
355	the documents requiring signatures under this section must be
356	signed by a person having an ownership interest in the entity
357	that employs the assistant and by the licensed chiropractic
358	physician who supervises the assistant. In lieu of written
359	signatures, the board may provide for electronic alternatives to
360	signatures if an application is submitted electronically, in
361	which instance all other requirements in this section apply.
362	Section 7.  Section 460.4167, Florida Statutes, is amended
363	to read:
364	460.4167  Proprietorship by persons other than licensed
365	chiropractic physicians.-
366	(1)  A No person other than a sole proprietorship, group
367	practice, partnership, or corporation that is wholly owned by
368	one or more chiropractic physicians licensed under this chapter
369	or by a chiropractic physician licensed under this chapter and
370	the spouse, parent, child, or sibling of that chiropractic
371	physician may not employ a chiropractic physician licensed under
372	this chapter or engage a chiropractic physician licensed under
373	this chapter as an independent contractor to provide services
374	that chiropractic physicians are authorized to offer by this
375	chapter to be offered by a chiropractic physician licensed under
376	this chapter, unless the person is any of the following, except
377	for:
378	(a)  A sole proprietorship, group practice, partnership,
379	corporation, limited liability company, limited partnership,
380	professional association, or any other entity that is wholly
381	owned by:
382	1.  One or more chiropractic physicians licensed under this
383	chapter;
384	2.  A chiropractic physician licensed under this chapter
385	and the spouse or surviving spouse, parent, child, or sibling of
386	the chiropractic physician; or
387	3.  A trust whose trustees are chiropractic physicians
388	licensed under this chapter and the spouse, parent, child, or
389	sibling of a chiropractic physician.
390
391	If the chiropractic physician described in subparagraph (a)2.
392	dies, notwithstanding part X of chapter 400, the surviving
393	spouse or adult children may hold, operate, pledge, sell,
394	mortgage, assign, transfer, own, or control the chiropractic
395	physician's ownership interests for so long as the surviving
396	spouse or adult children remain the sole proprietors of the
397	chiropractic practice.
398	(b)(a)  A sole proprietorship, group practice, partnership,
399	or corporation, limited liability company, limited partnership,
400	professional association, or any other entity that is wholly
401	owned by a physician or physicians licensed under this chapter,
402	chapter 458, chapter 459, or chapter 461.
403	(c)(b)  An entity Entities that is wholly are owned,
404	directly or indirectly, by an entity licensed or registered by
405	the state under chapter 395.
406	(d)(c)  A clinical facility that is facilities affiliated
407	with a college of chiropractic accredited by the Council on
408	Chiropractic Education at which training is provided for
409	chiropractic students.
410	(e)(d)  A public or private university or college.
411	(f)(e)  An entity wholly owned and operated by an
412	organization that is exempt from federal taxation under s.
413	501(c)(3) or (4) of the Internal Revenue Code, a any community
414	college or university clinic, or an and any entity owned or
415	operated by the Federal Government or by state government,
416	including any agency, county, municipality, or other political
417	subdivision thereof.
418	(g)(f)  An entity owned by a corporation the stock of which
419	is publicly traded.
420	(h)(g)  A clinic licensed under part X of chapter 400 which
421	that provides chiropractic services by a chiropractic physician
422	licensed under this chapter and other health care services by
423	physicians licensed under chapter 458 or, chapter 459, or
424	chapter 460, the medical director of which is licensed under
425	chapter 458 or chapter 459.
426	(i)(h)  A state-licensed insurer.
427	(j)  A health maintenance organization or prepaid health
428	clinic regulated under chapter 641.
429	(2)  A No person other than a chiropractic physician
430	licensed under this chapter may not shall direct, control, or
431	interfere with a chiropractic physician's clinical judgment
432	regarding the medical necessity of chiropractic treatment. For
433	purposes of this subsection, a chiropractic physician's clinical
434	judgment does not apply to chiropractic services that are
435	contractually excluded, the application of alternative services
436	that may be appropriate given the chiropractic physician's
437	prescribed course of treatment, or determinations that compare
438	comparing contractual provisions and scope of coverage with a
439	chiropractic physician's prescribed treatment on behalf of a
440	covered person by an insurer, health maintenance organization,
441	or prepaid limited health service organization.
442	(3)  Any lease agreement, rental agreement, or other
443	arrangement between a person other than a licensed chiropractic
444	physician and a chiropractic physician whereby the person other
445	than a licensed chiropractic physician provides the chiropractic
446	physician with chiropractic equipment or chiropractic materials
447	must shall contain a provision whereby the chiropractic
448	physician expressly maintains complete care, custody, and
449	control of the equipment or practice.
450	(4)  The purpose of this section is to prevent a person
451	other than the a licensed chiropractic physician from
452	influencing or otherwise interfering with the exercise of the a
453	chiropractic physician's independent professional judgment. In
454	addition to the acts specified in subsection (2) (1), a person
455	or entity other than an employer or entity authorized in
456	subsection (1) a licensed chiropractic physician and any entity
457	other than a sole proprietorship, group practice, partnership,
458	or corporation that is wholly owned by one or more chiropractic
459	physicians licensed under this chapter or by a chiropractic
460	physician licensed under this chapter and the spouse, parent,
461	child, or sibling of that physician, may not employ or engage a
462	chiropractic physician licensed under this chapter. A person or
463	entity may not or enter into a contract or arrangement with a
464	chiropractic physician pursuant to which such unlicensed person
465	or such entity exercises control over the following:
466	(a)  The selection of a course of treatment for a patient,
467	the procedures or materials to be used as part of the such
468	course of treatment, and the manner in which the such course of
469	treatment is carried out by the chiropractic physician licensee;
470	(b)  The patient records of the chiropractic physician a
471	chiropractor;
472	(c)  The policies and decisions relating to pricing,
473	credit, refunds, warranties, and advertising; or
474	(d)  The decisions relating to office personnel and hours
475	of practice.
476
477	However, a person or entity that is authorized to employ a
478	chiropractic physician under subsection (1) may exercise control
479	over the patient records of the employed chiropractic physician;
480	the policies and decisions relating to pricing, credit, refunds,
481	warranties, and advertising; and the decisions relating to
482	office personnel and hours of practice.
483	(5)  Any person who violates this section commits a felony
484	of the third degree, punishable as provided in s. 775.082 s.
485	775.081, s. 775.083, or s. 775.084 s. 775.035.
486	(6)  Any contract or arrangement entered into or undertaken
487	in violation of this section is shall be void as contrary to
488	public policy. This section applies to contracts entered into or
489	renewed on or after July 1, 2008.
490	Section 8.  This act shall take effect July 1, 2012.

CODING: Words stricken are deletions; words underlined are additions.